I welcome the statement made by our esteemed DG regarding the use of social media by health professionals.
I agree in parts. Disagree in others. Neutral in some.
I agree that ethics and professionalism need to be maintained in the use of social media when it comes to certain aspects of our work. When it comes to confidentiality, there is USUALLY no compromise to it, I agree. (there is a reason why I CAPSLOCK the word ‘usually’. Read on and I will elaborate)
But I am more interested in this particular paragraph written by our DG:
I would like to elaborate on this, in particular. Because I know the older generation has NO IDEA how social media can be used effectively. We cannot blame them. We are the ones who grow up with social media. They (the politicians and leaders) took up social media as part of the evil necessity in this current age, but they don’t know how to effectively use it.
They need help. But they have to help us to help them.
Before I elaborate further, I would like to tell you that any game cannot be fairly played when there is no level playing field.
One side will always lose when there are different rules for one team, and another set of rules for the opposite team, when they are playing THE SAME GAME.
In chess, my king can move the exact same minuscule step as your king. My queen is as powerful as your queen. My cavalry and my pawns have equal strengths as your cavalry and your pawns. See? Chess is the fairest game in the world. They eliminate all biases and all other factors that could influence the outcome of the game. Discounting luck, takdir’ or ‘qada and qadar’, the winner MUST be the most strategic, and the most brilliant. No biased referees, no other judge. (not even courts can be THIS fair). I was never a sporty person, and the only game I could play were chess and carrom when I was in school. (And I was not even that good but I like it because it’s fair. I lose fairly. And I win fairly).
In any other sports, you cannot guarantee that each player in one team has his EXACT equivalent in the other team. So they have to buy players into their team.
Social media is not like chess.
Social media is a sport. And to make it worse, it is a sport with different rules for different people. And someone will always be at the losing end.
At the moment, the doctors are at the losing end. ALWAYS!
The patient with allergic reaction can breach her/his own confidentiality when they go to the newspaper and claimed “doktor salah bagi ubat”. Can the doctor go to the same media and breach the patient’s confidentiality to clear up his name? He can’t. He has to abide by different rules. His hands are tied. He suffers by the unfairness and the indignity of it all. And what can we say to him. “Tough luck, mate!”
Is that it?
It happened to my own colleague! Someone snapped her picture and accused her of nonsense. It was viral in the social media. The whole Malaysia talked and commented about her. Inquiries were made by the Pengarah and the DG. But when all facts have been laid out, and accusations against her have been cleared, who in Malaysia knew about it except her colleagues and her superiors? The facts were not even published in the social media. So the whole Malaysia STILL THINKS she was wrong. If you are a decent human being, the injustice of it all would grieve you. I can never tolerate injustice against others without commenting scathingly, let alone against myself!
Are patients the only one who have the rights to be treated ethically? That is NOT the ethics that I learn in medical school. Ethic is a guide. In general, you can’t commit murder; But you can in self-defense. In general, you can’t breach confidentiality, but if it were to happen to me, I will breach confidentiality to defend myself and my honour. I will sue the media and the patient! And I WILL viral it to the same extent the accusation was viralled against me. It’s not a threat, it’s a promise. I am very protective of my good name. And I think, everyone should too.
The problem is, MOST health professionals don’t like to GO ALL THE WAY when they are fighting against these sort of injustice. They rather take the attitude of “malas nak panjang-panjang”.
See? We are too kind. Our inherent goodness is also ANOTHER reason we are always losing.
Another reason why we are always at the losing end.
Doctors are generally brilliant people in their own field (non-doctors are brilliant in their own field; have to clear that up just in case some people think I am being arrogant. Been accused of that too many times). We can explain things brilliantly because some of us were also elocutionists and debaters and public speakers when we were at school.
Unfortunately talking and debating about diseases is not the same thing as debating about “whether or not school uniforms should be abolished in public school” in a school-level debate competition.
It’s not that we are not brilliant speakers in our own rights. It’s just because whatever brilliant explanation we can give will always be lost to translation. Medical terms are most accurate in its Latin form and English form. And informed consent is only as good as the patient’s level of understanding.
