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Dr Sam Walker is a doctor in training in the Accident and Emergency department of a hospital and he has been working since early morning. During his break, he is in the hospital coffee shop and he is using his smart-phone to access Twitter. He uses his Twitter account mainly for personal use, although he follows a number of healthcare organisations and other doctors. Recently, he has started to occasionally comment on health issues in the news and to re-tweet posts from other doctors.

A friend of his has tweeted a cartoon of a tired and hung-over female character in a business suit asleep at her desk with the text 'This is why you should never drink on a Sunday night #hatemondays'.

Sam enjoys the cartoon and retweets the message for his followers on Twitter from his account @dr_sam_walker and adds the text 'Exactly how I feel this morning!'

A few minutes later, Sam receives a phone call from his friend Chris.



That cartoon you posted on Twitter was hilarious, I've retweeted it too. But you could have told me you had the morning off today - you still owe me a game of squash remember?

Dr Walker


Sorry to disappoint you, but I'll have to beat you at squash another time, I'm at work at the moment and will be heading straight to bed when I finish.



Oh, well... are you sure that Tweet you posted is ok? It makes it sound like you were out drinking last night and you're hung-over at work.

Dr Walker


Of course it's OK - I just meant that I'm asleep on my feet - I've been on since 5am in A&E.

And don't worry, nobody's going to see that message apart from my Twitter followers like you, so it doesn't matter if they get the wrong end of the stick.



You're wrong about that mate. It's a public message, so anyone could search for it and see it ' even if they're not signed up to Twitter. And your account name and photo make it pretty easy to tell it's you.

I'd delete the message if I was you - you wouldn't want any patients seeing it. Let alone your bosses. Mind you, you'd have more time for squash if you get sacked...

What should the doctor do...?
(Select A, B, C or D)


Change his Twitter profile so that all his Tweets are protected from now on (ie they are only visible to approved followers and are not public)?


Delete the Twitter message and any other previous messages that may offend or worry people, then be more careful when posting messages in the future?


Close down his Twitter account and stop using social media all together?


Change his Twitter account name so he can tweet anonymously?

Dr Walker

See what the doctor did

Until the conversation with Chris, Sam 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.


You must make sure that your conduct justifies your patients' trust in you and the public's trust in the profession.
(Good Medical Practice paragraph 65)

When communicating publicly, including speaking to or writing in the media, you must maintain patient confidentiality. You should remember when using social media that communications intended for friends or family may become more widely available.
(Good Medical Practice paragraph 69)

The standards expected of doctors do not change because they are communicating through social media rather than face to face or through other traditional media. However, using social media creates new circumstances in which the established principles apply.
(Doctors' use of social media paragraph 5)

Using of social media has blurred the boundaries between public and private life and online information can be easily accessed, by others. You should be aware of the limitations of privacy online and you should regularly review the privacy settings for each of your social media profiles. This is for the following reasons.
a. Social media sites cannot guarantee confidentiality whatever privacy settings are in place.
b. Patients, your employer and potential employers, or any other organisation that you have a relationship with, may be able to access your personal information.
c. Information about your location may be embedded within photographs and other content and available for others to see.
d. Once information is published online it can be difficult to remove as other users may distribute it further or comment on it.
(Doctors' use of social media paragraph 8)

Using social media also creates risks, particularly where social and professional boundaries become unclear. You must follow the guidance in Maintaining a professional boundary between you and your patient.
(Doctors' use of social media paragraph 10)

You must not use publicly accessible social media to discuss individual patients or their care, with those patients or anyone else.
(Doctors' use of social media paragraph 14)

You must consider the potential risks involved in using social media and the impact that inappropriate use could have on your patients' trust in you and society's trust in the medical profession. Social media can blur the boundaries between a doctor's personal and professional lives and may change the nature of the relationship between a doctor and a patient. You must follow our guidance on the use of social media.
(Maintaining a professional boundary between you and your patient paragraph 14)