Ethical social networking

Social networking may have transformed your professional and personal life but your ethical responsibilities still apply online, as recent GMC guidance makes clear. Dr Wendy Pugh, MDU medico-legal adviser, outlines the professional dos and don'ts for the social media age.

DO respect patient confidentiality

You wouldn't share information about patients or those close to them where you might be overheard and the same principle applies in online communities. The GMC's guidance, Doctors' use of social media states that publicly accessible social media sites should never be used to discuss individual patients or their care. You should also be extremely cautious when using membership-only professional sites to seek advice in specific circumstances. Even if you are careful not to divulge too much information in a single post, there is a risk of identification if the details in multiple posts can be pieced together to form a clear picture of the patient.

DON'T blur professional boundaries

We are notified of between 10 and 30 cases each year where patients have made romantic advances, most commonly to GPs. Five years ago it was more common to receive a handwritten note but today doctors are more likely to be contacted on a social networking site.

A 'friend' request on Facebook, or other site, is outside the boundaries of your professional relationship and should not be encouraged, however impolite it might seem to ignore or decline the request. If a patient contacts you through your private profile, the GMC says "you should indicate that you cannot mix social and professional relationships and, where appropriate, direct them to your professional profile"1.

It's also important to check your privacy settings regularly but as the GMC points out "social media sites cannot guarantee confidentiality, whatever privacy settings are in place"2. With this in mind, consider how you would feel if a patient or colleague could see any personal details or images you share because once posted, these can be difficult to remove and may be distributed by other users. If you regularly 'check-in' or post images when out socialising or with your family, ask yourself if you really want others (who may include your patients) to know your whereabouts.

DO be open about conflicts of interest

When posting material, the GMC states that you "should be open about any conflict of interest and declare any financial or commercial interests in healthcare organisations or pharmaceutical and biomedical companies"3 and follow its guidance in Financial and commercial arrangements and conflicts of interest (2013)4.

DON'T make abusive or gratuitous comments about individuals online

Many people use social media to let off steam after a difficult day but you should avoid making it personal. The laws of defamation also apply to online posts and the GMC states: "You must not bully, harass or make gratuitous unsubstantiated or unsustainable comments about individuals online"5.

Even if you believe your words can't be taken seriously, others might have an entirely different view. It's far easier to accidentally give offence when you cannot pick up the visual cues from your audience and online arguments can quickly escalate.

DO identify yourself by name when posting as a doctor on publicly accessible social media

This is because the GMC considers that "any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely"6.

If you would not be comfortable making a comment in your professional career offline, do not use social media to do so anonymously. Be aware that apparently anonymous posts can usually be traced to the user's IP (internet protocol) address.

DO use appropriate channels to raise concerns rather than social media

Social media is unlikely to be an appropriate forum for discussing concerns about patient care. Instead, this should be done through local procedures in the first instance and then through the regulator if appropriate action is not taken. The GMC says concerns should only be made public if you have tried these options and still believe patients are at risk. It adds that you should not breach patient confidentiality and should seek advice before making a decision of this kind.

Case scenario

A newly-registered patient visited her GP after twisting her ankle while running a few days before. The GP mentioned in passing that he was also a keen runner and the patient asked him to recommend a couple of local running groups as she had just moved to the area. The consultation was otherwise uneventful and the patient left with a prescription for a non-steroidal anti-inflammatory gel.

A week or so later the GP received a friendship request from the patient on his Facebook account. He unthinkingly accepted the request but quickly regretted his decision after the patient posted flirtatious comments underneath several photos on his page. The GP tried to ignore this but a few weeks later the patient made another appointment, this time complaining of breathlessness. The GP found nothing amiss on examination and when he asked her about her symptoms she was evasive. The patient later messaged the GP, confessing the appointment was a ruse to see him and suggesting that they meet for a drink.

Our advice

When the GP contacted us, he was advised not to respond online and instead to write to the patient explaining that the relationship between them was purely professional. He also needed to 'unfriend' her in order to avoid further blurring the professional boundaries. The GP followed this advice, apologising to the patient if he had inadvertently given her the wrong impression.

Shortly afterwards the patient unfriended the GP and he later discovered she had registered with another practice.

This is a fictional case compiled from actual cases in the MDU files.

References

1 GMC, Doctors' use of social media (2013), paragraph 11.
2 GMC, Doctors' use of social media (2013), paragraph 8a
3 GMC, Doctors' use of social media (2013), paragraph 19. 
4 GMC, Financial and commercial arrangements and conflicts of interest (2013) 
5 GMC, Doctors' use of social media (2013), paragraph 15. 
6 GMC, Doctors' use of social media (2013), paragraph17. 

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This page was correct at publication on . 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.

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