Whenever I mention working to support 'cyber-victims' to GP colleagues I see question marks on their faces - what is this? Why would it be a concern to doctors?
Discrimination against people with chronic conditions and disabilities is a documented phenomenon, taking the form of harassment, bullying, stalking or even hate crimes. With advancements in technology these experiences were taken to new levels, complicated by the anonymity of harassers and continuous trauma via social media, blogs, forums or mobile phones.
Despite the number of legal acts to counteract these offences in the UK the impact is still ongoing. Cyber victimisation has devastating consequences upon victims, it results in somatic health complaints, mental health complications such as PTSD and depression, unemployment, social isolation, or suicidal thoughts.
All of these consequences could present to primary care during consultations, taking time in differential diagnosis without understanding the underlying cause. In fact, victims of cyber abuse are often seen in primary care.
GPs have proven to be more capable in recognising abnormal behaviour compared to police and hence have a crucial role in identifying victims. In the UK, research carried by the National Centre for Cyberstalking Research (NCCR) showed that among 274 cyberharrasment victims 38.5% contacted their doctors.
But there remains work to be done to ensure primary care can offer these patients the help they need. A number of participants expressed concerns that doctors made things worse or did not provide enough support. Some victims mentioned that they had to change GP to be 'taken seriously' or to get someone to understand their suffering, while other participants highlighted trust issues.
As a primary care doctor myself I understand the pressure GPs face every day, the busy schedule, communication issues and the vagueness of cyberharrasment impact and presentation in primary care, with a complex system of support.
Helping patients to manage their chronic conditions is part of our role as doctors, but it looks like this support now needs to acknowledge the virtual, online world our patients are connected to. In order to address this issue in the UK we started a new research programme based at the NCCR, in which we listen to patients/victims, GPs and police.
The research is ongoing and aims to address the impact of cyber victimisation on people living with chronic conditions and disabilities in the UK. Results so far indicate a disturbing impact on victims’ wellbeing and management of their conditions such as diabetes, COPD, ME, mental health and other conditions. Some victims were targeted in online health forums where they went based on advice from their GP.
While these patients are attending GP appointments to improve their self-management such experiences are disrupting their management. Patients/victims so far have rated GP support or understanding of the problem fairly low. But to appreciate the whole picture, input from GPs is highly needed - we want to recognise GPs' perspective from their experiences and medical point of view.
- Dr Zhraa Alhaboby is a primary care doctor who has specialised in community medicine and a researcher at the National Centre for Cyberstalking Research (NCCR) and the and the Institute for Health Research, University of Bedfordshire.