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Digital doctors


28 February 2012

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Dr Angelique Mastihi & Sara Williams
Medical Protection Society (MPS)

 
GPs must exercise extreme caution in making entries on social networking sites; the internet is not a private space and nothing is truly anonymous, even if you use a pseudonym. Recently, a hospital doctor’s tweeting sparked a national debate about what was appropriate for a medical professional to say on a social networking site.

Dr Angelique Mastihi & Sara Williams
Medical Protection Society (MPS)

 
GPs must exercise extreme caution in making entries on social networking sites; the internet is not a private space and nothing is truly anonymous, even if you use a pseudonym. Recently, a hospital doctor’s tweeting sparked a national debate about what was appropriate for a medical professional to say on a social networking site.

Dr Angelique Mastihi & Sara Williams
Medical Protection Society (MPS)

 
GPs must exercise extreme caution in making entries on social networking sites; the internet is not a private space and nothing is truly anonymous, even if you use a pseudonym. Recently, a hospital doctor’s tweeting sparked a national debate about what was appropriate for a medical professional to say on a social networking site.

The problem lies in that you never really know who is reading what you write; you could potentially have a friend-of-a-friend reading your Facebook status, who might happen to be a patient or a disapproving member of the public. A rapidly growing number of doctors have fallen foul of constraints to behave in a professional manner online. The charge extends to doctors who make disparaging remarks or identify patients on doctors-only websites.

The General Medical Council (GMC) is tackling the challenging issues around social media as part of its review of Good Medical Practice that is due out next year. Niall Dickson, Chief Executive of the GMC, said: “Doctors who comment in the public domain about their work or the provision of healthcare must respect patient confidentiality. Doctors should also be aware of appropriate professional boundaries if their patients make contact via social media.”

Posting material online
Social networking sites blur the boundary between an individual’s public and professional life. Be wary of posting inappropriate material on social media sites, such as photos that may bring your professionalism into question, even if they are taken in your free time.

In 2009, seven doctors and nurses were suspended from duty at Great Western Hospital in Swindon after taking part in the Facebook craze the ‘Lying Down Game’. The staff on night shift took turns to photograph themselves on ward floors, resuscitation trolleys and on the building’s helipad.

If you do choose to post photographs, then you should be careful about both their content and your privacy settings. However, tight privacy settings can create a false sense of security. Comments about your day-to-day work and the patients you have seen, even if anonymous, still pose a risk, as the information may be identifiable and so may breach confidentiality. 

Friend requests
The British Medical Association recommends that doctors should not accept Facebook friend requests from current or former patients. Should a GP post about a patient and they identify themselves, that GP could face a charge of breaching patient confidentiality and, before you know it, a GMC investigation into their fitness to practise.

Caution should also be exercised when accepting friend requests from practice colleagues. Consider the consequences of your new receptionist or practice manager viewing your profile and daily insights.

Defamation
Doctor’s social networking sites or blogs do exist, for example the Medical Registrar and Doctors.net.uk (the biggest forum). However, the freedom individuals have to voice their opinions on forums and blogs is not absolute and should be restricted by the need to prevent harm to the rights and reputations of others.

Defamation is the act of making an unjustified statement about a person or organisation that is considered to harm their reputation. Should you make a statement that is allegedly defamatory, it could result in legal action.

Responding to comments
If there is a critical comment about your practice on a social networking site, it is often too easy to give a knee-jerk reaction. Although a negative comment may be upsetting, and seen as damaging to your professionalism or even possibly defamatory, it is important to keep a cool head and look at the issues objectively.

Initially, it is worth talking to your medical defence organisation to discuss the situation and the best way forward. Think about what the patient has said and whether this is an indicator of an underlying concern that needs to be investigated further. You may wish to consider inviting the individual into the practice to discuss their concerns. It is important to inform them of the NHS complaints process. By lodging their concerns in this way, the matter can be investigated, an explanation provided, lessons learned and if appropriate an apology provided.

Bear in mind that patient comments on these sites are opinions, not statements of fact. Use them to help develop your services and share them with staff.

Patient feedback sites
Sites like NHS Choices allow the public to post comments about their experience of GP practices. More than 25,000 GP practice ratings and comments have already been published on NHS Choices.

GPs can use websites like this to their advantage by adopting a constructive approach rather than a defensive one. All comments on NHS Choices are moderated before publication and individual staff members are not named. Practices have a right to reply so that any issues patients raise can be addressed.

When responding to the comment, state that patient confidentiality prevents you from going into detail, but that the commenter is welcome to meet to discuss the issues personally.

Conclusion
“Privacy is dead, and social media holds the smoking gun,” said Pete Cashmore, founder of Mashable, one of the most popular websites for digital, social media and technology news, with 20 million unique visitors per month. The appetite for social networking can only get bigger, so doctors should take advantage of its many benefits, as long as they are balanced against the risks.

[[GPBAMSW]]

References
1. Hospital Staff suspended for playing Facebook ‘lying down game’. The Guardian. 9 Sept 2009. Available from: http://www.guardian.co.uk/uk/2009/sep/09/hospital-lying-down-game
2. British Medical Association. Using Social Media: practical and ethical guidance for doctors and medical students. London: BMA; 2011.

Resources
MPS factsheet, Using NHS Choices
www.medicalprotection.org/uk/uk-factsheets/using-nhs-choices

‘Do’s and don’ts of emailing patients’
www.medicalprotection.org/uk/your-practice/spring-2009/dos-and-donts-of-emailing-patients

NHS Choices. Managing Patient Feedback
www.nhs.uk/aboutNHSChoices/professionals/healthandcareprofessionals/your-pages/Pages/managingfeedback.aspx

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