Why Now? Doctors.net.uk DNUK and Doctors Behaving Badly

Last week a crowd of doctors from Doctors.net.uk started a unpleasant game of "Space Invaders" attacking me and my blog.

Doctors.net.uk (DNUK) is a private forum for doctors. You have to be a registered medical practitioner to join.

Within the forum doctors are allowed to post either under their own names or under closed profiles, where their identities are known to only the forum moderators. Posts are voted on, much like the Comment is Free section of the Guardian website. This leads doctors to compete for votes in order to get a "Top Quality Post". A Top Quality Post (TQP) is any post in the top five voting for any given week. Competition for a TQP is fierce, TQPs get a link in the right hand margin of the forum drawing other doctors attention to them. At this stage, they immediately get more votes and the competition hots up.

Under these circumstances, it is not surprising that behaviour deteriorates. Doctors are a frustrated lot and by no means are they all bad people. Most people, like myself, set out on the medical path with strong ideals and a belief in human kindness and compassion. These beliefs have been trampled on by the system within which they find themselves. Doctors are largely held prisoner in a culture dominated by fear and greed, otherwise known as the NHS. Unsurprisingly many "go native" and support the target driven, performance indicated, management dominated hands that feed them.

Even when I was a member (I am now banned) I rarely went there. DNUK has, incidentally, interesting ways of ensuring that just about every doctor is a member. Every now and again I dropped in to check my email. Last week I noticed a TQP post labelled "Acute Psychosis Fun". It opened with a post from a popular and well known doctor giving a recognisable description of a patient with severe mania and received 118 votes. There were various comments until one doctor made a spectacularly puerile quip which last time I saw it had 340 votes and was a TQP

I objected and all hell broke loose. The abuse I personally received for spoiling their fun was spectacular. It ended after a week. A week in which I described the incident on Doctor Bloggs (Click) was banned from the forum, and was threatened with lawyers. After three days the thread was withdraw and after six days the moderators agreed to delete my data and posts, all discussion of me, my mental health and the book Mood Mapping presently on the forum and in the future.

How did this happen? Firstly, doctors believe that they can be as flippant with patient confidentiality as the Department of Health, Secondly, altough it is accepted that you no longer make jokes about coloured, disabled or gay patients and doctors, people with mental health problems have no such rights. Thirdly, doctors consider DNUK a safe place to vent their frustration, especially when posting from behind closed profiles. It is not safe, as I demonstrated. I broke their Terms and Conditions, discussed the forum outside DNUK and have been banned, but I am not the only hole in the sieve.

The General Medical Council (GMC) has close links with DNUK and it can reasonably be assumed that everything that goes on within that forum does so with the tacit acceptance and approval of the General Medical Council. I say that because the forum frequently publishes recognisable patient details without patient consent, and the GMC takes no action. Members of the GMC Council post on the forum. Although in fairness to the GMC, they have guidelines in place to prevent doctors stigmatising patients.

In addition, nurses are referred to as "noctors" and "clinical mistakes" that they might or might not make are gleefully recounted. There are many "hate threads" against nurses or any other group that might offend the DNUK collective. Each attempting to be more trite and vitriolic than the last in order to attract more votes.

How should this be resolved?

I believe that kettling frustrated doctors inside a closed forum, with closed profiles stops proper and mature debate of the numerous well justified topics that are raised within the Forum

Doctors need a forum where they can openly discuss their concerns and where such discussions lead to action, not further increase frustration.

Closed profiles give a false sense of security. If you say something, you should be prepared to stand by it or apologise. The General Medical Council has full access to all discussions in the DNUK. They may also request further details about any exchange on DNUK should they require them.

Doctors do not need to discuss issues behind closed doors. In a world where patients are sent letters in the post, detailing the spread of their cancer and their life expectancy, there is no excuse for doctors to hide from their public. Their public can take whatever doctors say and judge accordingly. Moreover, many doctors would be surprised how supportive the public are.