Surviving Medical School: Social media

11 February 2021

We’ve compiled some essential advice about protecting yourself online as a medical student or new doctor. The article looks at social media guidance from the Irish Medical Council (IMC), answers some frequently asked questions, and considers learnings from real-life case studies. 

There is no doubt that social media is here to stay and it is used by many doctors worldwide. A recent survey by Medical Protection found 36% of respondents use Facebook and 21% use Twitter daily. The use of social media is especially commonplace among younger doctors, where it is now the norm.  

Health professionals are using social media tools in a variety of innovative and creative ways – to build and improve social and professional networks and relationships, to share health-related information and to engage with the public, patients and colleagues in shaping future health policies and priorities. Closed online groups are also commonly used for education and peer support. However, it comes with risk – and whether you are using social media to promote healthcare or to just connect with friends it is important to know how to keep your professional life safe.  

What should I consider before using social media for information sharing or healthcare promotion?

The IMC’s Guide to Professional Conduct and Ethics provides guidance for doctors on the safe and professional use of social media.  

The key points can be summarised as follows:

• You should maintain the professional standards expected in other forms of communication.

• You should always think about the possible impact on colleagues, patients or the public’s perception of the profession, before publishing comments on social media sites.

• You should treat patients and colleagues with respect and avoid abusive, unsustainable or malicious comments. 

• You should make sure your comments are not defamatory or otherwise in breach of the law. 

• You should keep personal and professional use of social media separate and, as far as possible, avoid communicating with patients through personal social networking sites. 

• You must not publish information about, or images of, individual patients from which those patients might be identified on publicly available platforms. 

• You should avoid discussing or commenting on your patients on social media platforms. 

• When using professional networks, as far as possible, you should not give information that would identify patients. 

• You should take reasonable steps to check that the network you are using has effective security settings and privacy policies, to minimise the risk of information about patients becoming more widely available. 

• If you give clinical advice online, you should always identify yourself by name. 

• You must take all reasonable steps to make sure that any information or advice you give is accurate and valid. Information about your practice or the services you offer should be factual and verifiable. 

• You should not make unsustainable claims for the effectiveness of treatments or exploit patients’ vulnerability or lack of medical knowledge. 

• To minimise the risk of information being shared more widely than you intend, you should usually use conservative privacy settings for your personal social media. Before posting, you should consider how information or images you post might be viewed by patients or the public, if they were to become more widely available. 

Should I accept a friend request from a patient? 

For doctors, there is the 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. It is important to retain professional boundaries and while you may not want to offend a patient by declining a friend request, it would be prudent to be very careful when considering these situations and to politely decline.  

What sort of content could get me into trouble? 

Beware of jokes or activities that can seem like harmless fun online; they could backfire in reality. In 2009, seven doctors and nurses were suspended from duty at a UK hospital after taking part in the Facebook craze – the Lying Down Game. 

The staff on the night shift took turns to photograph themselves on ward floors, resuscitation trolleys and on the building’s helipad. The pictures featured on a public Facebook page. 

Their employers were concerned that those involved had breached health and safety and infection control regulations, so they were suspended and faced disciplinary action. Of course, media interest also had a negative effect on the reputation of the hospital and the professionals involved. 

Can I discuss a patient’s care with a colleague via private messaging such as WhatsApp? 

You can, but as no platform is 100% secure, we suggest you avoid sharing any patient identifiable information (such as name, address, etc.). Remember to also keep all conversations professional and respectful, as it could become public should it ever be requested by, for example, a coroner.  

Can I be criticised for comments on social media made outside my work context? 

The short answer is yes. There is always going to be a balance between freedom of speech and your rights to have an opinion as a member of the public, and the public’s expectation of how a doctor should behave. After a bad day at work, or during times of stormy medical politics, doctors have taken to voicing their frustrations online. Even though we are posting as ourselves the public are likely to solely see us as doctors.  

Medical Protection has seen cases involving members who have experienced disciplinary, regulatory and complaint issues that have all stemmed from personal online activity. If anything, our use of social media for our personal lives is riskier than using it in our professional lives, as we tend to let our guard down or lose our social filters. In an article published by John Suler in Cyberpsychology and Behaviour (July 2004) this was called the “online disinhibition effect”.  

Before posting online, consider the following safety checklist: 

• Would I say this out loud to a group of patients/peers (or my grandmother)? 
• Am I about to make an offensive comment about another person or colleague? 

• Am I about to make a comment that could be perceived as prejudiced against a person’s race, sexuality, gender, religion or other protected characteristic? 

• Would what I am about to say damage the reputation of the medical profession? 

Is it safe to share my opinions via private messages? 

Not necessarily. One doctor was recently caught out and referred to the IMC because of inappropriate/sexualised comments made about patients during a private message conversation. The comments came to light as the other person in the conversation was being investigated by the police, who had gained access to their online activity as part of their investigations. The police were concerned enough to refer the doctor to the IMC who opened a fitness to practise case. The case was closed with a warning.  

Social media has a place in modern medicine and can be an effective way of supporting and educating patients and ourselves. While we are entitled to our opinions it is important to remain professional in any public communication and social media in particular can be a risky platform for doctors; our private lives may not be as private as we would wish.  

Case study: Befriending a patient 

Mark, a fourth-year medical student, chose to complete a student selected module in A&E. He was working one Friday night when a young female patient was brought in by two of her friends, having had a fit in a local pub. Mark took a history from the patient, and realised that she was a first-year geography student at the same university. 

Mark visited her the following day on the medical ward to follow up on her medical management. They seemed to get on well, so Mark invited her to be a friend on Facebook. 

After a while, the relationship soured, and the patient complained to the medical school about Mark’s conduct in contacting her and starting a relationship as a result of meeting her as a patient. Fitness to practise procedures were instigated. 

Learning points 

As a student, professional boundaries may seem blurred. Students may feel that, since they are not the professional caring for a patient, the limits around personal relationships do not apply.

However, the IMC is clear that while “social media provides new ways for doctors to communicate with patients, colleagues and the public… you should still maintain the professional standards expected in other forms of communication”.

Think about how you might handle situations like the one above. If you have any concerns, discuss these with your consultant or clinical supervisor. 

For more information or guidance around the use of social media or issues you might be facing, email us or call our student support and advice line: 1800 932 916