Paris (AFP)

A precious help to take the opinions of colleagues or share difficult experiences, but risks of breach of ethics and medical confidentiality, recently observed on a large Facebook group: for doctors, the use of social networks is twofold edged.

"Until the years 1995/97, each doctor was alone in the desert. The Internet led them to talk to each other," said AFP general practitioner Christian Lehmann, influential voice on Twitter (11,600 subscribers).

1997 is prehistory: exchanges were made by e-mail. Today, many doctors communicate on social networks.

On the one hand, they are used to question colleagues to ask them for an opinion.

"It can be questions about the use of drugs, things like + My patient had such a result, I wonder if it could not be such disease +, it can also be pictures of dermatological problems for example", lists the Dr. Lehmann.

On Twitter, these requests are often accompanied by the hashtag #doctoctoc.

Another scenario: sharing between carers "very personal things" such as "suffering over the death of a patient or a very difficult case".

More than Twitter, whose messages are public, this use mainly concerns Facebook, where we only discuss with those we have accepted as friends.

A major Facebook group, "The Divan of Doctors", has been the subject of controversy since an article in the Obs on January 5. In issue, publications mocking the physique of the patients, containing photos published without their consent or sexist remarks.

The administrators argued that this only concerned a tiny minority of the 11,000 members of this private group (subject to registration) and that it was not representative of the exchanges.

But the patient association France Assos Santé denounced a "very serious attack" on the rights of patients. The Minister of Health Agnès Buzyn, she judged the offending comments "horrible", seeing it "an ethical issue".

- Anonymity -

The National Council of the College of Physicians told AFP that it had reported these contents to justice, whether it was responsible for opening proceedings or not. Because disclosing information covered by medical confidentiality by violating the anonymity of a patient is liable to criminal sanctions.

"Social networks exist, everyone does what they want, but there is a code of ethics and I think we owe our patients something else," said Stéphane Oustric, general delegate for digital services at the council. of the order.

For him, the networks "bring nothing in terms of improvement of professional practices", and could be advantageously replaced within a few years by secure exchanges on a "digital health space", the creation of which appears in the health law adopted in July.

"Today, are networks a good thing: no. Does this foreshadow something positive: yes", says Professor Oustric.

However, it is difficult to sweep away practices that are part of our daily life.

"We could not get rid of social networks, we live with our time and it brings a lot of things," notes Dr. Lehmann, who says he has "learned a lot on Twitter: on patient experiences, on feminism".

Himself a member of the "Divan", he insists on the differences in use between Twitter and Facebook.

"Doctors on Twitter know they are on a public agora," he said. "They are careful, it is rare that there are problems with anonymization. And if someone does, he is quickly taken over by the others."

"Facebook is different: people are used to posting their family photos there, there is a side + we are with friends +", he analyzes.

Consequence: if the Twitter community "moderates itself", moderators are necessary on a Facebook group.

However, in the case of the "Divan", "there were three, which is too little" for 11,000 members, judges Dr. Lehmann. But despite these differences, "mutual aid, support, the exchange of medical skills are present on both networks".

© 2020 AFP