What happens on tour stays on tour, but what happens on Twitter stays on Google forever. Practices should be cautious when posting on social media sites, says web editor Jack Kellett and MPS medicolegal adviser Dr Rachel Birch

Social media is here to stay; once dismissed as a digital fad, it has exploded, embodying a far broader representation of society.

There have been cases where social media has been used positively to promote healthcare, such as the much popularised story of Stephen Sutton’s battle with cancer. Although tragic, the updates and honest accounts from Stephen were incredibly heartwarming, and gave patients a real insight in to how healthcare is delivered to the terminally ill.

However, it would not have been appropriate for Stephen’s treating doctors to post on social media about Stephen without his consent, as it would have breached his confidentiality. This may seem obvious to experienced health professionals, but MPS receives regular calls about social media dilemmas from practice staff. A couple of scenarios include patients identifying themselves in nameless comments on social media and inappropriate comments made by practice staff.

In response to this wide tide of complaints, the GMC issued guidance around social media. Doctors’ use of social media (2013) can be applied to any social media network, with the underlying message that the standards expected of doctors do not change because they are communicating through social media rather than face to face.

Inappropriate comments

Social media sites blur the boundary between an individual’s public and professional life – many indecent posts that have landed healthcare professionals in trouble are the result of a perceived lack of understanding when it comes to the privacy settings on their accounts.

In 2012 a surgeon updated his Facebook status when he finished work. He wrote: “Back and causing chaos. Been on call this week. Been in theatre… slaughtering the innocent.” His comments were flagged to the wife of a patient who died while under his supervision. She was understandably distressed and made a complaint to the health board. The surgeon was disciplined and forced to issue a public apology to the family.

 

Consequences

An ill-advised post does not simply bring an your reputation into question; it subsequently impacts on the reputation of the health profession as a whole. Your CCG or health board will take an equally dim view of you posting less than flattering comments about patients – it’s safer to exercise caution. It is worth noting that defamation law can apply to any comments posted on the web made in a personal or professional capacity, so think before you tweet.

What next?

In the future we may see practices impose stricter policies on appropriate usage, but for now you should follow the GMC’s guidelines on how to use social media professionally and responsibly.

Another area for you to consider is the popularity of newer networks, such as Instagram and Vine that focus specifically on alternative forms of media like photos and video. This may cause further misunderstanding as to what is perceived to be a breach of confidentiality.

Case 1

Dr A, a GP Registrar, wrote on Facebook that she was in close proximity to people using drugs. She joked that she may have attended work whilst affected by such substances after her numerous nights out. Her comments were picked up by another member of the practice, who alerted the practice manager. The practice manager organised a meeting with her GP trainer and she faced internal disciplinary proceedings.

Advice

Dr A’s attitude and subsequent actions could have put patient safety at risk and brought the profession into disrepute. Her practice would have had no choice but to investigate her actions.

Case 2

Following the death of a patient, Nurse S engaged in a conversation with Dr B on his Facebook wall about what happened. The conversation was brought to the practice’s attention and both practitioners faced internal disciplinary proceedings.

Advice

Most social networking sites have limited privacy settings. Although Nurse S did not identify the patient by name, practice or treatment, the fact the patient could have identified themselves meant that Nurse S and his colleague had breached patient confidentiality.

It is important not to share identifiable information about patients, even when using professional blogging sites, which are not accessible to the wider public.

Case 3

While working as a receptionist, Mrs G wrote a blog about her experiences. Although all of her posts were anonymous and she made up a lot of her stories, her practice was unhappy with her comments as it identified key members of staff within the practice. She was called into a meeting with her practice manager and the matter was investigated.

Advice

Before setting up a blog tread cautiously and consider all the following pitfalls: breaching patient confidentiality; defamation; breach of contract – your practice may not be happy with what you have to say, as was the case with Mrs G. It would have been sensible for Mrs G to obtain the permission of the practice management before she created the blog.

GMC Chairman Professor Sir Peter Rubin on the GMC’s stance on social media

Since publication, there’s been lively debate on the particular piece of guidance that states if we’re identifying ourselves as doctors in online discussions about health issues, we should say who we are, just as we normally do when writing to the correspondence columns of newspapers.

I want to stress that this isn’t a requirement: no-one is going to get struck off for failing to reveal their identity. The GMC isn’t concerned with what doctors tweet about food, fashion or football, and we acknowledge that everyone has a right to remain anonymous in their private life, outside practice. But by its very nature – social media is anything but private.

Declaring we’re doctors adds weight and credibility to our views. With that privilege comes a responsibility not to undermine public confidence in the profession, whether we’re discussing waiting lists or transfer lists. The GMC isn’t out to curtail anyone’s freedom to express their opinion on medical issues; a large part of Good Medical Practice is about better engaging with colleagues and patients, and better reporting of problems – something we all need a timely reminder of in light of the Francis report.

But I would suggest that a social network is not the place to raise a concern. If doctors with concerns find it hard to speak up locally they can contact our confidential helpline (0161 923 6399). If we’re going to get the best for patients, particularly in financially constrained times, we need to embrace digital technology and use it to our advantage. Reading Good Medical Practice and using it to guide the professional judgments we make every day will help us do that.

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