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THE Australian Medical Board’s Good Medical Practice guidelines clearly highlight the importance of professional, respectful and courteous behaviour among and towards medical colleagues and allied health professionals, including behaving professionally and courteously over social media and in other digital commentary.
Harassment, bullying and discrimination are unlawful and should never be tolerated by anyone.
Yet, from my observation, negative commentary by doctors towards medical authors in response to their published articles and opinion pieces is not uncommon. Of course, diversity of views and robust debate are healthy, but derogatory personal comments attempting to undermine authors’ authority or humiliate and embarrass them are unacceptable. Unfortunately, sometimes written abuse and negative comments by doctors on the internet are available to the public, and this reflects poorly on the whole medical profession.
Fortunately, reputable magazines and journals will often quite rightly screen and refuse to post harmful comments.
Commentary in medical social media on published articles and opinion pieces seems to have become more prevalent since these sites and publications are freely available digitally on the internet. This is good if comments are positive, constructive and helpful, particularly for debated topics, but not so if the comments are negative and harmful. Some authors have the ability to tolerate negative abusive commentary but others may find it difficult.
In the past, hard copies and written comments were once edited before publication. Comments in response to articles can now be posted with little editorial intervention and, in some cases, posted immediately to an article with no intervention. These negative comments are not only potentially harmful to the author but also discourage others from commenting if they choose to support the author, as they too may fear being targeted in an attack, particularly when issues are sensitive or controversial. For example, negative and sometimes harsh comments may occur in relation to euthanasia, termination of pregnancy, climate change, complementary medicine, racism, or sexual harassment within the medical profession. These are important issues that affect health care and should be discussed and debated with scientific rigour, openly and respectfully.
Medical practitioners often have a high level of awareness of the significant impact of cyberbullying on children and young adults, which may include abusive texts and emails, hurtful messages, humiliating others online, and spreading nasty online gossip and chat. About 20% of Australian young people have reported being socially excluded, threatened or abused online.
A systematic review of studies of young people found victims of cyberbullying are at a greater risk of self-harm and suicidal behaviour compared with non-victims. The perpetrators of cyberbullying were also found to be at risk of suicidal behaviour and suicidal ideation compared with non-perpetrators, which suggests they too are a vulnerable group.
Adults can also experience harm from cyber abuse that aims to threaten, intimidate, harass or humiliate someone — with the intention of hurting them socially, psychologically or even physically. This usually takes place on social media and in online forums that allow people to publicly comment. Negative commentary can ridicule, insult, embarrass, damage or humiliate a person. It may be based on their gender, race, disability, political beliefs, or diverse viewpoints. Thankfully, there are now new laws coming soon in Australia to help protect the public from severe online cyberbullying (here and here).
Sometimes sarcastic, or insulting comments may be inappropriate or hurtful but not serious enough to be classed as “adult cyber abuse”. However, the intent is still to humiliate the author. For example, strong opposing views sometimes gather momentum generating more negative comments or off-topic statements that deliberately derail conversation threads.
The harmful impact of racism, discrimination, harassment, social abuse, and cyberbullying on patients is well recognised by the medical profession. So, why do medical social media sites and some publications allow negative commentary targeted at the medical author to be published unfiltered? Authors of comments have every right to not agree with the article or express a different viewpoint, but comments can be phrased using respectful dialogue. For instance, commentary may not agree with the findings or content of the article and should state why, without the intention of harming or ridiculing the author, and uphold the evidence if required.
The medical profession has a duty of care to protect its members from negative or abusive comments that deliberately aim to shame the author. If we see a run of negative harmful commentary, we should not add to the onslaught but assist and support the author to avoid derailment of the subject and prevent any social and emotional harm to the author. Medical authors who challenge the status quo and write about challenging or divisive subjects are often brave to write an article that potentially exposes them to criticism in public. Articles may be limited by word count and authors may be unable to express their full viewpoints. For example, authors are sometimes given word count limits for short articles; there is a real skill and art involved in trying to provide a full picture or evidence in articles that are capped at certain word counts.
Authors may be young and/or first time writers eager to express new viewpoints, needing to gain confidence and experience with writing. We are their role models and mentors for young writers, and we need to ensure they are supported and encouraged in a positive healthy environment and how to deal with constructive criticism. However, negative harmful commentary that is posted on the internet for the world to view has the potential to reduce the author’s confidence and self-esteem, cause embarrassment, hurt and harm, and discourage them from writing again.
