Ask the expert – social media

Dr Emma Davies, medicolegal consultant at Medical Protection, answers some questions around the professional and personal use of social media and the potential pitfalls faced by those working in healthcare

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 on a daily basis. The use of social media is especially commonplace among younger doctors, where it is now the norm. In 2011 a cross-sectional survey in the Severn Deanery found 100% of medical students and Foundation Year doctors had Facebook accounts, compared with 30% of senior specialist grade doctors.

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 patient information or healthcare promotion?

The GMC advice on Doctors use of social media[1] is very helpful and the Royal College of General Practitioners has produced a social media highway code.[2] To summarise both sets of guidance the key points are:

• 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
• Maintain patient confidentiality at all times
• 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
• Remain polite and respectful to all
• 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

I have been invited to speak on social media to promote a healthy lifestyle for my local community – am I indemnified for this?

Medical Protection would be unlikely to assist with claims arising from any material published or broadcast by you, or on your behalf, or to which you have contributed. This is because it is not directly arising from your professional relationship with patients. In the unfortunate event you were the subject of a complaint to your regulator as a result of social media activity, you can approach Medical Protection for assistance in the usual way.

A patient has sent me a friend request on Facebook – what should I do?

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.

A patient has complained about the practice on Facebook – can I respond?

This is a common reason for our members to call our advice line. Complaints can be distressing enough and when they are made in such a public area it can be upsetting and frustrating, leaving you feeling like you have no way of defending your position. Our advice would be to contact the patient (offline) and inform them of the complaints policy and ask if they would like to outline their concerns so that you can offer a full response. We would strongly advise against the temptation to respond in the public arena.

A patient has made defamatory comments about the practice staff on social media – can we take legal action?

Defamation can be a difficult case to prove, as people are entitled to their own opinions. If a statement is made that is wholly factually incorrect and could cause reputational harm, then you may have a case. When comments are abusive or offensive you should contact the platform provider and ask them to remove the post. You could also contact the patient to discuss the matter with them. There are further ways of addressing unacceptable behaviour and there is a great document by NHS Protect that provides guidance on this.[3]

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

You can but as no platform is 100% secure we suggest you avoid sharing any patient identifiable information (such as name, NHS number, 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 coroner.

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 in July 2004, this was called the “online disinhibition effect”. Therefore, before posting 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 put the reputation of my profession at risk?

Ok, so if I save my opinions to my private messages can I be assured that this is medicolegally safe?

Not necessarily. One doctor was recently caught out and referred to the GMC 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 GMC who 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.