Concerns about online interactions are a constant theme in calls to the MDU, with many members asking for help and advice about harnessing the benefits of social media to communicate with the public and colleagues - while also avoiding the pitfalls.

Thankfully, there's plenty of guidance available to doctors in the Republic of Ireland to help them avoid medico-legal mishaps.

Here are five of the most common social media hazards, and advice from us and other organisations on how to avoid them.

Inadvertent breaches of patient confidentiality

You wouldn't disclose patients' personal information in front of strangers in a hospital waiting room, and the same principle applies in online communities. It goes without saying that publicly accessible social media sites should never be used to discuss individual patients or their care, but you should also be extremely cautious when using membership-only professional sites to discuss cases.

The Medical Council says these can be a useful way to "share experiences and case studies, set up expert or learning groups, and get advice or help". However, it adds that "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 the risk of information about patients becoming more widely available." (Paragraph 20.5.)

When contributing to group discussions, even on seemingly private groups or apps, be very wary about posting pictures and/or clinical details to discussions. Once they have been uploaded to the group, you have no control over what happens to them or how they are disseminated or used.

Direct messaging with patients

Patients may expect - and want - to use social media platforms and associated private messaging facilities to communicate with you.

However, by indicating a willingness to communicate on personal platforms rather than through traditional channels, you may blur the boundaries of your professional relationship. And if you provide your personal contact details to a patient, there is a risk that your intentions might be misunderstood.

Although it may initially be convenient to communicate with patients via direct messaging, a simple conversation about appointment availability (for example) could develop into a clinical enquiry - or even escalate into a complaint.

Under the General Data Protection Regulation (GDPR), health information is classified as 'special category data' and can only be processed if certain conditions are met. Special category data requires extra protection, and it is not appropriate for direct messages to contain health information unless this is in place.

For these reasons, we generally advise members to avoid communicating with patients through personal social networking sites, in line with Medical Council guidance.

Defamation and banter

Social media doesn't lend itself to nuanced argument, so it's not a good idea to use it to let off steam about a patient or colleague. Try not to get into a war of words, even if you feel provoked. Remember that others might have an entirely different view and things can escalate quickly. There are examples of people being reported to their employer or regulator for their online behaviour, and you're likely to be held to higher standards as a doctor than the average member of the public.

The Medical Council warns: "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." (Paragraph 20.2)

Straying outside your expertise

Doctors can play a valuable role in spreading reliable health information and debunking some inaccurate theories online.

However, problems can arise if you comment on issues outside your area of expertise or if you respond to individual requests for advice without access to the information you might normally have about the patient, such as the clinical records or the laws and regulations that apply in their country.

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 against you. There is also a risk that your indemnity won't extend to this situation.

The Medical Council says "you must take all reasonable steps to make sure that any information or advice you give is accurate and valid." It adds that you "should not make unsustainable claims for the effectiveness of treatments or exploit patients' vulnerability or lack of medical knowledge." (Paragraph 20.7)

Conflicts of interest

Be extremely careful about endorsing products, especially if being paid to promote them as a social media influencer. This can give rise to a potential conflict of interest.

The Medical Council has specific ethical guidance on managing conflicts of interest, which says: "If you are involved in any way in promoting or endorsing specific healthcare products or services, you must declare any financial or commercial interest you have in the organisation or company providing the products or services." (Paragraph 62.7)

In addition, the Medical Council expects you to identify yourself by name if you give clinical advice online and ensure information about your practice or the services you offer should be factual and verifiable. (Paragraphs 20.6 - 20.7)

It's important to abide by the Advertising Standards Authority for Ireland (ASAI) Code. The ASAI guidance note on influencer marketing states: "Where celebrities are sponsored by brands or paid directly to promote a brand's products, it must be clear that their posts are marketing communications or others."

Social media in the Republic of Ireland: top tips for doctors

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