3) Unequal ethical rules between doctors and the ‘natural healers’
For this point, I think my esteemed colleague (now, already a psychiatrist) has nailed it in the head with this part of his facebook status. Below is the print-screen of his brilliant elaboration of something I could not explain as clearly. His facebook status has got many shares and I took it for granted that he wouldn’t mind one more share in this humble blog of mine.
Dear doctors in any generation,
-We are losing!
-You are no longer practicing medicine in the golden age of 50 years ago, or even 10 years ago.
-We have to revise how we use the social media.
-We have to learn the ropes. We have to adapt. And we have to do it quick.
-Even medical ethics need revision. At least some of them. Not merely the clinical guidelines that need revision. (Don’t be so scandalised. Ethics and laws are revised according to the passage of time, provided it does not go against the law of God. This is nothing new)
Let the younger generation help you understand the social media, a little bit more.
We Need To Understand The Social Media Format
I will give you a simple analogy. Hopefully it will help demonstrate where I am coming from.
In our schooling days, we learned how to do essays, no? We learned how to write formal letters and informal letters. Language used in the informal letters (overt expression of tender feelings, peribahasa bagai, flowery words) will not give you high marks when they are used in the formal letters. Formal letters have to be succinct, precise and to-the-point.
On the other hand, if your task were to write an informal letter to your girlfriend…. using dry, unadorned, uninspired style of language will NOT give you an A. In real life, your girlfriend will say “you are a dry, stick-in-the-mud bore. Our relationship is finito!”
Writing a case report is the equivalent of writing a formal letter. The scientific, dry and to-the-point style is best used when we are speaking among health professionals and doctors.
In the social media, the general public who does not have the slightest idea about medicine will NOT read what you write if your facebook status is as dry and yawn-inducing as all that.
So when the DG wrote : “Inappropriate, emotional and irrelevant uses of words are not welcomed” when it comes to posting in the social media, we need to properly qualify what does ‘inappropriate, emotional and irrelevant’ means.
If it means we have to use the case-report style of language when posting in the social media, with all due respect, I have to disagree. (Read on, and I will elaborate)
We Need To Understand The Purpose Of Using The social Media
The point of using the social media is not to educate. It is to advocate. There is a fine line between ‘educate’ and ‘advocate’. The line is thin, but it’s there.
To simplify the matter, I will say that to educate is what the teachers are for. The textbooks, the case studies, the journal articles are all the tools being employed to educate. They belong in the class room. Not in facebook. Teachers are great people, but students don’t always listen to them.
To advocate, is what the celebrities and the artists are for. The celebrities and the artists are attractive, beautiful, appealing! Underneath all the make up, they have their flaws. But they magnify their strength and downplay their weaknesses.
We all do it in our own way. When I go for a holiday, I don’t show people the pictures of me being tired and grumpy and hungry. I show them only the fun things I do, the good food I eat, the beautiful sceneries I have seen.
Do you understand?
Doctors have to know how to coach their facebook status in a manner that is attractive and appealing for it to go viral enough to be read by the public and the target audience (not just by their fellow colleagues).
Sarcasm has its uses. Emotion has A LOT of uses (take it from the psychiatry MO).
Sarcasm has been (mistakenly) thought to be a sign of intelligence. It’s not always so, I know (sometimes, it only means you are rude, ill-mannered and uncouth). But the majority of people ARE entertained by sarcasm and they DO THINK sarcastic people are intelligent. In the battle of the social media, we need to be perceived as intelligent for our words to attract attention, and in turn, having the power to influence.
It’s all about perception.
Being dry will not even cause anyone to READ your status, let alone influence them to think favourable of you. Perception is everything. Some people manipulate perception for a bad purpose. At least we are manipulating it for a good purpose.
I say, where appropriate, use sarcasm!
I say, where appropriate, use emotion! Most people don’t decide based on reason, they decide based on emotion. This is true! The evidence of this is rampant in the psychiatric clinic when it comes to relationship and marital conflicts.
Now, when I say ‘where appropriate’ what do I mean? (read on!)
We Need To Understand The Power Of Context And Words In Our Argument
Absolute truth can only be known by God.
In real life, truth is very relative. In real life, logic is only patterns that have nothing to do with the truth.
Premise 1: A is B
Premise 2: B is C
Logic: A is C
That’s logic. It is ONLY true if Premise 1 and Premise 2 are REALLY true (if A REALLY is B, and if B REALLY is C). In life, premises are not as simple as ABC. Sometimes, you will never know whether the premises are ACTUALLY true in the first place.
