Social media can be a powerful and effective tool for healthcare professionals, but there are risks. In this article Dr Graham Howarth, Medical South Africa Lead at Medical Protection, looks at the new HPCSA guidelines on social media and advises on best practice.

The recent publication of the HPCSA’s Ethical Guidelines on Social Media is no surprise. The world has rapidly transformed into a highly technological place and the field of medicine has been affected by this revolution, mostly positively.

Social media can be used to help raise awareness of health issues. It encourages a collaborative approach to education as a means of engagement with patients and stakeholders, and it can be used for promotion or brand messaging. However, the risks of social media cannot be ignored, and the hazards to be wary of are highlighted in the guidance.

Respect confidentiality

Doctors are afforded a privileged position by their access to patients and information divulged in communication with them. To abuse this is to erode trust and confidence in the doctor–patient relationship. According to the HPCSA, disclosure of a patient’s information may only be in accordance with the patient’s consent or a court order. 

It is very important that doctors are always aware of this principle when using any social network, even if it is to communicate with colleagues. Medical Protection advises doctors to never publish any information about patients on social media unless they have explicit consent.

Posting inappropriate comments/photographs or describing a patient’s care on social media could damage your reputation, lead to disciplinary action and attract unwanted media attention. Even if you do not mention a patient’s name they may be identifiable from information written about them, especially if the case is reported in the local press.

Responding to comments by patients

While critical comments patients make online about the care you provided may be upsetting, potentially damaging to your reputation or even defamatory, avoid giving a knee-jerk reaction when responding. It is important to keep a cool head and look at the issues objectively. 

Consider treating the comment as a formal complaint. Using the appropriate formal complaint channels will allow you to explore and investigate patients’ concerns and provide an explanation and apology where appropriate. Doctor–patient confidentiality can prevent you from directly challenging negative feedback.

However, negative comments can be defused creatively with a positive response. For instance, if a patient comments “my appointment was late and my doctor seemed in a hurry to get me out the door”, you could reply by stating: “We are sorry that you are unhappy with the service on this occasion. As the only practice offering this service in the area, we pride ourselves on serving as many patients as possible.”

Should a user’s feedback reveal a genuine deficiency, use it as an opportunity to improve your practice. Invite the patient to discuss their concerns and provide a point of contact, and demonstrate that you have listened to their concerns and are addressing them – the patient may even reply with a positive comment online. 

Maintain boundaries

It may be flattering to receive online contact or a friend request from a patient with whom you have a good rapport but conversing with patients online is inadvisable. Relationships should be kept strictly professional and the doctor–patient boundary should not be blurred.

Be cautious about online contact with colleagues too, to maintain the distinction between your personal and professional lives.

Be secure

Maintain strict security settings and be vigilant with your standards.

Use the most secure privacy settings on social networking sites but remember this is not failsafe and not all information can be protected online. Identities can be traced so be careful you don’t inadvertently post comments about your work, patients or your hospital.

Declaring that you are a doctor adds weight and credibility to your views; however, with that privilege comes a responsibility not to undermine public confidence in the profession. If you are providing medical opinion and are happy for it to be professionally held to account, then you must identify yourself as a doctor.

A social network is not an appropriate place to raise a concern. Even ‘doctors only’ forums have risks as they may be accessed by members of the public or employers, and friends of friends may pass on information attributable to you.

Act professionally

As doctors, you are not only representing yourself but the hospital or practice you work in. You have a responsibility to act professionally at all times and not bring the profession into disrepute.

Consider who may be able to access photographs of you on your personal accounts and whether there is information you would not want your employer to see. Derogatory or flippant comments about patients can be damaging to the public perception of doctors and their trust in the profession.

If you are still unsure

If you are still unsure about how to tackle a tricky situation online, talk to your employer, supervisor or medical school, or contact your medical defence organisation to discuss the best way forward. Taking care to avoid these potential pitfalls will help you make the most of social media, which offers exciting new ways to communicate in the ever-changing world of medicine and has become an integral part of our lives.

Medical Protection previously held a webinar for members that talked through the HPCSA’s Ethical Guidelines on Social Media. A recording can be accessed through PRISM.