Doctors are drowning in guidelines: ‘social learning’ a lifeline


Dr James Quekett says doctors are struggling to keep up with guidelines, and can learn from online peer conversations. Pharma can join the conversation too – but must understand the rules of engagement.

Since I started working as a general practitioner in 2000, I have seen the demands on frontline doctors (and other primary care health professionals) rise and rise.

Many GPs have a working day of around 12 hours – from eight in the morning to eight in the evening. A lot of what goes on in a GP practice is invisible, because it involves lots of paperwork and administrative tasks.

This issue is a particularly hot topic in England at the moment, as the health secretary Jeremy Hunt has promised to ensure a 7-days-a-week NHS service. This is a huge bone of contention with GPs, because many are already working at weekends, just to maintain current standards, and one wonders where the extra manpower will come from to make this round-the-clock service feasible.

These days I only work part time as a GP, as most of my week is dedicated to helping doctors to continue their learning (continuing medical education or continuing professional development) through my role as a clinical adviser.

Working with online doctor communities, I am interested in figuring out how time-poor doctors can maximise their learning and professional development through online resources.

I think the key to this is what I call 'social learning', which is simply learning and improving practices by discussing practical medical issues with peers, and has always been done. But the potential for this highly effective way of learning is hugely increased thanks to 21st century resources – if you know how to use them effectively.

Guidelines still trusted – but are they acted upon?

We conducted a survey of doctors recently to find out what sources they trusted most, and what influenced their practices. The poll found that guidelines produced by national bodies such as NICE in England and SIGN in Scotland were the most highly rated.

After this, guidelines from local NHS bodies (Clinical Commissioning Group guidelines in England) were ranked next most trusted, followed by guidelines from a professional college or association.

However, while these guidelines are trusted, often they just get added to the already huge pile of information the doctor is supposed to digest and put into practice.

That comes back to the problem of more and more demands being made on doctors' time. For that reason, I think doctors' roles will change from being holders of all the relevant information to being navigators of the information. There is another good reason for this shift – patients increasingly know a lot about their conditions, and doctors have to involve them in their decision-making too.

So how can doctors pick out the relevant information from all this guidance? I think the answer lies in social learning. The poll found that 30 per cent of the doctors regarded an expert summary as relevant to their clinical practice.

That doesn't sound like an overwhelming percentage, but when they were asked what would change their behaviour, their responses were very interesting.

"The poll found that a review of a guideline by an expert in the area was seen as more likely to change behaviour"



The poll found that a review of a guideline by an expert in the area was seen as more likely to change behaviour: 30 per cent said it would change their behaviour compared to 20 per cent for those just reading the guideline. On top of that, discussion around specific cases with a trusted colleague with reference to the guideline was seen as effective, being preferred by 22 per cent.

Online communities

Online resources and social media platforms are now well-established as places doctors can converse, and seek out advice and guidance on clinical matters from their peers.

There are many doctors in 'mainstream' social networks such as Facebook or Twitter, but while these have their uses, these aren't the place for medical professionals to discuss medical problems, or discuss a specific case in detail.

A key benefit of a closed, doctors-only community is that you can discuss cases more freely. You still can't breach patient confidentiality, but you can say 'I don't know this – please help me out' without exposing your ignorance in a more public forum.

So for instance I recently asked a question about the pros and cons of using novel oral anticoagulants (NOACs) or warfarin. If I did that on an open platform with patients around, they might well doubt my competence. But in a doctors-only community, I got a lot of valuable opinions. Interestingly enough, it was a controversial one, about 50 per cent recommended I use warfarin, the other 50 per cent said I should use a NOAC. So it didn't answer that particular question for me, but the point was I could go to my peers and ask their advice, and they could give me the latest evidence as well, which is a powerful resource.

How should pharma engage in these communities?

I think there is some wariness among pharma companies in engaging in online doctor communities. Whichever online community a company uses, the rules are broadly the same: pharma companies are able to join in the conversation, but must remember that they are on doctors' territory. That means they can't just shout out their messages; they need to be open to conversations, and that means listening to what is being said as well.

I think one obstacle is that companies need to be agile and responsive in how they communicate within social media. That's difficult because pharma has to be careful in terms of compliance, which means it can't be so quick to respond to the conversation.


"It probably means not being drug-led, but being thought leaders in a whole therapy area"



But that doesn't mean pharma shouldn't engage around a therapy area. It probably means not being drug-led, but being thought leaders in a whole therapy area. For instance, sharing best practice in chronic obstructive pulmonary disease (COPD) and raising questions about how to improve patient care.

If you sign up to this broader aim of educating doctors in the area of COPD, you are often likely to see an increase in the amount of drugs being used in the area, because that is good management. But you shouldn't focus on the drug; you have to focus on good management of the disease, and how to make sure more patients benefit.

Your social media persona

Finally, many doctors do use 'mainstream' social media, which I think is only right. The GMC guidance on social media is full of warnings, including advising not to communicate with patients online. But, in my view, if you are a GP you are part of your community, and you shouldn't stay aloof online. Engaging with patients online is a good idea – you just have to use common sense and maintain boundaries.

One way doctors do this is to switch between different social media platforms, or use one anonymous account for personal use and another for public, professional use. The point is that each social media platform has its own use and character. I am not the biggest fan of Twitter as I find it often full of people being angry or taking offence. However the flip side is that it is a good place to vent your spleen. That's why I posted on Twitter recently using the #ImInWorkJeremy hashtag.

This hashtag emerged in response to Jeremy Hunt's call for a 7-days-a-week NHS service, and shows the power of social media in helping to generate different perspectives – and this is one subject I think GPs should discuss in public.

But doctors also need a way of quickly tapping in to the wisdom of their peers – and when discussing tricky medical questions, this is best done away from the big and very public online forums such as Twitter and Facebook.

About the author:

Dr James Quekett is director for primary care at M3 EU. He qualified from Bristol University medical school in 1994, becoming a General Practitioner in 2000. Over the past 14 years he has been involved with the development of eLearning, initially as an author, before joining the team at in 2008. He remains a working GP in Gloucestershire and is also a GP appraiser looking at the continuing professional development (CPD) needs of qualified GPs. He is passionate about the pivotal role that primary care plays in the delivery of healthcare within the NHS.

Dr Quekett presented a free-to-attend webinar on the value of social learning for doctors on 22 July 2015. The on-demand version is available, and is designed to inform and offer expert resource on this emerging educational trend. It delivers a case study showing how peer-to-peer learning through social media in physician communities is saving lives by reducing misdiagnosis in cancer. Click to register and view.

Read more from James Quekett:

Five-Year Forward View: tackle GP recruitment crisis

Linda Banks

2 September, 2015