In WPR March 2018

With healthcare professionals experiencing rising rates of stress, social media forums can provide a useful outlet to discuss the pressures of the job – sharing ideas, voicing frustrations, and raising questions with colleagues. But do the perils of posting online eclipse the relief reaped from doing so? Dr Nicola Lennard and Dr Ellie Mein, Medico-Legal Advisers at the Medical Defence Union, discuss.

Many forums popular with healthcare professionals are ‘closed’ groups purporting to allow discussions in ‘members only’ areas. But are these forums entirely safe – and is there potential for the information posted there to leak to the wider world?

The General Medical Council (GMC) has produced guidance for healthcare professionals in which it outlines the general principles for them to consider when posting online (Doctors’ Use of Social Media, 2013).

The GMC emphasises the importance of patient confidentiality in paragraphs 13 and 14, explaining, ‘Although individual pieces of information may not breach confidentiality on their own, the sum of published information online could be enough to identify a patient or someone close to them. You must not use publicly-accessible social media to discuss individual patients or their care with those patients or anyone else.’

Despite the fact that closed forums may seem secure, it’s important to be mindful that some of these forums have hundreds or thousands of members. Some closed groups require doctors to provide their name and GMC number before they can join, but it’s not always possible to verify identities online and GMC numbers are readily available to all. This means that the forums may be accessible to people outside of the profession.

The GMC report, ‘The State of Medical Education and Practice in the UK 2016’ shows that nine per cent of complaints about doctors received in 2015 came from another doctor. What one doctor may find funny, another may not.

Comments can be taken out of context, or misunderstood, and it’s easy to inadvertently cause offence.

If you’re tempted to discuss an individual case, it helps to remember that doctors have friends and relatives too, who, from-time-to-time, will need to seek advice from their own doctor.

Another important consideration is the potential for someone within the group to take a screenshot of your post, and publish it in another forum.

Would you be happy for your post to be shared with a wider audience and possibly with no reference to the original context in which it was made?

There have been some high profile cases reported in the media where derogatory comments about colleagues or patients have led to doctors being reported to regulatory bodies by other social media users. Figures obtained by BMJ Careers found that social media sites, like Facebook and Twitter, contributed to at least 13 complaints about doctors made to the GMC in 2015 and 11 in 2014.

The MDU’s advice is that prior to posting, even in a closed group, consider what the purpose of the post is and who may read it. Could it potentially identify an individual and what could be the repercussions if the post was reproduced elsewhere? If you’re unsure, it may be best to alter your post, or not to post the content at all.

Case Study: Facing The Consequences

After work the GP posted in a closed Facebook group for doctors with the suggestion that they play ‘top trumps’ and shared his patient’s blood test result. Several other doctors then posted the highest level of the tumour marker they had come across.

A few days later the doctor got a private message from another GP in the group who had seen his post. She explained that her father had called her with the bad news that his tumour marker was raised and was audibly upset by this.

She also explained that when she had read the original GP’s post she realised that it was describing her father’s case. She was able to confirm her suspicions by doing an online search for the GP’s name which showed he worked at the practice where her father was registered.

She was angry that her father’s health and recent bad news had been used for humorous ‘banter’ online. She demanded a written apology and explanation to be sent to her father with the threat of a GMC referral if she remained dissatisfied.

The MDU member was given advice on how to approach this complaint, and after a written response, and a meeting with the patient and his daughter, no further action was taken. The daughter was able to explain to the GP in person how unprofessional and disrespectful she had found his post, particularly at a time when her family had received bad news. The GP appreciated this and sincerely regretted the distress his post had caused.

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