Private life and social media

This would not be in line with GMC guidance.

The details given about the patient - together with information about the students on placement - mean he could be identified. Students should make sure they never discuss patients on social media. Even if they don’t mention a patient by name, there’s a chance that someone might know who they are talking about. (AGMP paras 56-59).

The fact that this is a private group on Facebook does not make it a secure place for sharing confidential information. Especially as neither student is in charge of membership or administration of that group, as it has been set up by a third party.

The students might also want to consider whether joking about the patient, the negative tone used and speculation over the patient’s mental health is in keeping with professional practice. Would they want the patient, their school or supervisor to see this? Letting off steam after a difficult day should be done more privately.

This would be in line with GMC guidance.

Students and doctors must not use publicly accessible social media such as Facebook to discuss individual patients, but professional social media sites that are not accessible to the public can be useful places to find advice and exchange experiences. 

Even on private professional sites, students and doctors must be careful not to share identifiable information about patients. Although individual pieces of information may not breach confidentiality on their own, the sum of published information online could be enough to identify a patient or someone close to them. Students should never disclose patient identifiable information without a patient’s consent. Even if they don’t mention a patient by name, there’s a chance that someone might know who they are talking about. (AGMP paras 56-59).

Students must also ensure that their tone online is in keeping with professional practice and that their comments don't risk damaging public trust in the profession. The standards expected of students and doctors do not change because they are communicating through social media rather than face to face or through other traditional media.

This might be in line with GMC guidance.

But it would be an extreme reaction to the risks presented by social media to say that students and doctors can't use it for professional purposes at all.

We recognise the value that professional social media sites that are not publicly accessible can have for doctors in establishing professional networks and as useful places to find advice and exchange views about current practice in specific circumstances.

But students and doctors must still be careful not to share identifiable information about patients. Although individual pieces of information may not breach confidentiality on their own, the sum of published information online could be enough to identify a patient or someone close to them. 

Students must also ensure that their tone online is in keeping with professional practice and that they don’t behave in a derogatory manner. The standards expected of students and doctors do not change because they are communicating through social media rather than face to face or through other traditional media.

Michael, another member of the Facebook study group, saw the exchange between Sarah and Mohammed, and was alarmed by their conversation. He sent them both a private message on Facebook explaining that their exchange breached patient confidentiality and risked damaging public trust in the profession. He explained that they could not control the information they had already posted online - even though the group had private membership. He also explained that it was unacceptable use of social media for a medical student. He recommended that they end the conversation and try to have the conversation deleted from Facebook.

Sarah and Mohammed had thought their messages were private, but the message from Michael made them realise that the group wasn't quite as private and secure as they had thought.

They ended the conversation immediately and contacted the administrators of the Facebook group to ask them to delete the messages they had posted.

They agreed that they would no longer post messages that discussed patients directly or that might undermine public trust in the profession.

Michael also reported the incident to the medical school, who decided to start a fitness to practise investigation. Sarah and Mohammed each received a letter outlining the allegations against them, the relevant guidance, and a copy of the student fitness to practise processes at their school.

The medical school appointed an investigator who spoke with each of the students to get the facts of the case. They presented their findings to an investigation committee within the medical school. The school told Mohammed and Sarah about the student support services available to them and their personal tutors would be on hand to offer support where necessary.

The investigation committee felt that Sarah and Mohammed had failed to demonstrate good practice by misusing social media, however they had subsequently shown insight by asking the Facebook group administrator to take the relevant posts down, and had agreed not to post messages on social media that discussed patients.

The committee decided to issue a warning to both Sarah and Mohammed, and asked them to complete a piece of reflective writing about the experience.

This might be in line with GMC guidance.

There is an option on Twitter to make all your tweets protected so that only followers you have approved can see them, and retweets of your tweets are not permitted.

But although this may mitigate the risk a little it doesn't remove it entirely. Previous public messages (including the cartoon David's just retweeted) could still be visible and the messages could still make it into the public domain in the form of screenshots.

No social media site can guarantee confidentiality, regardless of the privacy settings you choose.

This would be in line with GMC guidance.

But deleting the tweet doesn't guarantee that people won't be able to find it and link it back to David. Once information is published online it can be difficult to remove as other users may distribute it further or comment on it.

Still, unless David has previously tweeted malicious comments about a colleague, or information that breaches patient confidentiality - then he shouldn't have anything to worry about. 

However, it makes sense for him to be more careful about his tweets in the future, and remember that social media is a public forum.

This would be in line with GMC guidance.

But it's a rather drastic response to the problem. Social media presents unique opportunities for doctors to build professional networks, keep up to date and supplement medical training. David wouldn't have to go this far to comply with GMC guidance.

Closing down the account would remove the risk of causing offence with tweets in the future. But there is no reason why David can't continue to use social media for personal and professional purposes, as long as he's careful that what he posts online doesn't breach patient confidentiality, or bully or harass colleagues. Doctors also have a duty to make sure that their conduct justifies their patients' trust and wider public trust in the profession.

They should make sure that their actions in social media are within the law - whether or not these are performed in a professional capacity.

This might not be in line with GMC guidance.

If David only ever uses his Twitter account for personal purposes, then tweeting anonymously wouldn't be a problem (provided he didn't undermine trust by, eg making malicious comments about colleagues or patients). The GMC has no interest in doctors' personal use of social media. But David should remember that tweets intended for his friends or family may become more widely available.

If David were to tweet about health or healthcare issues from a medical perspective - then it'd be good practice to identify himself.

Until the conversation with Sarah, David hadn't been aware that tweets he'd meant to be seen only by his friends might be easily accessible to the public. With hindsight, he saw how his innocent message might be misconstrued.

He still wanted to keep on using Twitter in his private life, so he decided to delete the message and resolved to take greater care with what he posted in future.

This would not be in line with GMC guidance.

It’s important that Mohammed be clear about the professional boundary between him and Charlotte, and not cross it by accepting her friend request.

Also, although Mohammed may be confident that he hasn't put anything inappropriate on his Facebook page, he can't control the actions of other people on his friends list and the material they may post on his page.

This would not be in line with GMC guidance.

Even providing patients with limited access to a private profile is not advised.

Social media sites cannot guarantee confidentiality whatever privacy settings are in place. Mohammed also cannot control the actions of other people on his friends list and the material they may post on his page.

This would be in line with GMC guidance.

It's important that doctors maintain a professional boundary between themselves and their patients, however minimal the professional contact may be. This professional boundary is important to maintain trust. If the boundary is breached, whether the breach is deliberate or accidental, this can undermine a patient's trust in their doctor, and society's trust in the medical profession more widely.

If Mohammed were to allow Charlotte to access his personal Facebook page, this would risk breaching the professional boundary between them and so undermine Charlotte's trust in Mohammed and perhaps even undermine her trust in all doctors.

Mohammed thought back to his encounter with the school’s investigation committee about him posting messages about his clinical placement experiences on Facebook. He was now hyperaware of how doctors should use social media.

Mohammed decided against accepting Charlotte's friend request because he wanted to maintain the professional boundary between them. 
He sensitively explained that, even if he was unlikely to treat Charlotte again, it wouldn't be appropriate for him to be Facebook friends with a patient.