Fellow pseudonymous neuroblogger Neuroskeptic (to whom I owe a great deal in inspiration) has published a fantastic explainer in Trends in Cognitive Sciences ($) on the benefits to science of anonymity. Last November Neuroskeptic became the first blogger to publish a scientific paper under a pseudonym. Neuroskeptic cites examples ranging from "Nicolaus Copernicus who first put forward his theory of heliocentrism anonymously, in the form of a manuscript now known as the Commentariolus" to the famous "Student" - creator of the t-test, whose real name was William Sealy Gosset. A list of scientists and mathematicians who have published under pseudonyms can be found here, which includes: Isaac Newton as Jehovah Sanctus Unus, Felix Hausdorff as Paul Mongré and Sophie Germain as Monsieur Antoine Auguste Le Blanc. The last is an example of a woman writing as a man in order to be taken seriously by mathematicians. Neuroskeptic gives the example of:
"The pioneering computer scientist Donald Knuth once submitted a paper under the name ‘Ursula N. Owens’. Knuth did this because, he said, he wanted to ensure that the manuscript received a thorough critique."
Neuroskeptic goes on to examine the case of Science-Fraud.org which was a fantastic anonymous resource focusing on data falsification and manipulation until it was closed following legal action which revealed the identity of the creator of the resource - biologist Paul Brookes. Neuroskeptic points out:
"Not long after the closure of Science Fraud, however, a paper by the first scientist to send Brookes a cease-and-desist letter, Rui Curi, was retracted. Another was corrected – to address just those image irregularities originally noted by Brookes"
Neuroskeptic makes the very important point that:
"By exposing misconduct, Brookes, and other investigators like him, do science a great service. Though anonymous, they contribute more to the advancement of knowledge than those who publish false data under their own names."
Neuroskeptic's paper couldn't come at a more opportune time, in only thirteen days new rules will come in to effect banning British doctors from using social media without their real names. We are already beginning to see the departure of familiar faces. If you'd like to help stop this, please sign this Downing Street petition against the ban on doctors writing anonymously. If this fails doctors may have to resort to the Human Rights Act to protect their right to write, as Max Pemberton (a pseudonym) writes in the Telegraph:
"It seems to me that, by preventing doctors from speaking out anonymously, the move is also ripe for a legal challenge, as it would seemingly contradict Articles 8 and 10 of the Human Rights Act. These guarantee a right to private life and to freedom of expression, without interference by a public authority. While the GMC is responsible for doctors’ conduct in the workplace – and no one is disputing the importance of this role – doctors are still entitled to a private life and to freedom of expression, and the GMC – an unelected and unaccountable quango – has no business interfering in this area. It has overstepped its remit. This is not about patient confidentiality, which is already covered in detail in the guidelines in which all doctors are well versed. This is simply preventing doctors from being allowed to speak out anonymously or under a pseudonym."
Pemberton sums up the fundamental importance of this case fantastically so I'm going to finish this post with Pemberton's argument for why we must protect the right for doctors to communicate without providing their given name:
This unwelcome intrusion into doctors’ private behaviour is relevant to everyone. This country has a long and rich tradition of individuals writing about their profession from behind a veil of anonymity. Oscar Wilde wrote that “man is least himself when he talks in his own person. Give him a mask, and he will tell you the truth.” Soldiers, nurses, ambulance drivers, lawyers and even prostitutes have all written under pseudonyms to preserve – for a variety of reasons – their anonymity. Authors such as James Herriot, Theodore Dalrymple and Miss Read have become touchstones to contemporary writers and bloggers, who use their work as springboards for their stories and who often provide valuable insights into social, cultural and political issues.
It is particularly worrying that for doctors, the right to anonymity in social media is under attack. The public is served well by individuals who use the internet or print to anonymously discuss what is happening in the health service. By this I do not necessarily mean the serious cases of abuse or neglect exposed by whistleblowers (although that is relevant, too) but the day-to-day stories of life in the NHS that so often expose larger truths; and the candid thoughts of those on the coalface dealing with the fall-out of government policy.
I should here declare an interest. As is widely known, Max Pemberton is a pen name that I use for my journalism. I decided to use a nom de plume when I started this column 10 years ago because I wanted to write frankly about my experiences in the NHS and I knew that I would struggle to do this if I used my real name. Over time, my colleagues came to know of my other career as a journalist and now, in my personal life, more people – including my partner – call me Max than Alex, the name I practise under.
But I’m pleased that there is still a robust distinction between my clinical work and my media career. I want it to be clear to my patients that when they sit in front of me I am not a journalist, but their doctor. It also helps me maintain a distance between my two careers. While most of my patients are aware of my work in the media, they are grateful for the distinction. Yet I know for certain that I would never have written those first columns if the GMC’s guidance had been in place then. Writing anonymously helped me to be honest.
These regulations will have a far-reaching impact. Doctors are naturally cautious and I can now see a time when they will be reluctant to pen anonymous pieces for the press, for fear that they will be tracked down by those they annoy and referred to the GMC. If they want to write articles criticising the government or NHS management, they will be in the impossible position of either disclosing their name or writing anonymously, risking exposure. This is a chilling situation. At a crucial time in the history of the NHS, silencing doctors in this way means the public will no longer hear their views about what is happening.
If you agree, please sign the petition (update: UK citizens only).
Neuroskeptic, . (2013). Anonymity in science Trends in Cognitive Sciences DOI: 10.1016/j.tics.2013.03.004
Jane O'Brien from the GMC's standards and ethics team on our new social media guidance.
