Why the General Medical Council should discipline doctors who misuse social media

On 30 January 2024, the General Medical Council’s guidance on doctors’ use of social media came into effect. At paragraph 14 it reads: “You must not use social media to abuse, discriminate against, bully, harass or deliberately target any individual or group.”1 This rule falls under the broader category of “Behaving professionally and maintaining boundaries.”

The guidance does not define what constitutes abuse, bullying, harassment, or deliberate targeting. It follows, in my view, that these terms should be given their natural and ordinary meaning.

In some cases, there will be ambiguity about whether a doctor has breached this rule, but in many cases it will be obvious. Last year, for example, the Medical Practitioners Tribunal Service suspended a doctor for sending racist messages on WhatsApp.2 There are also many instances of doctors trolling doctors.3

The social media platform X is full of doctors violating the rule, with some even goading the GMC by tagging the @gmcuk handle in the post. For example, I have seen doctors openly accusing staff at the GMC of lacking integrity and moral cowardice about physician associates (PAs). The topic of PAs has become particularly toxic on social media.

Like many members of the public, I do not feel in a position to form a view on the PA issue. I know too little about their training or clinical competence to comment one way or another. I can, however, form a view on the offensiveness of social media posts written by critics of PAs. Some are nothing short of appalling, regardless of the merits of their concerns. It is small wonder that many PAs feel disheartened and hurt by the vitriol directed at them by their colleagues. These posts can, and do, cause psychological distress and damage morale. Even if posts are written by a small minority of doctors, they tarnish the reputation of the whole profession.

The GMC is aware of these violations. In October 2023, a GMC representative told Health Education and Improvement Wales that the GMC was “aware of the social media issues circulating around [PAs and anaesthesia associates]” and “hugely disappointed to see the tone of language being used and recognise the impact it is having on qualified and training [PAs and anaesthesia associates].”4 The representative said the GMC was looking at possible actions.

I do not know if the GMC took action. When the doctors are anonymous there is usually little the GMC can do to uncover the poster’s identity. While I understand the regulator’s probable concerns about inflaming the situation and attracting backlash, its apparent inaction undermines its credibility and authority. What use are rules if they can be breached with impunity? For the rules to be meaningful, they must be enforced.

I have avoided referring anyone to the GMC for misconduct on social media, mindful of the distress that such a referral can cause. However, the situation has become so serious that something must be done. The GMC should identify a clear-cut case of wrongdoing and initiate disciplinary proceedings if necessary. This would deter future violations and promote ethical behaviour. Only the most obstinate and naive doctors would risk disciplinary action, public scrutiny, and professional sanctions to protect their right to be offensive on social media.

To be clear, the misconduct in question is not doctors expressing critical views about PAs. Doctors have every right to voice their opinions. The problem lies in the insulting, abusive, and malicious way in which these opinions are expressed. My own regulator, the Bar Standards Board, has emphasised this in its latest guidance: “it is the manner in which barristers express their views that is more likely to concern us rather than the substance of that view.”5 It is a subtle but important distinction.