We’ve compiled some essential advice about protecting yourself online as a medical student or new doctor.

There is no doubt that social media is here to stay, and it is used by many doctors worldwide. A recent survey by Medical Protection found 36% of respondents use Facebook and 21% use Twitter daily. The use of social media is especially commonplace among younger doctors, where it is now the norm.

Health professionals are using social media tools in a variety of innovative and creative ways – to build and improve social and professional networks and relationships, to share health-related information and to engage with the public, patients and colleagues in shaping future health policies and priorities. Closed online groups are also commonly used for education and peer support. However, it comes with risk – and whether you are using social media to promote healthcare or to just connect with friends it is important to know how to keep your professional life safe.

What should I consider before using social media for information sharing or healthcare promotion?

Here are some top tips for staying safe and reducing your risks online:

•  Be aware that expectations around doctors’ professionalism – for example maintaining boundaries with patients, safeguarding confidentiality and showing respect for colleagues - are the same when using social media.

•  If you are using social media in your professional capacity be clear about your role, title and name. •  Remember you are being watched and you are representing your profession, therefore you should behave in a way that does not bring the profession into disrepute.

•  It is fine to contribute your expertise, insights and experience but avoid giving definitive advice. •  Make sure you check the facts before posting and wherever possible quote your sources.

•  When interacting with or commenting about individuals or organisations online, you should be aware that postings online are subject to the same laws of copyright and defamation as written or verbal communications, whether they are made in a personal or professional capacity.

•  Be honest about any conflicts of interest or financial dealings.

Should I accept a friend request from a patient?

For doctors, there is the additional risk of patients contacting you through social networking sites. In addition to allowing patients access to your personal details, these sites are generally inappropriate for medical discussions. It is important to retain professional boundaries and while you may not want to offend a patient by declining a friend request, it would be prudent to be very careful when considering these situations and to politely decline.

What sort of content could get me into trouble?

Beware of jokes or activities that can seem like harmless fun online; they could backfire in reality. In 2009, seven doctors and nurses were suspended from duty at a hospital in the UK after taking part in the Facebook craze – the Lying Down Game.

The staff on the night shift took turns to photograph themselves on ward floors, resuscitation trolleys and on the building’s helipad. The pictures featured on a Facebook page.

Their employers were concerned that those involved had breached health and safety and infection control regulations, so they were suspended and faced disciplinary action. Of course, media interest also had a negative effect on the reputation of the hospital and the professionals involved.

Can I discuss a patient’s care with a colleague via private messaging such as WhatsApp?

You can, provided that the necessary consent has been obtained from the patient, but as no platform is 100% secure, we suggest you avoid sharing any patient identifiable information (such as name, address, etc.). Remember to also keep all conversations professional and respectful, as it could become public should it ever be requested by, for example, a South African Police Services officer investigating an unnatural death.

Can I be criticised for comments on social media made outside my work context?

The short answer is yes. There is always going to be a balance between freedom of speech and your rights to have an opinion as a member of the public, and the public’s expectation of how a doctor should behave. After a bad day at work, or during times of stormy medical politics, doctors have taken to voicing their frustrations online. Even though we are posting as ourselves the public are likely to solely see us as doctors.

Medical Protection has seen cases involving members who have experienced disciplinary, regulatory and complaint issues that have all stemmed from personal online activity. If anything, our use of social media for our personal lives is riskier than using it in our professional lives, as we tend to let our guard down or lose our social filters. In an article published by John Suler in Cyberpsychology and Behaviour (July 2004) this was called the “online disinhibition effect”.

Before posting online, consider the following safety checklist:

• Would I say this out loud to a group of patients/peers (or my grandmother)?

• Am I about to make an offensive comment about another person or colleague?

• Am I about to make a comment that could be perceived as prejudiced against a person’s race, sexuality, gender, religion or other protected characteristic?

• Would what I am about to say damage the reputation of the medical profession?

Is it safe to share my opinions via private messages?

Not necessarily. One doctor was recently caught out because of inappropriate/sexualised comments made about patients during a private message conversation. The comments came to light as the other person in the conversation was being investigated by the police, who had gained access to their online activity as part of their investigations. The police were concerned enough to refer the doctor to the healthcare regulator which subsequently opened a fitness to practise case. The case was closed with a warning.

Social media has a place in modern medicine and can be an effective way of supporting and educating patients and ourselves. While we are entitled to our opinions it is important to remain professional in any public communication and social media in particular can be a risky platform for doctors; our private lives may not be as private as we would wish.   

Case study: Befriending a patient

Mark, a fourth-year medical student, was working one Friday night in the Emergency Department when a young female patient was brought in by two of her friends, having had a fit in a local bar. Mark took a history from the patient and realised that she was a student at the same university.

Mark visited her the following day on the medical ward to follow up on her medical management. They seemed to get on well, so Mark invited her to be a friend on Facebook.

After a while, the relationship soured, and the patient complained to the medical school about Mark’s conduct in contacting her and starting a relationship as a result of meeting her as a patient.

Learning points

As a student, professional boundaries may seem blurred. Students may feel that, since they are not the professional caring for a patient, the limits around personal relationships do not apply.

Medics should maintain professional boundaries with patients and their carers. The HPCSA Ethical guidelines for good practice in the health care professions states that practitioners should “avoid improper relationships with their patients and those who are accompanying the patient (for example sexual relationships or exploitative financial arrangements)”.

Think about how you might handle situations like the one above. If you have any concerns, discuss these with your supervisor.

For further guidance around the use of social media or to discuss any issues you might be facing, email us or call our student advice line on 0800 952 0442.