With over 50 million users in the UK, it's not surprising that many doctors and medical students use social media in their personal lives. However, many are also using it for a professional presence online - for example, to advertise their services, to help disseminate specialist knowledge to the wider public, and to form professional networks with other clinicians.
We are increasingly getting queries about the potential pitfalls of being a medical influencer. In this guide, we'll consider some of the aspects you should consider before taking on this role.
The rise of medical influencers
Before considering the pros and cons, it's important to try to define what an influencer is - although this is easier said than done.
In broad terms, a social media influencer is someone with established credibility in a specific area, with access to a huge audience and the ability to influence others to act based on their recommendations. Many people will view the term 'influencers' as being an Instagram phenomenon, but they also use Facebook, TikTok and Youtube, among other platforms.
This definition covers pre-existing celebrities who can use their fame to influence other users on social media, but there are also plenty of influencers who have become famous purely because of their social media activities.
Some medics who use social media will be experienced health professionals and some will be less so. It's important to be clear about your credentials when posting online.
Some medical influencers will also develop opportunities to monetise their social media presence, and some will be sponsored for content.
Different medics use social media for different reasons. It may be to educate or encourage others into the profession. It may be to explore issues related to being a medical professional, such as one's own mental health. The reasons medics use social media are growing every day.
Wherever on this spectrum a doctor falls, many of the medico-legal issues connected to their social media use are universal.
The benefits of social media
While medics do sometimes face challenging circumstances when using social media for professional purposes, many also report the benefits to having medics with large audiences on social media. It can be an invaluable method of reaching patients and public with health education from those who have the appropriate knowledge to give it.
It can encourage people to engage with healthcare professionals when they otherwise wouldn't, raise awareness of public health campaigns, and actually enhance the image of the profession, as well as the public's trust in it - if done right.
Some medics have reported that using social media humanises doctors, as it gives their followers a chance to peek behind the curtain. They can observe some of the more mundane parts of being a health professional, in contrast to the presentations of doctors on TV or in film.
If social media was devoid of qualified health professionals, it would be an arena where health misinformation goes unchallenged by those best placed to do so.
GMC guidance on social media for doctors
The GMC has issued guidance for doctors about social media use and advises doctors:
- not to discuss individual patients or their care via publicly accessible social media
- not to bully, harass or make gratuitous, unsubstantiated or unsustainable comments about individuals online - whether about patients or colleagues
- that it is not appropriate to raise concerns about patient safety through social media
- if you identify yourself as a doctor, you should also identify yourself by name.
In 2013, the GMC made it clear that it is not trying to restrict doctors from expressing their opinions or views. The GMC said it has no interest in doctors' use of social media in their personal lives - tweets, blogs, social media forums' pages etc. But doctors mustn't undermine public trust in the profession.
The pitfalls of social media
Negative or unwanted attention
Some doctors still view the use of social media with a certain amount of distrust, especially as it can result in receiving negative comments from colleagues and the public.
Similarly, patients may be concerned about their doctor having a significant online presence for several reasons. For example, patients may feel that if you are committing significant time and effort to your social media presence, it reduces your focus on patient care. In the event of something going wrong, it is possible they would raise your social media activities as being a contributory factor to alleged poor care.
We have previously advised doctors on how to manage unwanted attention from patients. Having an online presence increases your exposure to patients, or complete strangers who may take an unhealthy interest in you. It can therefore increase potential problems of this kind. Being aware of this risk is useful to help manage any pitfalls before they arise.
Choosing your content wisely
In the GMC's Good medical practice (2013), paragraph 14 states that you must recognise and work within the limits of your competence. In keeping with this, you will need to be sure that when discussing medical issues, you are appropriately qualified in and knowledgeable about those areas.
The GMC also expects doctors to be able to substantiate and justify anything they write. It's important to take reasonable steps to make sure any information you are providing is correct and not leave out things that are relevant.
The GMC's guidance on doctors' use of social media is clear; even online, doctors' conduct should justify patients' trust in you and the public's trust in the profession. Therefore, in addition to considering your expertise when posting advice or opinions on medical matters, you will also need to consider if other content could erode trust in the profession or be viewed critically by your employer or the GMC.
An example of how a light-hearted post can backfire was seen when an American healthcare worker posted a video of her playing the roles of both a patient and a nurse. The patient is seeming to struggle to breathe but recovers when the nurse mocks her. It was captioned, "We know when y'all are faking."
The post sparked a backlash accompanied by the hashtag #PatientsAreNotFaking and many patients shared experiences of when their symptoms had been disregarded.
Interactions with others
It's not just your posts that matter, but also your comments and interactions with others on social media. The GMC's social media guidance states that a doctor's communication online should meet the same standards as would apply face-to-face.
