On the 25th March – approximately a lifetime ago in internet terms – the GMC published guidelines for doctors’ use of social media. The guidelines come into effect later this month.

Publication of the guidelines caused something of a social media uproar, particularly around the anonymity clause. The brilliant Anne Marie Cunningham, who has written and spoken a lot about social media in medicine, has hosted a particularly fascinating conversation about this on her blog, with well made points on both sides.

With all the high-quality discussion and carefully thought-through points flying back and forth, I’ve taken a back seat on this one. I’m not sure that I have all that much that’s new to add, and I don’t blog all that much about medical matters any more. But a nagging feeling in the back of my head says that this is exactly the sort of debate I would once have jumped into with both feet, and the focus hasn’t been on the part of the guidelines to which I most object. So here goes.

In all guidelines, I’ve always been lead to believe that definitions are crucial. For a guideline to be effective, let alone for it to be enforced, it must be clear what it covers. And yet, the GMC’s definition of social media is absurdly wide:

Social media describes web-based applications that allow people to create and exchange content.

Later in the guidelines, it is clarified that this definition includes non-public, professional social networks too. As I’ve discussed this issue with tech friends and colleagues over the last couple of weeks, this definition has caused several to – literally – laugh out loud.

It, of course, includes all manner of things that are not social media, and essentially describes any form of cloud-based application. If we interpret this guidance as written, then from 22nd April patient-identifiable information can no longer be uploaded to web-based GP note systems, or to HPZone used by Public Health England to track outbreaks, or indeed transferred via NHSMail, the restricted-level security email system designed exactly for that purpose. Use of Choose and Book will be against the GMC’s rules. All of these are online applications which allow people to create and share content. All are clearly not supposed to be covered by this guidance.

It can be argued that even if the definition as written is unclear, it is perfectly clear to most people what it is supposed to refer to. I don’t buy that, for two reasons. Firstly, what’s the point in publishing the guidance at all if we aren’t to interpret it as written? Some might say that the definition has to be broad in a fast-moving environment, and that the guidance would quickly be outdated if it were too pinned down.

Which brings me to my second problem: you may understand it, but I don’t. I actually don’t know whether this guidance applies in edge cases. Office 365 and Google Drive are both web-based applications which allow the creation and exchange of content. Applications like these are almost certain to replace locally hosted applications like the Word and Excel of today within this decade. Indeed, some organisations have already made the switch.

Is use of these outlawed by the guidance? I can see arguments why it, perhaps, should be. There are inherent risks about patient confidentiality in these systems. But to ban their use for patient identifiable information is a big statement, and I suspect that they didn’t actually mean it. But I’m far from certain.

To me, the nub of the problem here is that this is guidance on using a particular medium – and one that is ill-defined, at that. Publication might feel relevant now, and everyone from the BMA to the RCGP is helping people to understand how to use this medium safely. But I don’t think this is the place of a regulator. I’m acutely aware that others will strongly disagree with this position.

By and large, I think the GMC should stick to outlining principles. I no more expect to see supplementary guidelines on social media use than I would on letter writing or telephone conversations. Although, if – like many hospitals – you’re using a VOIP system, it could be argued that these guidelines apply. Just like the GMC does with those two media, I think case studies would have been a better way to illustrate the application of principles, rather than a list of inflexible “rules”. I don’t think it’s sensible or advisable to try and give over-arching “explanatory guidance” about an area of life which is changing so rapidly.

After all, these are only supposed to be explanatory. They are not intended to introduce new regulation. Though, to my reading, their poor formulation does lead to new regulatory burdens being placed on doctors.

When the last Good Medical Practice was published, Twitter had barely been conceived, and Facebook had yet to open to the general public. These guidelines aren’t clear now, so goodness knows what we’ll think of them in seven years’ time. I think they should be withdrawn.

Lectures can, in short, bring a subject alive and make it more meaningful. Alternatively, they can kill it.

A true, but not altogether encouraging, sentiment in this excellent 2001 paper by Brown and Manogue, sent to me by Newcastle Medical School to help me prepare my first big scary lecture for their students.

With both Wendy and me feeling under the weather at the moment, we’ve been through a fair few over the counter medications in the past week or so… although I have to admit that, in line with gender stereotypes, I’m more often sighted rummaging through the medicine cabinet!

Regular readers will know I’m a fan of infographics, and I thought this was was particularly powerful (though clearly more “graphic” than “info” – what’s with that 50% reduction “graph”?). Still, it’s a powerful message – 100,000 new donors needed in the next few weeks. Sign up to give blood today.

I’m now officially a flu-fighting super-doc, and hope that all of my clinical colleagues are similarly brilliant!

The evidence is clear: in randomised trials, care facilities with high uptake of flu vaccine amongst staff have been consistently shown to have significantly lower levels of flu-like illness and mortality. In the 2010/11 flu season, the UK saw 2,200 ITU admissions with flu, mostly in under-65s.

So do your bit, and get your jab!

Newcastle has a history of pioneering leadership in the field of paediatrics. In fact, one of the UK’s first paediatric hospitals, the Fleming Memorial Hospital for Sick Children, opened here in the 1860s.

By the late 1890s, we had a second paediatric hospital, the Sanderson Children’s Hospital, where some of the first groundbreaking work in paediatric orthopaedics was carried out.

And, in the last century, Sir James Spence – the UK’s first full-time paediatrician – founded the social paediatrics subspecialty, and revolutionised our understanding of child mortality (and much more besides) through the Newcastle Thousand Families Study.

The Great North Children’s Hospital – of which this is a particularly bad photo – is a £100m development opened in 2010. It is but the next step in this illustrious journey. It’s designed to be as un-hospital like as possible, even including a teenage “penthouse” on the top floor, with a pool table, massive flat screen TV, and some of the best views in the city. It also has unrivalled medical facilities, of course, including a genuinely world-leading “bubble unit” for kids with severe immunity problems.

Who knows what the next step will be?

This is a tiny bit of the Royal Society of Medicine’s incredible library, which is one of the biggest medical libraries in Europe. It’s spread over four floors, holding over half a million volumes – with around a thousand new ones added each year. It holds books dating back to the 1400s – when the occasional outbreak of Black Death was still claiming the lives of young Londoners. Even I couldn’t resist pulling a book off the shelf and reading for a while.

I think bringing Wendy here would be dangerous: she’s can easily spend an hour looking at the fairly pitiful selection of medical books in our local Blackwell’s, and has even taken her mum to the BMA library when on holiday! If I brought her here, she might move in… especially if she knew there’s a Mango nearby!