More than a century ago, Sir William Osler — probably the most celebrated doctor in modern history — gave a lecture to medical students in which he referred to doctors as belonging to “the great army of quiet workers” whose voices are not heard in the streets but who offer “consolation in sorrow, need, and sickness.” The best doctor, Osler noted, is often the one of whom the public hears the least.
Nowadays, doctors are heard loud and clear by all and sundry. Social media is brimming with doctors and medical students opening their hearts, sharing their frustrations, and venting their anger.
We can read tweets from doctors who describe how they cried at work, struggled with lack of sleep, lost their temper with incompetent colleagues, and even made mistakes. Are airplane pilots equally open, I wonder?
In a different address, this one to newly minted doctors at the University of Pennsylvania School of Medicine, Osler said that “in the physician or surgeon no quality takes rank with imperturbability.” He described imperturbability as a physical quality — a steadiness of hand and coolness of nerve under pressure which reassures patients and colleagues.
For Osler, the mental equivalent of imperturbability was equanimity: serenity of mind. This mental composure could be ruffled by patients, overwork, and the uncertainty of medicine. Yet attaining equanimity would enable a doctor “to rise superior to the trials of life.”
Osler observed that these two qualities should be used judiciously and not harden the human heart by which we live.
Since Osler’s time, the public perception of doctors has changed. Their descent onto the bustling crowds of social media is likely to have played a part. With greater openness about physicians’ vulnerabilities and fallibilities, the mystique of the medical profession is fading. The Oslerian emphasis on imperturbability, equanimity, and quiet dignity has given way to the doctor as Everyman, prone to the same weaknesses as all of us.
Doctors, who hitherto got things off their chests in private, now bellow their discontent to the world. This may be therapeutic and may humanize doctors, but it risks undermining public confidence and damaging the nobility of the medical profession. A loss of confidence in doctors brings a greater inclination for patients to challenge, complain, and sue. Moreover, it risks the loss of the placebo effect borne from seeing doctors, whose very presence can be reassuring.
Younger doctors have grown up with social media. They tweeted as students and now do so as doctors. Some of their older colleagues have also embraced this newfound freedom to instantly share their views to the world, contributing to lifting the veil on the inner life of doctors.
Those tempted to share insights into the working life of doctors on social media must ask themselves whether the benefits of this candor outweigh the possible harms to their own reputation and to the image of the medical profession as a whole. This restraint forms part of medical professionalism.
I am surprised, for example, by how common it is for doctors to criticize colleagues on Twitter. The American Medical Association’s Code of Medical Ethics states that physicians who identify unprofessional content on social media “have a responsibility to bring that content to the attention of the individual” and may need to report the matter to “appropriate authorities.”
Doctors must assume that their patients, relatives, and colleagues — past, present and future — will read their posts. This knowledge should help triage appropriate posts from inappropriate ones.
Daniel Sokol, Ph.D., is a London-based bioethicist and lawyer specializing in medical law. He is the author of “Tough Choices: Stories from the Front Line of Medical Ethics” (Book Guild, 2018). An earlier version of this article was published by the Hippocratic Post.