Tweeting into trouble
Sara Williams explores the pitfalls of social networking
From two White House gatecrashers who celebrated their victory on Facebook, to the American Dana Hanna, who interrupted his wedding to update his Twitter and Facebook accounts and declare that he was about to kiss the bride – last year, social networking sites made headlines for very bizarre reasons.
However, they also made headlines for more contentious ones: the US Marine Corps banned social media from its computer networks, Dutch lawmakers were told off for Tweeting in Parliament and the British High Court ordered its first injunction via Twitter to stop an anonymous Tweeter impersonating someone else.1
The crucial thing to remember when interacting with medical blogs and social networking sites is that anonymity is a myth
Social media is now a permanent fixture in most people’s lives. We should all be aware of the dangers, but none more so than doctors, whose comments could get them into a lot of trouble with their regulator or trust.
Last year, the Journal of the American Medical Association uncovered online breaches of patient confidentiality on social networking sites. The study found explicit postings from trainee doctors that revealed private patient information. Most were in blogs, including one on Facebook, containing enough clinical information that a patient could be identified.2
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.
“The crucial thing to remember when interacting with medical blogs and social networking sites, or when taking part in forum discussions, is that anonymity is a myth,” says MPS Medicolegal Adviser Dr Chris Godeseth. “You should write everything as if you are signing it with your name.”
Keep it confidential
We are constantly bombarded with warnings about disclosing our bank details online, but the same principles apply to patient information. You would not write your account number on a social networking site, nor would you discuss personal financial matters.
“Patients may mistakenly identify themselves in discussions even where they are not being discussed. This might lead to complaints and trust disciplinary procedures, even if confidentiality is not breached,” explains Dr Godeseth.
“New doctors should select strict privacy settings on social networking sites.”
Professional vs personal
The GMC has no specific guidance relating to social networking, but has reiterated the need for consistent professionalism. You are expected to behave professionally and not bring the profession into disrepute, whether that be on or offline.
Last year, seven doctors and nurses were suspended from duty at Great Western Hospital in Swindon after taking party in the Facebook craze – the Lying Down Game.3 The staff on night shift took turns to photograph themselves on ward floors, resuscitation trolleys and on the building’s helipad.
The pictures featured on a Facebook page called the Secret swindon emergency department.
It was deemed that those involved had breached health and safety and infection control regulations, so they were suspended and faced disciplinary action.
Recently NHS Greater Glasgow and Clyde suspended a nurse after it emerged she had uploaded pictures of patients having operations on to Facebook without their consent. Even though the patients were not identifiable, Margaret Watt, chair of Scotland Patients’ Association, said it was “totally unacceptable” and a breach of patients’ human rights.
In today’s accelerated society it can be difficult to keep what you do socially behind closed doors.
Everyone has mobile phones, most of which have cameras, with links to popular social networking sites. Compromising images can be uploaded anywhere at any time. This lack of controls has created a situation where what was once private, is increasingly becoming public.
“When social networking you have to bear in mind all your professional responsibilities, and write as if you’re going to be identified. Even inappropriate pictures on Facebook could be subject to criticism,” says Dr Godeseth. “Sites like Facebook, Twitter and Bebo might appear very secure, but your information may be accessed more widely than you realise.”
Tweeting while you work
Tweeting or Facebooking your friends with amusing stories about work may seem innocent at the time. But such anecdotes will often involve unusual symptoms or other sensitive information, or might involve potential or actual harm to patients. It is unsurprising that a patient learning that their experience was being shared online could suffer distress.
Another element of this is commenting on medications and clinical practice while working or after a shift. GMC guidance states that a doctor cannot raise unfounded fears about medication or treatments.4 This equally applies to online activities, such as blogs or forum discussions.
Last year, Sophos, an international security firm, conducted an experiment to see how freely Facebook users shared their information.5 Just under half of those surveyed blindly accepted fake friend requests created by the firm. This gave them access to dates of birth, email addresses, schools they attended, information on family and friends, and workplaces.
You should certainly avoid adding patients as 'friends’, or engaging with them in this way
The firm commented that ten years ago it would have taken a thief or con artist weeks to get access to this sort of detail, now many social networkers are handing over their life story on a plate. Dr Godeseth says: “For doctors, there is an additional risk of patients contacting you through social networking sites. In addition to allowing patients access to your personal details, these sites are generally inappropriate for medical discussions. You should certainly avoid adding patients as 'friends’, or engaging with them in this way.
“Doctors are expected to maintain public confidence in the profession. It is important that all doctors consider this when posting material online, and are mindful of who could be reading what they write.”
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. Don’t forget to ensure you adhere to GMC guidance, such as 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 has set down their advice in this area which is available via the website.
Whether a patient approaches you in person, by text or online, it is always best to maintain a clear boundary from the outset.