Medical ethics in the age of the social media influencers

This article was exclusively written for The European Sting by Ms. Sonica Minhas, a second-year medical student in London interested in maternal and infant health, nutrition, climate change, human rights and healthcare policymaking. She is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

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This millennium has witnessed the exponential growth of social media and over the last few years, increasing numbers of doctors and medical students are using it, both personally and professionally. In fact, we are now entering an era where the doctors qualifying are those that have grown up with the epoch of the digital age. Debate is rife on the ethical standards to which doctors and medical students should be held to on social media but in general there is consensus that professional boundaries and patient confidentiality must be maintained. Organisations also state that personalised healthcare mustn’t be delivered over social media. However, there is far less guidance on the use of social media for public health promotion by medical professionals. Indeed, social media is a powerful platform for spreading public health messages to the wider masses and a purpose that many doctors/students use it for. However, it is absolutely imperative that in such cases professionals are held to the same standards as they would be at say a conference, for example. I’m talking about ensuring that evidence-base standards are maintained. This is becoming increasingly pertinent with the rise of so-called “influencers” who often blog about health (in particular nutrition) but end up spreading erroneous information. Under this umbrella unfortunately are also some doctors but we absolutely do not need them contributing to the noise, since that qualifier of doctor means that their message is perceived to be of greater credibility. Earlier this year, a study by the University of Glasgow revealed that the majority of influencers are giving inaccurate dietary advice. Of the nine influencer’s blogs that were analysed against 12 criterions (based on national dietary guidelines etc.), only one- a registered nutritionist- passed. Amongst those that failed was a medical doctor, exemplifying that doctors must be held to the same scientifically and medically justified principles that they are in practice when handing out health-related advice. A doctor is most certainly not limited by their level of education; if they have qualified, they have the competency to critically analyse scientific literature thus any information they present should be backed up with references where appropriate. This is something that must be instilled within medical students; the concept of adhering to science when posting about health. One way to do this may be to scour platforms for examples of doctors who blog about health and get students to discuss in small groups who they would say is providing the most accurate, objective and scientifically-sound information and how those that aren’t could improve their content. In this way, students are exposed to examples of good and poor social media usage for health promotion. As Aristotle put it, humans do not care for facts; they care for ethos, logos and pathos. Thus, how information is presented, i.e. the language that is used, is absolutely critical. This is why I believe medical schools must pave way to include development of scientific writing skills within their curricula. To some this may seem entirely unnecessary but I would argue given that more and more of us are creating and sharing content online, it is needed. Medical professionals when spreading health messages online must adopt a sombre, professional tone that is as unbiased and objective as possible. By learning how to write scientifically in medical school, students will learn the importance of avoiding emotive language and hyperboles because this introduces personal bias in the form of opinion which may be cloaked as fact, that ultimately can be misleading or flawed. “Primum non nocere” (“first do no harm”)-the Hippocratic maxim matters as much in digital life as it does in real life and that is something we must not forget. One of the core principles of the medical profession is integrity. Medical students must be taught that integrity is to be practiced on social media, the same way it is elsewhere. Often there is a fear to speak out against a point made by a fellow medical professional/student made on social media but this shouldn’t be the case. If we think something said by a fellow student or doctor on social media to be incorrect (be it the actual information or the way in which it is fashioned), we shouldn’t shy away from perhaps contacting them directly to say so or by creating a space for discussion and debate; this is how science progresses after all. Simply because they say or do something on social media out of good intentions does not mean we can let slip the fact that their content may be inaccurate; for that there is no defence, especially for a medically qualified doctor. Being in a position of public responsibility, doctors are, and rightfully so, subject to scrutiny which mustn’t change in the digital age. When used responsibly, social media is an impeccably powerful tool for public health promotion. With many doctors using it for this purpose, medical institutions and governing bodies for the medical profession must convene to develop guidelines on the ethical usage of social media for public health purposes. It may seem impossible but we must continue to push for standards to which health professionals should conform to when they use their expertise on social media. About the author Sonica Minhas is a second-year medical student in London interested in maternal and infant health, nutrition, climate change, human rights and healthcare policymaking. Her interests in global health stem from doing a project on the extortionately high caesarean section rates in countries like China and Brazil. It was then that she realised that as well as practicing medicine, she wants to provide a voice to the vulnerable members of our population by advocating for changes to education and healthcare policies. She’s currently expanding her horizons and exploring her interests by being on the committee of her medical school’s Students for Global Health branch and the nutrition society. She believes that as doctors we have a responsibility to share our opinions on matters that concern health and that we must be leaders for the changes needed in our healthcare systems to tackle threats to public health and the issues establishing health inequities.