The premises surrounding the (possible) truth is complex! So, let’s not try to explain it, if we don’t have to. (if we have to, we will do it. If we were asked, we should do it. Until then, simplify your explanation).
Just work with context and sharpen your vocab in any language you know. Learn human emotion and motivation.
The public claims they want to know the facts. But sometimes, the facts don’t MOVE them. The facts don’t affect their decision.
I make use of emotion when I want my patients to be compliant to medication. Yes, I make use of it. I, who always claim that I don’t like to be manipulative, actually manipulate emotion when it comes to dealing with my patients.
I started with a smile. In various subtle words, I showed that I care. I demonstrated the fact that I have no conflict of interest. “Gaji saya tiap-tiap bulan sama jer samada awak makan ubat ke tak. Saya tak dapat untung macam bomoh-bomoh tu. Kalau awak tak makan ubat pun saya tak rugi. Awak rasa kenapa la saya berleter panjang-panjang kat awak? Tu kat luar tu, banyak lagi pesakit dok tunggu.”
They will take the meds if they believe you genuinely feel a level of care towards them (why do you think doula is so populour?)
On the other hand, I have used sarcasm towards rude, demanding patients. And magically, they become less rude when I am more firm. They are more receptive to accurate information when we show who is the authority, here. I cannot show inferiority with these sort of patients. Bullies will trample the weak among them. If I look intimidated, I will no longer be effective as their therapist. I know this! And I change myself and my demeanor, accordingly.
In fact, it is my principle not to kowtow to anyone who acts superior towards me without no other basis other than their social position. It is irksome, and I show my polite poker face to them. No more and no less. (In general, I don’t prefer dealing with VIP patients. Sometimes, when there is no specialist around, MOs will have to see these VIP patients. Some VIPs are polite and never try to impose. Some like to subtly show they are someone important by certain words and certain attitude that I deal by simply pretending that I don’t understand and don’t care to know).
In psychiatry clinic, we have depressed patients, manic patients, psychotic patients, kids with learning disabilities, adults with dementia, drug addicts, personality disorders (psychopaths, sociopaths and the likes). Context is so important. Versatile ways of wording your emotion are very important to influence different type of people.
To quote a fellow PSY colleague, “our words are our tool of trade”. And now, this is also true for other doctors wanting to use the social media.
Doctors are brilliant at scientific biological facts. Doctors are brilliant life-long learners. We know what we know. We know, what we don’t know. What we don’t know, we know where to find out (if we want to find out). Indeed, where I graduate from, we made jokes about the term ‘self-directed learning’.
Tutorials and lectures were given to inspire curiosities and questions which we will have to find out the answers to on our own. We will then discuss it in the next tutorial session. That’s why tutorials are so stressful, folks. Australian mates right and left spoke on top of each other’s voices wanting to show off what they had found out from their own research. The dumbfounded Malaysians were waiting patiently for these mat sallehs to stop talking so that we could share what we have found out too. But they never stopped talking. They sounded brilliant. The timid Malaysians went home feeling dejected and stupid for not contributing in the discussion. The tutor made a remark “The Malaysians are passive and not participating”.
Like everyone else with problems, the Malaysians gradually learned to solve them. We self-directed-ly learned to interject, interfere and cut other people in the middle of their speech. We stopped waiting. We self-taught ourselves to be ruthless to survive, even though by the mat salleh standard, we were still very timid and passive.
See? Doctors are brilliant at solving problems. In life, we do what we have to do. In work, we do what we have to do for the sake of our patients. No sleep? No worries. No time to eat? We will simply starve. Got scolded publicly by specialist? We will simply develop a thicker skin.
We do what we have to do.
If you are not resilient, if you refuse to evolve, if you don’t know how to be like the adaptable chameleon, you cannot survive as a doctor.
May I suggest, that we start being self-taught on how to be effective in the social media too?
In the long run, it can only benefit us if we can use the weapon of social media to our advantage. Remember, social media is a sport with different rules for different people. But like any other game, practice can only make perfect.
If you don’t know, you can learn. But learn it, you must.
That is, if you want to survive and stay relevant.