Dr Yash Naidoo, case manager at Medical Protection, explains the risks of inappropriate attire, the unintended consequences of social media trends – and HPCSA responsibilities.
Naidoo writes:
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 (a feature on Twitter that shows the most popular topics or hashtags being discussed at that time).
What was unusual was that the acronym “HPCSA” was trending. It isn’t often our professional regulatory body gets widely discussed by the broader public, let alone rises to prominence on the trends page.
It didn’t take long to find out the reason for the trend, which was widely featured in prominent online news platforms, including MedicalBrief, the following week. It related to a KwaZulu-Natal doctor who had been trending online for his videos on social media platform TikTok. Those videos 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 his 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, presumably unintentionally.
The matter received so much publicity that the HPCSA’s spokesperson was reported to have said the following: “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 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. This involved a practitioner charged with unprofessional conduct after allegations that he had persuaded 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 not directly related to the rendering of health services.
The SCA emphasised that the HPCSA is not only a medical malpractice watchdog but also the primary guardian of morals of the profession.
The HPCSA thus has the power to hold registered practitioners to account even for conduct 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 he 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 attire could be held as unprofessional; to use an outrageous hypothetical example, if a complaint is that a practitioner treated patients while dressed in only 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 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 Limpopo’s Health MEC Dr Phophi Ramathuba for unprofessional behaviour after a video of her shouting at a patient 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 must be aware of the potential risks involved in the sharing of information via social media, even if the consequences are unintended. So, while health practitioners may find social media beneficial as it allows them to keep updated on the latest developments, build a professional support network and share health-related information with the public and colleagues, they must remember social media can also destroy their professional reputation and have an impact on the profession’s reputation.
As we have written previously, the HPCSA complaint process can be a long, costly, and trying one. 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 relate to their personal conduct or conduct 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 relating either to professional or personal conduct.
MedicalProtection case report – Professionalism is not a dress code (Open access)
See more from MedicalBrief archives:
Social media complaints and how to deal with them
‘Pantsula’ doctor creates social media stir