Editors of social medical media sites and medical publications have a duty of care to remove negative comments if they are hurtful or embarrassing to the author and/or to other commentators.
Let us be kind and compassionate to our medical colleagues and give everybody a go if they have a different valid viewpoint to express. If we do not agree, ensure our comments are respectful and courteous to the author and, where possible, evidence based. We are after all a caring profession and need to practice what we preach when engaging with other medical practitioners in any forum, including the internet.
Associate Professor Vicki Kotsirilos AM is a GP in Melbourne and a regular medical writer for various publications for over 28 years.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.
Noble sentiments. A problem arises when subjectivity is brought to definitions. One person is being direct; another sees this as bullying. In my view ‘bullying’ is overcalled when feelings are hurt unintentionally (e.g. “Just do your best! I can’t get out of theatres for 20 mins” leaving an RMO uncertain and unsupported, could be called bullying. In my experience, these situations arise in understaffed, overworked hospitals. Comprehensive studies should be undertaken to analyse these issues, and more discussion should be undertaken in Medical Schools. For example, it seems that women graduates experience more anxiety/depression, and so-called ‘bullying’ consultants may be under impossible stress heading for suicide. Getting the facts about these situations could lend more generosity and compassion to the debate
Bravo Vicki for your insightful and timely article regarding the difference between ‘robust discussion’ and derogatory and insulting vitriol.
We in the medical profession pride ourselves in being lights for the community, yet we are often brutal, sexist, racist, and bullying to each other.
It is overdue time to clean up our own act with increased mindfulness and skilful communication that opens the door to freedom and awareness of dissenting views that promotes creative thought processes, rather than its opposite.
Bullying at all levels is prevalent in medicine, an issue which is certainly not being addressed at all in its entirety.
Unfortunately I have personally experienced as well as witnessed how a physician or surgeon disagreeing with how a GP practices, whether the issue involves prescribing practices, referrals to outpatient clinics or hospital emergency departments or other issues, rapidly elicits a claim of bullying and statements made to the effect of an “us versus them” mindset. This does not seem to be the outcome when a physician disagrees with a surgeon or vice versa, and this happens quite frequently.
Perhaps this issue needs to be examined in greater detail and with introspection.
Our duty of care ultimately lies with the patient.
Well said Vicki. Is is a sign of a healthy profession to see animated diverse opinions expressed with confidence and even backed by evidence in some instances. However the basic rules of etiquette should apply. Nasty or angry rhetoric demeans the profession and reflects poorly on the author of those comments. We should keep in mind that whatever we write, becomes permanent. That’s the power of writing and it should not be abused.
Unfortunately, not all people understand the expression ‘be kind to others’ but the concept of etiquette/ politeness is something rigid thinkers do comprehend. Even narcissists know how to be polite when necessary.
I find it hilarious that the amount of discrimination hatred and vitriol that I get in hospitals for being a coloured and linguistically diverse doctor (as compared to a white person) despite being a specialist is not articulated nor addressed but comments ? Well if opposing views are intolerable, there is no modern society – we are not promoting elitism do we ?
Vicki this is an important opinion piece. As a reasonably regular writer for MJA Insight Plus, I usually find the MJA readers’ comments professional. I write to challenge debate so I always welcome strong opposing views. However, in the past, I have also attracted some damaging personal comments in other forums, which have deterred me from writing. For this reason, I frequently defend other authors if I see them being unfairly attacked by colleagues.
Of course, doctors are a diverse group with diverse views, working in diverse environments.
During the pandemic and beyond, doctors of all specialities are continuing to serve their patients and communities with fortitude and courage – from epidemiologists, public health and primary care physicians, to those working in surgery, accident and emergency, intensive care and aged care etc etc, and at all stages of their careers – from medical student to chief medical officer.
And as we continue to live with the uncertainty of a world in pandemic turmoil, many of us are also chronically stressed, grieving, traumatised and burnout – but still going.
At this time when we are living through a one hundred year pandemic, we are experiencing profound insights into our work and our lives. Our advocacy matters. Our fearless opinions and independent reflections can influence positive change.
As Vicki concludes: ‘Let us be kind and compassionate to our medical colleagues and give everybody a go if they have a different valid viewpoint to express. If we do not agree, ensure our comments are respectful and courteous to the author and, where possible, evidence based’.