Doctor shaming and public health

fear-299679_1920More than a year ago, #HealthXPh organized a tweet chat on handling social media posts that can either have a positive or negative impact on the reputation of doctors and other health professionals.

Inevitably, an issue that came up in this tweet chat was the growing threat of doctor shaming on social media, where doctors (and increasingly, other health professionals such as nurses and dentists) are being blamed for unsuccessful medical interventions, usually accompanied by personal insults. Often, the post contains a covertly photographed or video-recorded encounter with a doctor or health professional, with an accompanying narrative of the poster's negative experience. The poster then shares the post to generate public sympathy, until it reaches authorities and the mass media, without offering the affected doctor or health professional an equal chance to explain oneself.

A year has passed and these attacks on doctors and health professionals have continued to generate differing opinions among the health profession and the general public it serves. It continues to compromise the dignity of doctors and health professionals, but also the posters who have exposed their tendency to take matters into their own hands, and unfortunately, to use social media as a way to exact vengeance. I won't be naming specific instances here for the sake of my colleagues' reputations and privacy, but each instance has ended up with the doctor or health professional at the losing end, thereby affecting the person's career, leading the person to put up practice elsewhere, or worse, leaving the health profession altogether.

In discussing this phenomenon, one important thing must be made clear: no one likes a clinical encounter or procedure go wrong. 

There are many sociocultural factors that are involved with this phenomenon. One possible factor is how social media gives a sense of empowerment to patients, who ordinarily consider themselves at the vulnerable side in the doctor-patient relationship. Thus, as a means available to anyone with access to the internet, social media offers a venue for balancing this power disparity, since, posting their experiences on social media affords great power in either promoting a doctor's career, or destroying it, depending on the level of satisfaction with the services they received.

The sociological impact of this phenomenon deserves further study, but unfortunately, few definitive studies have been done on the matter. For instance, in a 2015 Dartmouth study, some patients secretly recorded their encounters as future evidence to hold their doctors accountable in a negative clinical experience, but in my limited research, I haven't encountered any published study that specifically tackles this subject. Another apparent factor in the growth of doctor shaming is unmet expectations, which may not have been leveled off at the start of the patient encounter. Probably because many doctors have become too busy to take time explaining things to their patients.

Aside from the aforementioned, there are other factors, but a more concerning aspect to this issue is its effect on healthcare.

Googling "doctor shaming," I came across a blogpost published a year ago by an unnamed government physician that summarizes how this phenomenon can potentially impact on healthcare (edits and italics mine).

So I'm a doctor, I've been working in a [government] hospital for more than 5 years now and during that small amount of time, i've noticed a drastic change [in] patients attitude towards the doctors and all medical professionals ever since doctor shaming on Facebook became a thing.

In the recent months, people are posting more and more […] stuff on Facebook or any kind of social media how doctors are only after the money and that they should do this and not that. [I've] seen a lot of young doctors who [haven't] started their careers yet get their name tainted by […] people who post the doctors' faces on Facebook and say bad things to them. I am now thinking of giving up on becoming a doctor and just start a business or something or maybe just go abroad. Becoming a doctor in the Philippines is not worth it.

Not only does this post encapsulate a collective rage against this phenomenon and perpetuates revenge, but it also points out how takes away satisfaction from one's medical career and how it risks to deter students from taking up medicine as a career in the Philippines. Since career achievement and its accompanying satisfaction have been shown as significant sources of motivation for pursuing a medical career, doctor shaming is not just an affair to be resolved between aggrieved parties. It is an issue that will affect the future of the medical profession. With the public health concerns that currently plague the country such as the continuing increase of patients with tuberculosis and non-communicable diseases, the last thing the Philippines needs is a shortage in its health workforce.

This leads me to ask these questions for this Saturday's tweet chat:

T1 What examples of doctor shaming have you encountered?

T2 In your opinion, how does doctor shaming affect healthcare delivery?

T3 How can we educate the general public against doctor shaming?

Though disgruntled patients posting their views on social media are to be directly blamed, doctor shaming may well be considered a symptom of a deeper problem in our health care system. In my opinion, I think we in the health profession should practice mutual respect, empathy, adequate communication, and leveling off of expectations. We need to treat our patients with dignity, provide genuine care, and be ready to listen to our patients. Finally, from a health policy perspective, we need to examine how our health systems convey a sense of vulnerability, and rethink how we can make our health facilities promote patient empowerment.

Hopefully, by becoming compassionate health professionals working within empowering health systems, we provide health care that truly puts the patient first, thereby erasing any feeling of vulnerability, or even superiority.

In closing, I would like to share a lesson I learned during my years in the barrio: respect begets respect. And this goes for doctors, for our health system, and the patients we serve.

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Let's continue the conversation! Join us this Saturday, 22 July 2017, at 9:00 PM Philippine Time/ 9:00 AM US Eastern Standard Time at #HealthXPh on Twitter.

 

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