France: Le Divan des médecins, an uncomfortable sofa

A private Facebook group for physicians is in the spotlight because of its excesses, including offensive comments against patients.

The social media group raises issues on the overlaps of medical ethics, privacy, freedom of expression and patient rights

A French Facebook group reserved for physicians is in the spotlight because of its excesses, including offensive comments against patients.

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Created in 2017, Le Divan des médecins is a Facebook group reserved for physicians. It contains, unfortunately, quite an amount of questionable content: recognizable photos of patients and, above all, many offensive comments, some of which are liable to criminal prosecution.

Originally, a peer-support group

Some people consider this Facebook group a real professional and moral support space. More and more physicians may feel isolated, work under pressure and have little time to meet their peers. The professional pressure and emotional impact of the profession entice them to reach out to other physicians, not only to relieve stress but also to ask for clinical advice. This need is felt in particular by general practitioners, who find it increasingly difficult to reach out to specialists directly. Social networks are a simple way. On Twitter, for example, there is the hashtag #DocTocToc that allows you to attract the attention of colleagues.

A physician explained to the French-language L'Obs magazine a personal story regarding Le Divan des médecins. He had to stop working to take care of his son with leukemia. The group members then organized a fundraiser to allow him to pay for medical tests. The same thing happened on Twitter.  A physician was looking for support so that she could stop working and take care of her tumor-sick partner. Another physician immediately organized a fundraiser that was very successful.

The other side of the coin

The first problem is patient privacy. On this Facebook group, usually, physicians blur the images, but sometimes people are still recognizable. On an MRI scan, the patient's name was only partially erased, and in a few clicks, the authors of a complaint article that tackled the groups' professional integrity issues, identified the patient. any physician that wants to publish a photo or visit data on a website or social network must have the patient's consent. 

The main problem, however, is the activity of a minority of individuals (about twenty according to one of the members) who constantly make obscene jokes and propose, for example, "naked challenges" (physicians must send them naked in their practice). Above all, there are frequent offensive comments against medical personnel that are not physicians.

A "vent valve"

Among the targets: patients with certain pathologies (fibromyalgia for example), but also those with free health insurance (i.e. people in precarious situations) and those who do not show up for appointments. Other comments target women and homosexuals. Even the most serious posts end up being contaminated by offensive comments. For example, when a physician posts a photo of a patient to ask a specialist for advice, other physicians criticize the patient's physique. "If her breasts are drooping, I won't even examine her" is written in one of the comments.

When a member of the group dares to criticize these behaviors, he or she may, in turn, become the target of violent comments, be considered a "traitor" and sometimes banned by the group. A physician also reported the group to the Pharos platform, which allows the police to investigate illegal content on websites and social networks, but so far no action has been taken. All these behaviors pose a problem of professional ethics. In the article, a lawyer recalls that "Even in the private sphere, a doctor must behave according to his code of ethics 24 hours a day".

The National Council of the College of Physicians (In French: Conseil National de l'Ordre des Médecin), which is the national organization that regulates the medical profession in France, stated that it was not aware of this group. It described some of the content as "frightening" and is considering initiating legal proceedings. In 2011, it published recommendations on the web on how physicians should behave: "They should not slip into derision, offensive irony, stigmatization of a social category, public insult or even defamation". The group administrator, quoted in the article, assures that the accusations against the group come from members who simply want to criticize it.

The welcome message of the group is clear: "this is the realm of Carabin humor". "Carabin" is the nickname given to French medical students. The origin of the nickname is not clear. Perhaps it comes from the word "scarabée" (beetle), an animal that digs into the ground because during plague epidemics it was medical students who buried the dead. Another explanation is derived from the word "carbines" (rifle) because in the 18th-century medical students in military hospitals were armed. This term is mainly used to refer to the vulgar or sexual jokes used by medical students. But does this very specific humor allow all sorts of excesses?

The "carabin humor"

In the L'Obs article, a physician and anthropologist provided a definition: "It is humor practiced by physicians to distance themselves from the taboos that their profession confronts them with". It would be a way for physicians to fight the rising stress levels that have been associated with the profession since the beginning of the 19th century. Young physicians from the bourgeoisie were brutally confronted with the misery and suffering during their training. They reacted by doing what their impunity allowed them to do. They got drunk or went to prostitutes. This culture and humor became less present after the rise in the number of women in the medical profession, and since physicians are no longer systematically coming from social elites. Physicians are no longer considered "above" the law and patients claim their rights. This particular humor, which often mocks them, is, therefore, less and less tolerated.

Can you write anything on a Facebook group in the name of humor, freedom of expression, and privacy in communication? Firstly, freedom of expression does not allow certain comments and are punishable by law. Secondly, the private nature of a group of this size is called into question. This is the famous 'grey area' of public communication: you cannot behave with 11,000 colleagues as if you were with a few colleagues in the same room. Moreover, some physicians explain that they should, on the contrary, set an example to the population and not make fun of homosexuals, women, overweight people, and vulnerable populations.

And now what?

It may seem surprising that physicians, who know the legal value of a written document because they are used to writing certificates, have taken the liberty of writing such comments. Moreover, French physicians generally do not want to feed the "doc bashing" that regularly re-emerges on social networks. For example, a controversy has recently broken out about the alleged racism of some physicians, following a controversial tweet from a very popular French medical professional on Twitter.

However, it seems that some group members believe they are protected from a "double impunity" provided by their status as physicians, and the anonymity possible in social networks. But some Divan des médecins members are not surprised that the excesses have been revealed. "Let's not kid ourselves, this group will eventually be discovered and will be the new LOL League," wrote one of the members. He was referring to the scandal that hit the media in early 2019. La "Ligue du LOL" was a confidential Twitter group composed in 2010 by about thirty young journalists. This sexist and homophobic group organized computer harassment of different types, including photomontages and hoaxes. Many of the members, some of whom had careers in the media, were fired as a result of the scandal.

A similar story concerned the Facebook group "Les médecins ne sont pas des pigeons" (In English: "Physicians are no doves") whose excesses were revealed in the autumn of 2016. Many posts were racist, homophobic and mocked the disabled. After a complaint filed by a feminist association, the judicial system decided that the group's administrator was not responsible for what the members had said, and could not be convicted. The group still exists.

What is the future of "Divan des médecins"? It could be "cleaned up" from problematic content, or shut down. And maybe reopened elsewhere, under another name. Or it could mutate into a "mini Divan", a digital space that would be even harsher and mordant.

Source: 
(In French only): «Quand les seins tombent, je refuse la consultation» Sur Facebook, des médecins violent leur serment. Par Louise Auvitu et Béatrice Kammerer. 05 janvier 2020. https://www.nouvelobs.com/notre-epoque/20200105.OBS23047/quand-les-seins-tombent-comme-ca-je-refuse-la-consultation-sur-facebook-11-000-medecins-violent-leur-serment.html

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