What do you expect of your doctor outside medicine?

Dr Melissa McCullough is a lecturer in medical ethics and law at Queen's University Belfast

Should doctors be able to behave how they like in their private lives?

I am not sure students entering medicine truly realise what they have committed to before commencing their studies. For some, it doesn't take long to figure out they have entered a profession that requires more of them in terms of knowledge, skill and professionalism than most other professions. For others, a Fitness to Practise panel may be their awakening to this fact. There are extreme consequences to some behaviour that for any other professional would perhaps be much less—or at least maintained as a private issue. Should doctors be able to behave how they like (within the acceptable boundaries of the law, of course) in their private lives?

Expectations, if not respect too, have somewhat diminished over the past decade in the wake of tragedies such as the death of numerous children at the hands of the Bristol heart surgeons and murders committed by Shipman. Nevertheless expectations and respect for the healthcare profession remain high. We would prefer not to see a picture of our doctor splashed across some Facebook page (possibly his own), drunk and in a compromising pose. And we may also prefer to be given advice by someone who appears to take his own advice. But there will be doctors that smoke, drink, have affairs, overeat or have other forms of addiction. At best, their struggles can sometimes increase their empathy for patients in the same situation or even inspire patients facing the same challenge. At worse, patients may find it hard to trust a doctor who falls short of their expectations. If the way a doctor lives his personal life causes a problem with a patient they will likely find an alternative doctor in the practice or the doctor should help the patient to do so. In the end, virtues such as honesty, compassion and integrity are paramount to the doctor-patient relationship and being human is all part of the relationship.

Doctors should of course set a good example to their patients, but this is not a must. They are not obliged to be role models but should try to be.

I remember a consultant with a huge belly telling me I'd stop snoring if I lost weight. Yes I was offended, even though I did have at least a stone to lose. But he had three to lose. Not that that matters, or does it?

Sol Mead is Chair of the Academy of Medical Royal Colleges Patient Liaison Group

How should doctors conduct themselves in society at large?

When a doctor treats a patient it is the patients' best interests that should prevail, so I prefer to express expectations of doctors in a positive, rather than negative, way. We can write endless lists of prohibitions and still not cover all the possibilities even though there are already many GMC work related rules in place. Better, I believe, to say how we expect doctors to conduct themselves in society at large.

In general, patients have an expectation that doctors that will not do things that undermine confidence in them, either by bringing themselves, their practice or their colleagues into disrepute. To take an example, patients do not want to see conflicts of interest, but expect impartial choices about treatment from doctors and pecuniary interests should not affect those choices.  I do not want to feel that certain drugs are being prescribed because the doctor is a shareholder in the company that produces the drug.

The Hippocratic Oath is still appropriate, but must now reflect our 21st century diverse society under which we expect our doctors to regard and treat all patients with respect and consideration, irrespective of the patient's race, gender, creed, sexual orientation, lifestyle or views. That's a big ask, if the patient's views are extreme or abhorrent to the doctor, but we are entitled to expect our doctors, whom we trust, to disregard such views. Equally, I would be unhappy with a doctor supporting a racist organisation, advocating religious fundamentalism, or being part of an organisation promoting conflict as it would bring into question their wider judgement and commitment to different groups in society.

Dr Christopher Pell is a General Adult Psychiatrist working in NHS Tayside. On-line he goes by @egosyntonically

Doctors should remain mindful of their duty to act professionally in all public arenas

The explosion of social media since 2005 has led to rapid changes in the way we communicate, self-promote and network. Social networking sites like Facebook, Twitter and YouTube now account for 12.5% all internet use, and society is still adjusting to accommodate these new technologies. Doctors have been earlier adopters of these tools, establishing many excellent medical blogs, podcasts and twitter journal clubs, as well as innovative new ways to inform, educate and communicate with patients and colleagues.

Legal frameworks are emerging however that establish tweets, blog posts, YouTube videos and other internet commentary as public domain material.

These media therefore impinge on the duties of a doctor to avoid disclosing personal information and beliefs to patients, and to maintain confidentiality and trust in the profession. By necessity then, doctors should moderate what they disclose in their online profiles and postings. How do we square this with our private personas and rights under the Human Rights Act to retain a private life? Local policies and guidance from the GMC need to carefully balance these competing rights with the responsibilities of being a doctor.

Each time I have hesitated before clicking "send" for fear of potential repercussions or misinterpretations, I wonder whether doctors can ever fully engage with these useful web technologies or divide our private and professional personas. Whilst society has yet to finalise the status of tweets and posts they are increasingly being treated as public statements in the courts and traditional media. High profile cases such as the #twitterjoketrial and the unnamed footballer saga focus public attention on the negative consequences that can arise from seemingly harmless comments. A good rule of thumb is to always consider the analogue situation. Would you be confident speaking the content of your post to a public lecture theatre? Would you hang that photo you have as your profile picture in the reception of your practice or ward?

New technologies often lead to new ethical challenges for doctors. Whilst the new version of Good Medical Practice should offer guidance on the professional responsibilities of doctors when using these social media, we should remain mindful of our duty to act professionally in all public arenas.

Antony Townsend is the Chief Executive of the Solicitors Regulation Authority

View from another profession…

There are 10 overarching principles with which all solicitors must comply. These define the fundamental ethical and professional standards that the SRA expects from them. Most of the principles relate to the solicitors conduct in the course of practice but that is not true of all of them. Principle 6, for example, requires solicitors to behave in a way that maintains the trust the public places in them and in the provision of legal services - this principle applies to conduct outside of practice.

A solicitor is an officer the senior courts and as such their behaviour must be beyond reproach whether in practice or their private life. One could hardly expect members of the public to respect the rule of law if solicitors fail to lead by example. The public must be able to place their faith in the profession and the behaviour of individual solicitors is a contributing factor to the public perception. The solicitor's responsibility for their conduct cannot, therefore, end at the office door.

Disciplinary action is generally taken where a solicitor commits a serious offence such as drink driving, however, it is not always breaking the law that may cause difficulty - a solicitor writing a blog in which they make lewd or racist comments would be at risk under this principle. A drunken solicitor at a private party would not be in difficulty, but one who got involved in a brawl as a consequence would be.

The SRA would take into account all the circumstances including mitigating factors but that in itself would not prevent the SRA from imposing a disciplinary sanction, the SRA would have to consider the effect the conduct would have on the profession as a whole.