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.