The saying goes "what happens on tour stays on tour", but when posting online bear in mind that what happens on Twitter stays on Google forever. Doctors should exercise caution when making entries on social networking sites – the internet is not a private space and nothing is truly anonymous, even if you use a pseudonym.
Recently, a hospital doctor's tweeting sparked a national debate about what was appropriate for a medical professional to say on a social networking site. The trouble lies in that you never really know who is reading what you write; you could have a friend-of-a-friend reading your Facebook status, who might happen to be a patient or a disapproving member of the public.
In hot water
MPS is aware of cases where junior doctors have discussed patients on social networking sites, assuming that they would not be identified – but they were exposed and those involved were disciplined.
Similar findings were released by the American Medical Association, who undertook research that uncovered online breaches of patient confidentiality on social networking sites by junior doctors. The research found explicit postings that revealed private patient information; most were in blogs, including Facebook, some containing enough clinical information that a patient could be identified.
Posting material online
Social networking sites blur the boundary between an individual's public and professional life. Be wary of posting inappropriate material on social media sites, such as photos that may bring your professionalism or that of colleagues into question, even if they are taken in your free time.
If you do choose to post photographs, then you should be careful about both their content and your privacy settings – remember what happened to the doctors and nurses who took part in the Lying Down Game while at work and posted about it online?
However, tight privacy settings can create a false sense of security. Comments about your day-to-day work and the patients you have seen, even if anonymous, still pose a risk, as the information may be identifiable and so may breach confidentiality.
Ways to protect yourself when using social media:
Remember to log out when you are moving from one terminal to another.
- Check what levels of privacy you have set up.
- Enable secure browsing using https. This can be found under the account settings tabs of most social networking sites.
- Choose a password with a mixture of upper and lower case letters and other characters, and change it as regularly as is practical.
The appetite for social networking can only get bigger, so doctors should take advantage of its many benefits, as long as they are balanced against the risks.
Frequently asked questions
Q. I work as a junior doctor in urology in a large teaching hospital; I've been thinking of setting up a blog. What advice would you give?
A. Our advice would be to tread cautiously and to consider all the following pitfalls: breach of patient confidentiality; defamation; breach of contract (your trust or board may not be happy with what you have to say). It would be sensible to obtain the permission of trust/board management and your educational supervisor before taking the matter forward. Ensure you adhere to relevant GMC guidance, see Good Medical Practice.
Q. A former patient whom I saw when I was a medical student has approached me on Facebook - they want to add me as a friend. What should I do?
A. Don't accept. Social network sites are called so for a reason. It is extremely important that you retain professional boundaries between yourself, your patients and former patients. The GMC says that doctors who comment in the public domain about their work or the provision of healthcare must respect patient confidentiality. Should you post about a patient and they identify themselves, you could face a charge of breaching patient confidentiality and, before you know it, a GMC investigation into your fitness to practise.
Responding to negative comments
Q. A patient has written negative comments about me on a social networking site; what should I do?
It is often too easy to give a knee-jerk reaction. Although a negative comment may be upsetting, and seen as damaging to your professionalism, or even possibly defamatory, it is important to keep a cool head and look at the issues objectively.
Initially, talk to senior trusted colleague or your medical defence organisation to discuss the situation and the best way forward. Think about what the patient has said and whether this is an indicator of an underlying concern that needs to be investigated further. You may wish to consider treating this as a complaints, and invite the individual to discuss their concerns. By following this advice, the matter can be investigated, an explanation provided, lessons learned and if appropriate an apology provided.
Things to remember:
- Do not accept current or former patients as friends/followers.
- Doctors and medical students who post online have an ethical obligation to declare any conflicts of interest.
- The ethical and legal duty to protect confidentiality applies equally on the internet as to other media.
- It is inappropriate to post informal, personal or derogatory comments about patients or colleagues on public internet forums.
- Ensure that you do not inadvertently breach your contract of employment, by being aware of your local commissioning body or health board's policy on blogging, etc.
- Defamation law can apply to any comments posted on the web made in either a personal or professional capacity.
- Have tight privacy settings, but be aware that not all information can be protected on the web.
- Be conscious of your online image when posting images on the web and consider how it may impact on your professional standing.