Debating or Disagreeing Online or in Your Workplace

The following documents are available on the Quality Assurance Page:

CDBC Standards of Practice 9 and 10, communication and collaboration standards. Specifically,

Standard 9: A Dietitian communicates in a clear, concise and respectful manner

1. Select communication styles to maximize clarity and facilitate understanding.

3. Communicate through active listening, clarification, questions and open responses.

7. Maintain personal and professional integrity when communicating via social media.

9. Use principles of facilitation, negotiation and conflict management as needed, showing respect for others’ viewpoints.

Standard 10: A Dietitian contributes to the provision of quality professional services as a member of the clients’ interprofessional team

1. Contribute professional knowledge to discussions and interactions with team members using an open, collaborative approach.

CDBC Code of Ethics. Specifically,

• Principle 1: A Registered Dietitian complies with law and policy at all times by… avoiding any situation that could be perceived as improper.
• Principle 2: A registered dietitian assumes responsibility and holds him/herself personally accountable for all actions taken in the delivery of dietetic services by…
  • refraining from acts which negatively affect the dignity of the profession.
  • avoiding any situation which could be perceived as irresponsible.
• Principle 3: A registered dietitian demonstrates professional competence by… managing change in professional practice in a cooperative manner.

CDBC Social Media Guidelines. Specifically,

3a) Maintain responsible and respectful relationships with other members of the health care team including physicians, hospital staff, volunteers, students, and all other individuals who contribute to health care delivery.

3b) Be mindful of social media presence and be proactive in removing content which may be viewed as unprofessional.

• Opinions and comments about clients, colleagues, employers, the CDBC and the profession, both of professional and personal social media pages, which would be considered damaging to their reputations.

3d) Be aware of laws related to defamation, copyright and plagiarism and take action to prevent any violations

As a healthcare professional, you may be seen in a position of power or knowledge, regardless of your personal scope of practice. (1, 2)

Your professional image and your public image can be intertwined online. This is especially important when considering CDBC Standard of Practice 9.7:

“Maintain personal and professional integrity when communicating via social media.” (3)

It’s important to consider that every interaction online needs professional judgement. CDBC Social Media Guidelines 3b):

“Be mindful of social media presence and be proactive in removing content which may be viewed as unprofessional. [This includes] opinions and comments about clients, colleagues, employers, the CDBC and the profession, both of professional and personal social media pages, which would be considered damaging to their reputations.” (4)

What you write or publish online has the potential to go “viral” and while this can be a positive outcome, it can also have negative consequences. Online publications often become permanent, even if you attempt to remove the post/comment/video. Your ability to make meaningful change to your digital footprint is limited. (5)

Questions to ask yourself, adapted from Government of BC Social Media Guidelines (6), with consideration from CDBC Conflict of Interest and Sales Policy (7), CDBC Professional Boundaries: Where’s the Line? (2), and CPSBC and FNHA’s Joint Statement (8).

• Can my public debate comments be seen as disreputable to my colleagues, my profession, my professional association, my workplace?
• Am I able to publicly debate the use of a policy while also having to comply with it? Does this discredit me?
• Can my debate on a certain topic be seen as impacting the already imbalanced therapeutic relationship with my clients?
• Are my personal views and professional views being interchanged? By me? By potential clients?
• Am I using employed time or resources to debate my personal views?
• Can any action above be perceived as occurring, even if it is not my intention?

1. BC Health Regulators. Statement on COVID-19 Misinformation. https://bchealthregulators.ca/bchr-statement-on-covid-19-misinformation/
2. Quality Assurance Page. Professional Boundaries: Where’s the Line? https://collegeofdietitiansofbc.org/registrants/quality-assurance-program/
3. Quality Assurance Page. Standards of Practice. https://collegeofdietitiansofbc.org/registrants/quality-assurance-program/
4. Quality Assurance Page. Social Media Guidelines. https://collegeofdietitiansofbc.org/registrants/quality-assurance-program/
5. Developing your digital presence. https://www.cmpa-acpm.ca/serve/docs/ela/goodpracticesguide/pages/professionalism/Social_media/developing_your_digital_presence-e.html
6. Government of BC. Social Media Toolkit for BC Public Service Employees. https://socialmediatoolkit.gov.bc.ca/
7. Quality Assurance Page. Conflict of Interest and Sales Policy. https://collegeofdietitiansofbc.org/registrants/quality-assurance-program/
8. CPSBC and FNHA Joint Statement on Misleading COVID-19 Information. https://www.cpsbc.ca/files/pdf/Joint-Statement-on-Misleading-COVID-19-Information-2021-05-06.pdf

Are you listening/reading? Respectfully? Practice this skill instead of considering what to say or write next. (1)

Consider your position in relation to others. Are you genuinely trying to understand the other person’s point of view? Have you requested other opinions/positions? Have you asked for clarity directly from the person with whom you are disagreeing? (1)

