The biggest danger facing the medical profession is moral certitude, not Jeremy Hunt

UPDATE: A few hours after I wrote this, the BMA announced a two-day, all-out strike in which even emergency cover will be withdrawn. Probably safe to say they didn’t read my blog…

When I wrote a 500-word column on the junior doctor strikes a couple of weeks ago, I realised the position I was taking would be controversial with many in the medical profession. But I hadn’t expected to become the focus of overwhelming personal attacks on Twitter.

I completely understand that when it comes to industrial disputes, emotions run high, and lots of doctors are very angry about the way they perceive they’ve been treated by the government.

But I’ve been quite shocked at the way some doctors have chosen to interact with me: I’ve been accused of lazy journalism, of swallowing government propaganda whole, and of being incapable of understanding the issues at stake.

Part of me is loath to wade into the debate again for fear of unleashing another round of unpleasant Twitter trolling. But I have a few reflections that might be useful for professionals involved in industrial disputes engaging with the media in the future.

The immediate BMA reaction to my piece was to question my integrity as a journalist: Johann Malawana, the chair of the BMA’s junior doctors’ committee, accused me of misrepresenting the BMA spokesperson I’d spoken to.

I was surprised at this reaction. I relied on the tone and emphasis of a c. half hour call with someone in the BMA press office to guide my understanding of what mattered to the BMA. They didn’t raise issues such as potentially-unsafe rotas or on-call allowances with me, and said concerns about the proposed system of fines had receded as more concessions had been offered (which I didn’t think too much of, as it teed up with what the government negotiator has said in public). I even emailed them to confirm they were comfortable with the line I was going to use in my piece, and they didn’t take issue with it. They sent me some links to BMA correspondence that referenced other issues involved — there are always plenty in a complex industrial action — but not, as I’d explicitly asked for, any briefing explaining and contextualising the issues that would normally get produced in a dispute like this for members and for journalists.

So what I wrote about reflected the conversation I’d had. I didn’t imagine for a second that reflecting back the concerns we’d talked about on the phone — albeit within an argument the BMA disagrees with — would result in quite so many toys being thrown out of the pram.

I can’t stress how important it is for the union leading the dispute to have clear briefing lines — and ideally, clear Q&A that explain and contextualise issues — for journalists. In an industrial dispute, it is entirely reasonable for us to rely on a union to accurately represent its position to journalists writing opinion columns about it.

I was also saddened by the personal attacks I was subjected to by some (I must stress, not all) doctors on twitter. Tweets like this:

Not exactly fun when you’re receiving a load of tweets in this vein. And when doctors who I first tried engaging with, but then blocked for offensive tweeting, used junior doctor Facebook forums to organise groups of their mates to tweet at me asking why I’d blocked them.

(There’ve been a handful of doctors like @timboyroy and @cmrwdk who’ve publicly called out this behaviour on twitter, to whom I’m sure the majority of doctors are extremely grateful).

I think there’s an important lesson here. While emotions are running high, and junior doctors are clearly angry, this doesn’t mean that their position or that of the BMA’s is beyond scrutiny, or that people don’t have the right to challenge it. I’m left with the impression some doctors simply don’t think you can legitimately look at the facts and be against industrial action.

Hence I’ve been accused of writing a piece full of factual inaccuracies — when I think what doctors meant was they disagreed with my opinion on the implications of the new contract. I’ve been accused of swallowing government propaganda by the same people that have attacked me for not taking junior doctors’ claims at face value. And some doctors have asserted only doctors with frontline experience can take an informed view of the industrial dispute — without seeming to realise the problem with that.

This level of moral certitude — mixed with the personal attacks a small but vocal minority of doctors on Twitter have levelled at journalists who’ve tried to apply scrutiny — is dangerous for the profession. It shuts down debate and undermines the ability of journalists to provide public scrutiny of a major industrial dispute. And I think it will counterproductively undermine public trust in the long term.

If I thought there was any point — that it would provoke a constructive debate rather than further abuse — I’d have written a longer blog setting out my views after a week of engagement with junior doctors who chose to communicate with me politely and respectfully. While I still think strikes are unjustified, I do think junior doctors have a real grievance with the government: the looming financial crisis facing the NHS. Whether about rotas or on-call allowances, my conversations with junior doctors about the new contract frequently ended with something along the lines of ‘And when a trust is under great financial strain, they will exploit junior doctors in this way, using this loophole’. Of course financial pressures will have implications for the relationship between employers and employees in the NHS — whether under the old contract (indeed, they already are) or the new one.

But striking on the basis of a contractual dispute is not going to solve this bigger problem. If the NHS is going to get more funding, it has to come from somewhere — particularly given health is one of the few departments to get a real-terms funding increase (albeit one that’s lower than the historic increases the NHS has seen to date). There are other public services and professionals under even greater strain — look at local authority social services and social workers, for example. I think junior doctors could take a much more constructive approach, using the high levels of public trust they currently enjoy, by talking to the public about why we might need to pay more tax to maintain our health service.

That would be my number one takeaway from this dispute. Even when you’re angry, positive and constructive engagement will always serve you better than negativity and personal attacks. For what it’s worth, my advice would be less of the personal attacks on Jeremy Hunt, and more making the case for increased NHS funding to the public. If the BMA doesn’t change tack, there’s a real risk it could start to alienate the public.