Instant messaging and social media posts – Nothing is private

Dr Gabrielle Pendlebury, Medico-Legal Consultant, and Ms Ceylan Simsek, Case Manager at Medical Protection,
advise how to minimise medico-legal risk in various online settings

Many doctors may not be aware that they could face scrutiny by the regulator should private messages be perceived as unprofessional, offensive or inappropriate by others.

The standards expected of doctors do not change just because they are communicating online. Doctors are advised to “treat their interactions online no differently than what they would do in the physical world, with the same considerations to professionalism”, according to the IMO’s position paper on social media (2013).

In the UK, the regulator closed 28 investigations on doctors’ use of social media between January 2015 and June 2017. Fourteen cases were closed without further action and a further four were closed with advice issued to the doctor. Of those which progressed further, three doctors received a warning, three were referred to their employers and two doctors had their registration suspended. In one case, a doctor agreed an undertaking about their future practice and, in another, the doctor was issued with a condition on their registration. Investigations involved the doctors’ use of Facebook, Twitter, and WhatsApp.

The Medical Council’s Guide to Professional Conduct and Ethics for Registered Medical Practitioners (the ‘Guide’) states doctors who use social media should still maintain the professional standards expected in other forms of communication.

The Guide adds: “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.”

The Medical Council further advises: “Social media sites cannot guarantee confidentiality, whatever privacy settings are used. 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. Further advice on maintaining confidentiality and using images of patients can be found at paragraph 34.”

The Council also acknowledges that closed professional networks online are a useful way to share experiences and case studies. It reminds doctors that they should be mindful not to give information that would dentify patients. They should also take reasonable steps to check that the network has effective security settings and privacy policies to minimise risk of information about patients becoming more widely available.

The IMO’s position paper states: “You should always be mindful that the content you generate on sites can reach a public domain regardless of your intention for the information to be public or private. If any content you post leads to the identification of the patient without their consent it may be considered to be a breach of confidentiality.”

Appropriate disclosures are not strictly limited to comments and messages – newer social media services, such as TikTok, focus on multimedia content. Photos and videos can be potentially damaging, not just in terms of confidential details they may reveal, but also in a wider professional sense. Taking pictures/videos for personal use within a hospital or practice environment is not advised, and if you intend to take pictures/videos for a professional purpose, make sure you obtain proper consent from any patients or staff who are present, as well as someone in a supervisory role.

The organisation you represent may also have their own policies on proper usage, which you must also be aware of.

Right to anonymity

The Medical Council stipulates that if you post clinical advice online, you should always identify yourself by name. Patients, medical colleagues, and the public may rely on information that you provide online. Therefore, the Medical Council advises that you must take all reasonable steps to ensure that any information or advice that you give is accurate and valid. Any information that is posted in relation to your practice or the services that 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.

Maintaining boundaries with patients

When discussing boundaries, the IMO warns that social media can “cross public and private domains, inextricably linking both professional and personal lives”. Its guidelines advise to “avoid adding/accepting your patients and their relatives into social networks”.

If a patient contacts you through your private online account it would be wise to inform them that you cannot mix professional and social relationships and, where appropriate, direct them to your professional profile. This is also advised by the Medical Council: “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.”

Damage to professional image

Being mindful of the above guidance regarding private messaging platforms will also mitigate against the risk associated with the posting of what could be considered unprofessional content on social media platforms – be it in private or public social media accounts. While the above advice is in relation to discussions about or with patients and colleagues, the same advice could be applied to any ‘private’ conversation that you have with your family or friend, which may pose a risk to your professional reputation. Quite simply, whatever you discuss in a ‘private’ chat will likely leave a digital footprint and may resurface again in the future.

Humour in the form of memes and comments on Twitter, for example, may also be easily misinterpreted and reflect unfavourably on individuals and their affiliated institutions. Postings convey information about the poster’s personality, values, and priorities, and the first impression generated by this content can be lasting.

Other missteps by doctors on public social media platforms have included posting photos taken during surgery, posing with weapons or alcohol, airing frustrations that have proved offensive or harmful to a colleague or department, and the use of discriminatory or sexualised language.

It is always worthwhile considering before you post or write something on both private and public social media platforms, as well as private messaging apps, how it may be perceived out of context or in the context of a practising medical professional. It may be helpful to assume that patients, relatives, colleagues, and even the regulator may read the posts and your ‘private’ conversations.

It is worth noting that the Medical Council’s Guide is due to be updated next year. It is possible that the guidance surrounding the use of social media and messaging platforms will be updated. Medical Protection would recommend careful review of the updated guide when it becomes available.

Safeguarding your reputation

1. Beware of the image you present online and manage
   this proactively
2. Recognise that the
   personal and professional
   cannot always be separated
3. Engage with the public,
   but be cautious of giving personal advice
4. Respect the privacy
   of all patients, especially
   the vulnerable
5. Show your human side, but maintain professional boundaries
6. Contribute your expertise, insights and experience
7. Treat others with consideration, politeness,
   and respect
8. Remember that other
   people may be watching you
9. Support your colleagues
   and intervene when necessary
10. Test out innovative
    ideas, learn from mistakes – and have fun

Royal College of General Practitioners ‘Social Media Highway Code’ (2013)

For further advice, please contact Medical
Protection or your medical defence organisation.