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How to ‘like’ social media and remain professional

Dr Laura Murphy looks at the potential pitfalls of practising medicine in the social media age and provides some top tips on keeping your professionalism intact, both on and offline

Have you ever Googled your own name? What came up? An old photo from your long since deactivated Bebo account? A photo of “that night,” an occasion infamous among friends and acquaintances for the levels of wine imbibed and the generally uncivilised way in which you conducted yourself?

With the ever-expanding use of social networking sites, the ease of access to information can be a wonderful but alarming thing. Facebook recently surpassed 900 million active users;1 among them many potential past and future patients. As students, we might not have associated our behaviour with something that could affect our future career; nowadays, it is something that should be given greater consideration.

With a few clicks of a mouse, what information could a patient or future employer access about you that you would not reveal during a consultation or interview? The information available is often not the most recent, but rather old photos, blog posts or tweets that are long since forgotten in your own memory, but forever immortalised thanks to the internet.

With a few clicks of a mouse, what information could a patient or future employer access about you that you would not reveal during a consultation or interview?

Maintaining patient confidentiality

A number of issues arise with the increased use of social networking; in particular, patient confidentiality and professionalism. The principle of confidentiality is central to trust between patients and doctors. The Irish Medical Council’s A Guide to Professional Conduct and Ethics states that: “Patients are entitled to expect that information about them will be held in confidence. You should not disclose confidential patient information to others except in certain limited circumstances outlined in paragraphs 26 to 30.” (24.1)

These circumstances include disclosures with the patient’s consent to relatives and carers, disclosures required by law, disclosure in the interest of the patient or other people, and disclosure in the public interest.

In Australia, the NSW Medical Board issued a general caution to medical practitioners when one patient complained after reading derogatory comments made by a doctor on Facebook3

The Guide also states that: “You should ensure as far as possible that confidential information in relation to patients is maintained securely and in compliance with data protection legislation.”2 (24.4)

In most hospitals and medical schools, doctors are required to sign a code of confidentiality pledging to maintain patient confidentiality. In one such document, all of the situations pertaining to confidentiality relate to discussion amongst colleagues, case presentation or research.

Although the inclusion of social networking as a form of discussion is presumed, perhaps this should be outlined more clearly. In Australia, the NSW Medical Board issued a general caution to medical practitioners when one patient complained after reading derogatory comments made by a doctor on Facebook.3

This issue is even more pertinent in a country with such a small population like Ireland. There are more than 2,500 GPs in Ireland4 for a population of nearly four and a half million people, working out at approximately 1,800 patients per GP. In rural areas, with close-knit communities, it is easy to imagine how one or two comments posted flippantly online could provide enough information to recognise the person in question, even if you think you have been responsible in anonymising information.

Whilst it may not be the patient concerned that sees it, it is equally dangerous for a friend, relative or neighbour to garner this information which would not normally be given freely over afternoon tea. Moreover, it is rarely everyday stories that would be the subject of a Facebook post or blog entry, but more likely the weird, wonderful or generally embarrassing stories which patients would and should expect to remain privileged information.

Friend request dilemma

A young patient I treated on the ward last week has sent me a friend request on Facebook. What should I do?

Social networking sites such as Facebook and Twitter are now part of most people’s everyday lives, but there can be professional dangers associated with their use.

You should behave as professionally online as you would offline. This means maintaining professional boundaries, which social networking can sometimes blur. You should not add patients as "friends".

In addition, you should maintain strict privacy settings on social networking sites, being careful you do not inadvertently post comments about your work, patients, or your hospital.

Remaining professional online

Professionalism is defined as a set of values, behaviours and relationships. This includes integrity, compassion, altruism, continuous improvement, excellence and working in partnership with members of the wider healthcare team.5 Analysing the list of complaints made to the Irish Medical Council in 2010, the number of submissions relating to a particular doctor’s conduct was almost double the number made due to inappropriate or inadequate treatment.6

Whilst it is perfectly acceptable to expect that doctors will engage with social networking sites, it is prudent to remember that not only friends and family will necessarily have access to what is posted online.

Unguarded comments about patients, your employer, or other staff members can lead to sanctions by your hospital board or the Medical Council.

Remember that not only friends and family will necessarily have access to what is posted online

Comments of a racist, sexist or bigoted nature, or posting inappropriate images or extreme views, are also likely to get a junior doctor into trouble. One particular aspect that can lead to seemingly unprofessional posts is the feeling of anonymity afforded to people by the internet. This can often lead to people posting things online they would never dream of saying in real life. For example, a Welsh student was recently jailed for 56 days over his comments when the Bolton footballer, Fabrice Muamba, suffered a cardiac arrest as members of the football world looked on in horror.

His callous comments were made after a significant alcohol binge and were regretted in the cold light of day. However, he has now suffered the consequences of undoubtedly thoughtless actions and been expelled from his university. Whilst this is an extreme example, it highlights the potential negative repercussions when reality and the internet collide.

As doctors and medical students, we are not only representing ourselves, the hospital we work in and the university we are affiliated with, but also the future of the profession. Doctors are afforded a privileged position by their access to patients and information divulged in communication with them. To abuse this is to erode trust and confidence in the doctor–patient relationship.

Although there is no specific guidance on social media, the general principles of confidentiality still apply, whether you are on or offline.

Dr Murphy is an orthopaedic intern at the Beaumont Hospital in Dublin.

References

  1. Goldman D, Facebook tops 900 million users, CNN Money [serial online] 2012 Apr 23, available here.
  2. Irish Medical Council, A Guide to Professional Conduct and Ethics for Registered Medical Practitioners (2009)
  3. Pow, H, Doctors caught revealing secret patient information in Facebook posts, The Sunday Telegraph [serial online] 2010 Sep 25, available here.
  4. General practitioners. Irish Health [Internet] 2012 May 10, available here.
  5. Royal College of Physicians, Doctors in society: medical professionalism in a changing world: Report of a Working Party of the RCP (2005)
  6. Irish Medical Council, Complaints Considered by the Preliminary Proceedings Committee in 2010 (2010) available here.
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