While there may be occasions when you strongly disagree with the posts of another individual or organisation, it is important to remain measured and professional in any interactions.
The same principles of confidentiality apply whether you are communicating offline or online.
Social media should not be used to discuss individual patients, living or dead. Posting details of a clinical case, however heavily anonymised, without patient consent would constitute a breach of confidentiality - as would sharing a photograph of a patient's condition.
In discussing a case anonymously, it may be possible for someone to piece together details that identify the patient.
When you post personal comments on social media (say, about your working day), be aware of how your comments may be viewed by colleagues or patients, and whether you are revealing confidential information. Most breaches of confidentiality happen inadvertently.
Even if you plan to get consent from patients before posting about them, this approach has limitations.
- Seek informed consent: as with any consent it will need to be fully informed. Patients will need to know what information you intend to post about them, where it will be posted, for what purpose, and to what audience. There have been cases where patients have withdrawn their consent after a case report was published about them in a medical journal due to them being recognised from the information given about their circumstances.
- Recording consent: you will need to consider where you will record the discussion around consent given that the consent is not being obtained to assist in their clinical care or to go in a formal medical journal.
- Obtaining consent: consider when you will obtain consent; how will your employer feel about you taking time from your paid employment to undertake a process that is only for your benefit?
- Employer's rules: finally, even if you sought fully informed consent, you had an appropriate way of recording and storing it, and you did it on your own time, it may still be the case that your employer would take issue with you using patient information you had come by in the course of your employment for your own social media purposes.
Employers may have concerns about time taken during work hours to obtain consent from patients for social media purposes. But they may also take a dim view of other aspects of work-related social media activity.
Other aspects that employers could take exception to include:
- posts and comments being made at times when you are at work
- the hospital premises being used as settings for a photo shoot
- inappropriate use of hospital equipment as props
- infection control concerns (for example, are there areas where your personal smartphone should not be used?)
- the potential for complaints from patients or relatives who happen to be in the background of any photographs you post.
With all of these possible problems in mind, it would be prudent to check with your employer to see if they give permission for you to post work related content that might involve their resources.
Medical advice online
With an online presence as a doctor, there is the very real possibility that at some point you will be asked for specific medical advice by an individual.
Offering medical advice through the internet can be problematic when the doctor does not have access to the information they might normally have about the patient, such as the clinical records or a full medical history.
In addition to abiding by the requirements of the country they practice medicine in, doctors should ensure they practise within the laws and regulations applicable to the country where the patient is resident, and check that their indemnity covers such situations.
Consider the issues of giving advice to an individual who is resident in a country in which you are not registered with the medical regulator or indemnified to provide care.
Perhaps more importantly, advising individual patients about specific medical problems is likely to establish a duty of care and could allow a patient to pursue a clinical negligence claim or complaint, including to the GMC, if they were dissatisfied with any advice received.
Conflicts of interest
The GMC has published guidance on the subject of honesty in financial dealings and conflicts of interest. This includes various pieces of guidance in order to maintain trust in you and the profession and it is important that your interests do not affect, or are not seen to affect your professional judgment. "Conflicts of interest may arise in a range of situations. They are not confined to financial interests, and may also include other personal interests."
The GMC also advises that, "if you are in doubt about whether there is a conflict of interest, act as though there is."
The GMC's guidance on social media guidance ends with:
- 19. When you post material online, you should be open about any conflict of interest and declare any financial or commercial interests in healthcare organisations or pharmaceutical and biomedical companies.
There are strict rules in place to regulate social media promotions from the Advertising Standards Authority. Advertisements since 2018 must be clearly defined as such at the start of the post, commonly with the hashtag #AD, or similar. If you are being paid to promote a product by an organisation, it is best to be familiar with these standards to avoid falling foul of the rules and the reputational damage that can result for you and the organisation you are promoting.
In summary, not being transparent that advice is given in the context of a financial incentive can raise serious concerns about a doctor's probity. Even if a post does declare it is a paid for advert, it can still be problematic if the information is inaccurate or biased.
Last but not least, it is important to make sure you have appropriate indemnity in place for any work done in your capacity as a doctor. This is a GMC requirement (Good medical practice (2013), paragraph 63).
The MDU member guide includes information about when we are likely to help, and when we unlikely to provide support. Included in the latter category are "claims arising from material published or broadcast by you, or on your behalf, or to which you have contributed".
If you would like more information, please contact our membership department by emailing firstname.lastname@example.org or by phone on 0800 716 376 to ask about your indemnity in this context. You may need to consider exploring other options for indemnity for this sort of activity if you decide to go ahead with it.
This page was correct at publication on 09/07/2021. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.