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.
What if the next article was PhD’s should use blogs with restraint? All professions have the right to be vocal and advocate for change. If doctors were silent, people would still smoke on planes. Maybe people would never have connected smoking with lung cancer if doctors were silent. These are obvious examples that exemplify why you definitely want vocal doctors on social media for a variety of issues.
Speaking about lung cancer and bellowing their discontent to the world is hardly the same thing. How does one misconstrue words and take offense so easily (refering to others on this thread as well)?
Patients lose confidence in physicians and dentists when the devices they install harm us, when the procedures they do harm us, when the drugs they prescribe harm us, when the information they convey is outdated and from research tainted by sponsors, and when they do not listen to patients or learn from clinical experiences. Patients gain confidence in physicians and dentists when what they do helps us, and they convey accurate information based on real life clinical response, tailored to patients’ specific circumstances. Given the state of US medicine and dentisty today, a doctor or dentist without opinions loses credibility.
Personally, I am happy that doctors’ mystique is fading. Too many people take a doctor’s word as gospel, and they are very much human. They make mistakes. Medical schools and mentors instill patterns of thought that are not correct. They aren’t good at listening to patients. They often dismiss very real symptoms, particularly among women, seniors and kids.
I have multiple chronic illnesses, none of which were treated properly until I demanded it. If I had not been led to believe that doctors are always right, they know everything, they always act in the patients’ best interest … or if my parents had, since I was a baby when all of this started … I would have been more comfortable asking questions and digging deeper from a younger age. My childhood, teen and college years would have been very different. Instead I finally discovered what “healthy” felt like at the age of 28.
That occurred because I stopped assuming doctors knew everything. I insisted they answer questions and run the tests that all of my symptoms clearly indicated were necessary. Then I had to argue with my doctor about getting on the right medication, after those tests clearly showed what I needed. My health improved 1000%++, and doctors had very little to do with that.
I have a grandfather that was given multiple prescriptions that were not necessary. They shouldn’t have been taken together, and at least one was completely unnecessary. Instead, because he is of the generation that considers doctors infallible, there have been multiple accidents and it took some time before we discovered all of the pills his doctor had prescribed for him.
>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 elevated status and “mystique” of physicians started fading years before a significant number of us began speaking candidly on social media. Blaming our social media use for this is incorrect.
The medicine practiced by Osler more closely resembles blood letting from the Middle Ages than it does to medicine of the 21st century. To use Osler’s ideal as the model to which modern physicians should aspire is just plain silly.
>…damaging the nobility of the medical profession.
Thanks for your concern. [insert eye-rolling emoji here]
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