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Are you social media savvy?

The advantages of using social media to share information with colleagues and patients are obvious; the pitfalls are less so, says MPS Head of Medical Services (Africa), Dr Graham Howarth

It’s an obvious but important point: if you are going to use social media, make sure that you use the most secure privacy settings on social networking sites. Though remember, privacy settings are not foolproof, and not all information can be protected on the internet. Identities can be traced, so be careful you don’t inadvertently post comments about your work, patients, or your practice.

Declaring that you are a medical professional adds weight and credibility to your views, but this privilege brings a responsibility not to undermine public confidence in the profession. If you are providing medical opinion and are happy for it to be professionally held to account, then you must identify yourself as a doctor.

A social network is not an appropriate place to raise a concern. Even ‘doctors only’ forums have risks as they may be accessed by members of the public, employers, or friends of friends may pass on information attributable to you.

Keep information confidential

Doctors have a privileged position owing to 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.

The National Health Act 2003 makes it an offence to disclose patients’ information without their consent and the HPCSA’s official guidance, Confidentiality: Protecting and Providing Information (2008) views confidentiality as central to the doctor–patient relationship. It states that: “Patients have a right to expect that information about them will be held in confidence by health care practitioners. Confidentiality is central to trust between practitioners and patients. Without assurances about confidentiality, patients may be reluctant to give practitioners the information they need in order to provide good care.”1

Your duty of confidentiality applies online as well as offline. Posting inappropriate comments or photographs or describing a patient’s care on a social media website could damage your reputation, leading to disciplinary action and unwanted media attention. Even if you do not mention a patient’s name they may be identifiable from information written about them, especially if the case is reported in the local press. 

Be professional at all times

As doctors, you are not only representing yourself and your practice but also the profession. You have a responsibility to act professionally at all times and not bring the profession into disrepute. Consider who may be able to access photographs of you on your personal accounts and whether there is information you would not want your employer to see. Derogatory or flippant comments about patients can be damaging to the public perception of doctors and their trust in the profession.

Keep boundaries

It may be flattering to receive online contact or a “friend” request from a patient with whom you have a good rapport, but conversing with patients online is inadvisable. Relationships should be kept strictly professional and the doctor–patient boundary should not be blurred. Be cautious about online contact with colleagues too, to maintain the distinction between your personal and professional lives.

Think before you type

Once you post a comment or photograph online you relinquish control of that information, so think carefully before hitting ‘send’ or ‘upload’. Although critical comments patients make about your care online may be upsetting, potentially damaging to your reputation, or even defamatory, avoid giving a knee-jerk reaction when responding. It is important to keep a cool head and look at the issues objectively. 

Consider treating the comment as a formal complaint. Using the appropriate formal complaint channels will allow you to explore and investigate patients’ concerns and provide an explanation and apology where appropriate. Doctor–patient confidentiality can prevent you from directly challenging negative feedback; however, such comments can be defused creatively with a positive response.

For instance, if a patient comments “my appointment was late and my doctor seemed in a hurry to get me out the door”, you could reply by stating: “We are sorry that you are unhappy with the service on this occasion. As the only practice offering this service in the area, we pride ourselves on serving as many patients as possible.”

Should a user’s feedback reveal a genuine deficiency, use it as an opportunity to improve your practice. Invite the patient to discuss their concerns and provide a point of contact, demonstrate that you have listened to their concerns and are addressing them – the patient may even reply with a positive comment online. 

If in doubt…

If you are still unsure about how to tackle a tricky situation online, talk to your employer or contact MPS to discuss the best way forward. Taking care to avoid these potential pitfalls will help you make the most of social media, which offers exciting new ways to communicate in the ever-changing world of medicine, and has become an integral part of our lives.

References

  1. HPCSA, Confidentiality: Protecting and Providing Information (2008), para 4.

Consultations via Skype

Skype is currently a popular method of conducting video calls, both for personal and business needs, but is it an effective way for patients to consult their doctors? A recent MPS case concerned a patient who relocated and asked his doctor to continue their consultations via Skype. 

The advantages of Skype consultations are, like telephone consultations, improved access, speed, convenience and cost – although, like telephone consultations, there are disadvantages. Warning signs about a patient’s condition that are missed through a lack of face-to-face interaction will leave a doctor vulnerable if an adverse outcome follows. 

The HPCSA has no specific guidance on Skype consultations but the general flavour of their guidelines on telephone consultations is applicable. A full clinical assessment is not possible by either telephone or Skype, despite the disadvantages being slightly reduced in the latter. The guidelines do not permit charging for conveying test results by telephone, nor a first assessment conducted by telephone – and the same applies to Skype.

In addition, the HPCSA does not condone the initiation of prescription medicine on the basis of anything other than physical examination of the patient. The HPCSA specifically prohibits the prescription of schedule V, VI or VII substances in the absence of a personal examination or report from another clinician, except in the case of repeat prescriptions for chronic conditions.

Any perceived shortcomings with Skype itself – or with equipment associated with the consultation, such as a webcam or laptop computer – will not be a defence in the event of an error in diagnosis or treatment occurring. The HPCSA states that a practitioner will remain personally responsible for their diagnosis, irrespective of what facilities were relied upon to provide aid in that regard. 

Ultimately, a first consultation should always be held in person, when a full examination and detailed history can be taken. Although subsequent consultations could possibly be carried out via Skype or telephone, MPS does not encourage it – particularly because subtle changes in a patient’s condition could be missed. Additionally, doctors will not be able to alter previous prescriptions or prescribe for new medication in the absence of a personal consultation.

4 comments
  • By Alice on 30 November 2016 10:25 Thanks for your post, Adele. There are currently no particular legal or ethical guidelines with regard to booking doctor appointments online. If you are a patient, we would recommend discussing any concerns with your doctor. If you are a doctor and have any specific concerns regarding the ethical or legal implications, please contact us for medicolegal advice. With best wishes, The Web Team
  • By Adele on 23 November 2016 09:38 Are there any guidelines with regard to giving medial information online with the intention to guide patients to book appointments online at a medical practice? 
  • By Alice on 16 November 2015 09:10

    Thanks for your comment, Dr Henderson. The HPCSA has no specific guidance on Skype consultations, but we have drawn our advice from the available guidance on telephone consultations. While there is an obvious difference between Skype and a regular telephone call, the core principles behind the guidance are applicable. 

    The relevant document is the HPCSA General Ethical Guidelines For Good Practice in Telemedicine Booklet No 17, developed by the Human Rights, Ethics and Professional Practice Committee. Unfortunately this does not appear to be available online and we have used a hard copy for reference. I hope this is helpful. Best wishes, The Web Team

  • By Bertram Henderson on 12 November 2015 06:33

    Good morning

    Can you please provide a reference to the information about skype consultations.  I quoted this at a meeting recently and am now being challenged to present the HPCSA rule.  The HPCSA website is not helping me to find it quickly.

    Thank you

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