Social media forums provide opportunities for communicating with patients, colleagues and the public. They can be an effective outlet for promoting healthcare, but they can also present many challenges and risks for healthcare professionals. Therefore, it is imperative to ensure that when you use social media you maintain the professional standards expected in other forms of communication.
The Medical Council’s Guide to Professional Conduct and Ethics for Registered Medical Practitioners states – “You should always think about the possible impact on colleagues, patients or the public’s perception of the profession, before publishing comments on social media sites. You should treat patients and colleagues with respect and avoid abusive, unsustainable or malicious comments. You should make sure your comments are not defamatory or otherwise in breach of the law.”
Ensuring patient confidentiality
Patient confidentiality is a key issue – the very public nature of social media means doctors must take care to avoid unintentional disclosures. Although many online accounts provide privacy settings for users, there is still little control over the potential reach a seemingly innocent comment may have.
The Medical Council advises:
“Social media sites cannot guarantee confidentiality, whatever privacy settings are used. You must not publish information about, or images of, individual patients from which those patients might be identified on publicly available platforms. You should avoid discussing or commenting on your patients on social media platforms.
“Closed professional networks are a useful way to share experiences and case studies, set up expert or learning groups, and get advice or help. When using professional networks, as far as possible, you should not give information that would identify patients. You should also take reasonable steps to check that the network you are using has effective security settings and privacy policies, to minimise risk of information about patients becoming more widely available.”
The Irish Medical Organisation (IMO) also advises in their Position Paper on Social Media: “You should always be mindful that the content you generate on sites can reach a public domain regardless of your intention for the information to be public or private. If any content you post leads to the identification of the patient without their consent it may be considered to be a breach of confidentiality.”
Appropriate disclosures are not strictly limited to comments and messages –social media services such as Instagram, Snapchat and Pinterest focus on multimedia content, including photos and videos. Photos can also be potentially damaging, not just in terms of confidential details they may reveal but also in a wider professional sense. Taking pictures for personal use within a hospital or practice environment is not advised, and if you intend to take pictures for a professional purpose, or for a purpose external to your employers such as university studies or a charitable event, make sure you obtain proper consent from any patients or staff who are present as well as someone in a supervisory role.
The organisation you represent may also have their own policies on proper usage, which you must also be aware of.
For more information on confidentiality see the Medical Protection factsheet entitled Confidentiality – General Principles.
Right to Anonymity
The Medical Council stipulates that if you post clinical advice online, you should always identify yourself by name.
Patients, medical colleagues and the public may rely on information that you provide online. Therefore, the Medical Council advises that you must take all reasonable steps to ensure that any information or advice that you give is accurate and valid. Any information that is posted in relation to your practice or the services you offer should be factual and verifiable. You should not make unsustainable claims for the effectiveness of treatments or exploit patients’ vulnerability or lack of medical knowledge.
This position is also taken by the General Medical Council in the UK where it is advised that where doctors identify themselves as doctors in publicly accessible social media, they should also identify themselves by name because any written material by authors who represent themselves as doctors is likely to be taken on trust. This places an onus on doctors to be thoughtful in what they write.
Maintaining boundaries with patients
When discussing boundaries, the IMO warns that social media can “cross public and private domains, inextricably linking both professional and personal lives”. Their guidelines advise to “avoid adding/accepting your patients and their relatives into social networks”.
If a patient does contact you through your private online account it would be wise to inform them that you cannot mix professional and social relationships and where appropriate direct them to your professional profile. This is also advised by the Medical Council – “You should keep personal and professional use of social media separate and, as far as possible, avoid communicating with patients through personal social networking sites.”
Online reviews
As social media has become a part of daily life, leaving both positive and negative reviews have become commonplace. It is important to be cognisant to maintain patient confidentiality when responding to online reviews. Where the review is inaccurate or misleading, it may be possible to flag and request removal of the review within the social media platform. When reporting an online review, it may help you to provide reasons which focus primarily on the potential impacts of such a review on elderly or vulnerable patient populations, who, as a result of reading the review, may avoid seeking help despite requiring care, or for whom such a review may cause unnecessary distress or concern having attended the establishment previously. It is also appropriate to highlight the potential business implications, should such a misleading review be left on their website.
You should not include any patient information in any correspondence with any social media platforms.
Please note that, although the facility may be available to business owners to respond to reviews, it is generally not appropriate for you to respond to the review on the platform, for reasons of privacy, confidentiality and data protection.
Following initial flagging, request and appeal, should the social media platform decide not to remove the review, it may ultimately be best to ignore it, focussing instead on addressing the issues raised by the patient in the form of a complaint response.
Should you ultimately decide on publicly responding to the review, it is advisable to submit a very generic response not disclosing any patient information, more so focusing that you are taking the complaint seriously. This response must not reference the patient nor confirm that the patient is even a patient of the practice.
Conclusion
The full impact of social media will inevitably develop over the coming years. It is important that the way in which the public can become engaged and informed about health issues is not inhibited. However, the regulation of the profession’s use of new media opportunities may struggle to keep up with the pace of technological change and diverging social expectations of the profession.
Bearing these issues in mind, the IMO states - “The growth of social media and other technology that facilitates online interaction between individuals is a new and continuously developing environment that requires appropriate education and consideration to ensure a professional approach to its use.”
As always, please contact Medical Protection should you require further or specific advice.
Irish Medical Organisation (IMO), Position Paper on Social Media
MPS Factsheet, Confidentiality – General Principles
Medical Council - Guide to Professional Conduct & Ethics 8th Edition