Dr Yash Naidoo, Case Manager at Medical Protection comments on a recent news story that saw a doctor charged for unprofessional conduct due to his choice of dress.
While browsing Twitter recently – my digital equivalent of perusing the morning newspapers – I noticed something unusual. It was on the “trends” page of the popular social media platform. (This is a feature on Twitter that shows the most popular topics or hashtags being discussed by users at that time).
What was unusual on this particular day, was that the acronym 'HPCSA' was trending. It isn’t often that our professional regulatory body gets widely discussed by the broader public, let alone to the extent that it rises to prominence on the trends page. I promptly investigated.
It didn’t take long for me to find out the reason for the trend, which was widely reported on in prominent online news platforms including Medical Brief the following week. It was related to a Kwa-Zulu Natal based doctor, who had been trending online for his videos on a different social media platform, TikTok. Those videos reportedly portrayed a “pantsula-inspired dress code and lifestyle” or a “township-style dress code and cheerful attitude”.
Pictures of the doctor wearing scrubs, a stethoscope, and a bucket hat while smoking a cigarette, had surfaced and were the subject of much commentary on Twitter – resulting in it “trending”. While some users took no issue with the doctor’s attire, others criticised him and apparently called on his employer and the HPCSA to investigate. Many came to his defence and thought that he had done nothing wrong.
The only thing seemingly not in dispute was that the doctor had gone viral, and, given the circumstances, had done so presumably unintentionally. The matter received so much publicity that the HPCSA’s spokesperson was reported to have said the following on the issue: “The HPCSA does not regulate how its registered practitioners dress or their lifestyle. We only regulate their work-related code of conduct with the sole purpose of guiding the profession to protect the public.”
Dress codes and personal conduct
The quote above needs to be treated cautiously. It may give the impression that the HPCSA has no remit over the personal conduct of registered healthcare practitioners. This is not the case. In fact, the Supreme Court of Appeal (SCA) has held quite the contrary recently, in the matter of The Health Professions Council of South Africa and Others v Grieve. That matter involved a practitioner charged with unprofessional conduct emanating from allegations that he had persuaded his patients and former patients to invest in a financially distressed company of which he was a director. The practitioner objected to the disciplinary process, arguing that the charges fell outside the jurisdiction of the HPCSA because they did not relate to the health profession. The HPCSA eventually ended up appealing to the SCA which held that the definition of unprofessional conduct in the Health Professions Act is broad enough to support the HPCSA’s exercise of its supervisory functions over conduct that is not directly related to the rendering of health services. The SCA emphasised that the HPCSA is not only a medical malpractice watchdog but is also the primary guardian of morals of the health profession.
The HPCSA thus has the power to hold registered practitioners to account even for conduct that is not work related.
So, while the HPCSA does not have specific rules pertaining to dress codes, complaints about a practitioner’s attire could be brought against a practitioner and will necessitate investigation and ruling on by the council.
And such complaints do in fact arise and are dealt with by the council under their jurisdiction. I reported on one such case last year. In that case, the complaint was that a psychologist was dressed in torn, worn out and loose jeans and a sleeveless vest, had visible tattoos, a chain around his neck, and the physical appearance of a motorcyclist. The complainant said she thought that the psychologist was a patient instead of a practitioner and all of this, she said, was unprofessional. After asking the psychologist to submit some photos of himself and his practice (the latter of which also failed to meet the aesthetic standards of the complainant), the HPCSA accepted the psychologist’s explanation and found no evidence of unprofessional conduct. The complaint was dismissed.
While the outcome was lauded as being progressive for ostensibly not conflating and equating physical attire with professionalism or non-professionalism, the fact remains that the HPCSA is required to investigate complaints against practitioners regarding their appearance, and make findings on a case by case basis. It is not inconceivable that a complaint about one’s attire could be held as unprofessional; to use an outrageous hypothetical example, if a complaint is that a practitioner was treating patients whilst dressed in nothing but their underwear, it would be no surprise if the council upheld such a complaint if the facts supported it.
Going viral for other reasons
Apart from dress sense, other forms of personal conduct may be subjected to the scrutiny of the HPCSA (that is, conduct which is not work or patient related, or not pertaining to one’s scope of clinical practice). For example, we have seen tweets regarding nutrition landing practitioners in hot water and resulting in them spending years enduring the formal inquiry processes at the HPCSA. More recently, it was also reported that the HPCSA had sanctioned the MEC for Health in Limpopo, Dr Phophi Ramathuba, for unprofessional behaviour after a video of her shouting at a patient in a hospital went viral online. There are many other examples.
As the HPCSA correctly says in its ethical guidelines on social media (booklet 16), practitioners need to maintain high professional and ethical standards in using social media, irrespective of whether the content is accessible to the public at large or locked behind a private account or page. Health professionals need to be aware that there are potential risks involved in the sharing of information via social media, even if the consequences are unintended. So, as mentioned by the HPCSA, while health practitioners may find social media beneficial as it allows them to keep updated on the latest developments in healthcare, build a professional support network and share health-related information with the public and other health practitioners, they must remember that social media can also destroy their professional reputation and impact on the reputation of the profession.
As we have written previously, the HPCSA complaint process can be a long, costly, and trying one for a practitioner. This, coupled with the above, highlights the importance of professional indemnity. While the HPCSA has powers to sanction practitioners for conduct on social media that is not strictly work related, some indemnifiers may not assist practitioners if complaints are about matters relating to their personal conduct or conduct which is outside the scope of their clinical practice. It is therefore very important for practitioners to understand their individual indemnity.
Medical Protection and Dental Protection members can request assistance with HPCSA complaints that relate either to professional or personal conduct.