Is your debate directed against a position? If not, you may find yourself in an “ad hominem” argument, insulting or attacking the opposing person (for example, stereotyping, grammar correcting, intelligence attacking) rather than debating a position. Is your public statement defamatory, lowering another’s reputation, even subtly? You may also find yourself in a position of libel and thereby susceptible to legal consequence. From the CDBC Social Media Guidelines: “Be mindful of social media presence and be proactive in removing content which may be viewed as unprofessional. Opinions and comments about clients, colleagues, employers, the CDBC and the profession, both of professional and personal social media pages, which would be considered damaging to their reputations.” (2, 3, 4, 5)

Are you using evidence-informed arguments? (3)  

Is your tone and/or choice of words acceptable, or even conveyed? Consider that social media is a medium whereby tone and expression are left to be interpreted by the reader. Uphold cultural sensitivity, professionalism, and respectful interactions, and consider how your comments could be perceived. (4, 5, 6)

Have you asked questions to further your understanding? Have you explored other perspectives? Complex disagreements require genuine interest, respect, openness, and constructive questions to allow for meaningful conversations. Disagree constructively! (1)

1. UBC (2015) Respectful Dialogue and Debate: Principles and Practices. https://equity.ubc.ca/resources/respectful-dialogues/
2. Graham, P. (2008). How to disagree. http://www.paulgraham.com/disagree.html
3. Evidence Informed Practice Q&A. https://collegeofdietitiansofbc.org/you-asked-about-evidence-based-practice/
4. Quality Assurance Page. Social Media Guidelines. https://collegeofdietitiansofbc.org/registrants/quality-assurance-program/
5. Professional Guideline: Social Media. https://www.cpsbc.ca/files/pdf/PSG-Social-Media.pdf
6. Quality Assurance Page. Standards of Practice. https://collegeofdietitiansofbc.org/registrants/quality-assurance-program/

In this circumstance, there is disagreement not about a policy or publication, but about care for an individual with whom you have a therapeutic relationship.

Many of the same considerations, as above, exist. For example, you may find it pertinent to have a conversation with the MRP or NP about your concerns in satisfying CDBC Standard of Practice 14.10 “advocating on the client’s behalf.” (1). You may include other members of the healthcare team who are likely to be impacted by a plan of care, however, it is important to maintain professionalism and avoid direct, potentially insulting opinions, resulting in slander of a member of the healthcare team. It is often easier to facilitate respectful interactions when they are face-to-face interactions, while they can be more difficult in a social media setting.

Given that this debate or disagreement is specific to individual patient care, it is also important that all other aspects of care be included. Once elements of debate have been pursued and a course of care decided upon, it is important to ensure appropriate documentation, using professional and workplace specific language when recording a disagreement or deviation from your intended plan of care. Documentation should meet the CDBC Standards for Record Keeping and any workplace documentation policies and guidelines. (2)

1. Quality Assurance Page. Standards of Practice. https://collegeofdietitiansofbc.org/registrants/quality-assurance-program/
2. Quality Assurance Page. Standards for Record Keeping. https://collegeofdietitiansofbc.org/registrants/quality-assurance-program/

The following are some (non-exhaustive) examples of when to consider your role in a public online debate.

1. When you discover that the basis for disagreement is purely a personal one. Or you are asked to give your personal opinion on a professional matter.

 You should consider speaking in support of your employer, organization, or regulatory body and manage any personal disagreements privately and internally. (1)

2. Once a final decision has been made about a policy or guideline and it is implemented or passed, you may need to consider how strongly you publicly oppose a position. (1)

 You may be a dietitian whose job roles and responsibilities include use of, or comment on, the policy or guideline. You may be a dietitian whose practice isn’t affected by a policy or guideline, but you continue to have an informed opinion on it, or you may be a dietitian using your personal social media account to weigh in. Regardless, it is important to consider your perceived or actual position of authority in the therapeutic relationships you maintain and the potential impact on your clients’ health (page 3 of the CDBC document Professional Boundaries: Where’s the Line?) (2). This may mean limiting or concluding your online debate or continuing via a more appropriate channel and means outside of the public eyes.

3. If a debate escalates and is no longer a constructive disagreement, know your options for ending the conversation. Report/block/mute the person. (3)

1. Phillips, B. (2013). The Media Training Bible: 101 Things You Absolutely Positively Need to Know Before Your Next Interview. BookBaby.

2. Quality Assurance Page. Professional Boundaries: Where’s the Line? https://collegeofdietitiansofbc.org/registrants/quality-assurance-program/

3. Netsafe – Providing free online safety advice in New Zealand. How to respectfully disagree online. https://www.netsafe.org.nz/disagreeing-respectfully/#:~:text=Contact%20Netsafe