On the 25 March 2013 we published new explanatory guidance on Doctor's use of social media (PDF) alongside the new edition of Good medical practice for all UK doctors.The response from the profession has been lively — particularly about the phrase:'If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name.'Like all our guidance, Doctors' use of social media describes good practice, not minimum standards. It's not a set of rules.
But the response from the profession shows that doctors are unclear or uncertain about:
- Why we included this in the guidance
- What 'identify yourself as a doctor' means in practice
- Whether this curtails doctors' rights to express their views
- Whether the GMC would take disciplinary action against a doctor because they used a pseudonym
- Why doctors shouldn't raise concerns anonymously
We’ve answered these questions below and also provided some background information about how the guidance was developed.
Why identifying yourself as a doctor is good practice?Patients and the public generally respect doctors and trust their views — particularly about health and healthcare. Identifying yourself as a member of the profession gives credibility and weight to your views. Doctors are accountable for their actions and decisions in other aspects of their professional lives - and their behaviour must not undermine public trust in the profession. So we think doctors who want to express views, as doctors, should say who they are.What does 'identifying yourself as a doctor' mean in practice?There is a bit of judgement involved here. For example, if you want to blog about football and incidentally mention that you're a doctor, there is no need to identify yourself if you don't want to.If you're using social media to comment on health or healthcare issues, we think it's good practice to say who you are.In the guidance we say 'you should' rather than 'you must'. We use this language to support doctors exercising their professional judgement. This means we think it is good practice but not that it is mandatory.We've explained the difference in our use of these terms in paragraph 5 of Good medical practice, and at:We are not restricting doctors' right to express their views and opinions except:
- Where this would breach patient confidentiality
- Where comments bully, harass or make malicious comments about colleagues on line. (A colleague is anyone a doctor works with, whether or not they are also doctors).One of the key messages in the guidance is that although social media changes the means of communication, the standards expected of doctors do not change when communicating on social media rather than face to face or through other traditional media (see paragraph 5 of the social media guidance).Will the GMC take disciplinary action if I decide not to identify myself online?This is guidance on what we consider to be good practice. Failure to identify yourself online in and of itself will not raise a question about your fitness to practise.Any concern raised is judged on its own merits and the particular circumstances of the case. But a decision to be anonymous could be considered together with other more serious factors, such as bullying or harassing colleagues, or breaching confidentiality (or both) or breaking the law. The guidance doesn't change the threshold for investigating concerns about a doctor's fitness to practise.Does this guidance apply to personal use?The GMC has no interest in doctors' use of social media in their personal lives — Tweets, blogs, Facebook pages etc. But doctors mustn’t undermine public trust in the profession. Usually this means breaking the law, even where the conviction is unrelated to their professional life. For an example, read the recent Fitness to Practise Panel decision on the MPTS web page (PDF).Why can't I raise concerns anonymously in social media? We are not trying to restrict discussion about important issues relating to patient safety and certainly don't want to discourage doctors from raising concerns.However, we wouldn't encourage doctors to do so via social media because ultimately it's not private and it might well be missed by the people or organisations who are able to take action to protect patients.Our confidential helpline — where you can speak to an advisor anonymously — enables doctors to seek advice on issues they may be dealing with and to raise serious concerns about patient safety when they feel unable to do this at local level. Our Confidential Helpline number is 0161 923 6399.If you want to talk to an independent organisation, we work with Public Concern at Work whose legal advisors are trained in managing whistleblowing calls. They can support and direct doctors who wish to raise concerns.Why do publications like the BMJ allow anonymous blogs/letters articles? Does the guidance mean they can't do that anymore?BMJ is entirely independent of the GMC, and it is a matter for them to decide what is appropriate for their website. However the Committee on Publication Ethics considered a case and published their conclusions atMany blogs are published without formal editorial or publisher control — although there may be moderation on some sites. Using your name (or other identifying information) provides some transparency and accountability.BackgroundHow did we consult on the guidance?We consulted on the explanatory guidance in 2012 and wrote to all registered doctors via our publication GMC News in May 2012 asking them to tell us their thoughts on the draft social media guidance. As part of this public consultation, we received 80 responses from organisations and individuals (with 49 of the individual respondents identifying themselves as doctors). Specifically we asked whether it was reasonable for us to say that doctors should usually identify themselves when using social media in a professional capacity and 63% (49 respondents) agreed while 16 respondents disagreed and 13 were unsure. 39 of those who responded commented on this point.Some of the responses from doctors in the consultation included:'Doctors should take ownership of information given in a professional capacity as it is important that we are accountable for our professional actions.''Too often, people hide behind usernames on internet and on social media — if you have something to say, don't be a coward.'Patients groups also felt that being open and honest when communicating online was important saying:'Doctors should also be conscious of the widespread access to much social media, e.g. Twitter, which could mean that their social media engagement could endanger public confidence in the profession.'Of course, some expressed the opposite view including:'A doctor should be able to state that they are a medical professional without having to publicise their personal data. For example, when commenting on an online article it may be relevant that the comments come from a doctor but it should not require full identity disclosure. Where a comment is formal and part of a professional role, it would be more reasonable to expect identity disclosure.'What does the final guidance say?So after careful consideration of all the views and the arguments on both sides the final guidance says:If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name. Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely.What's happened since we published?e-petitionWe acknowledge the level and strength of feeling the petition represents. However, there is nothing in the guidance that restricts doctors' freedom of speech online or stops them from raising concerns. The guidance is a statement of good practice, and the paragraph on anonymity in the guidance is framed as 'you should'; rather than 'you must'; to support doctors exercising their professional judgement.