Pitfalls of social media

Social media is a common means of online interaction and is used for a myriad of reasons. This includes personal communication between friends and family; sharing information and creating content; and social networking. Some individuals also turn to social media to make complaints or give compliments, including about care they have received from their GP practice.

Use of social media can blur the boundaries between an individual’s public and private life, and information you place online may be accessed by others. It is therefore prudent to be mindful of privacy settings and understand that confidentiality is not guaranteed regardless of those settings. It is possible that any content you create or share online may be accessed by patients, employers or organisations such as NHS England or the GMC, and once published online it can be very difficult to remove.

It is also prudent to be aware that information you are not choosing to explicitly share may be included within your online content, such as location details embedded within photographs.

GMC guidance

The GMC is clear that the standards they expect of doctors do not change when communicating via social media. In particular, it is worth noting that the GMC expects a registrant to give their name when identifying themselves as a doctor in publicly accessible social media. The GMC states: “Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely.”

In addition, the GMC highlights that content posted anonymously or under a pseudonym may be traced back to its point of origin, and reminds doctors that any conflicts of interest should be declared.

Where can (and does) it go wrong?

Confidentiality

Identifiable information about patients should not be shared, including on professional sites or closed groups. Any individual piece of information may not breach confidentiality but it should be borne in mind that the sum of such information published online may allow a patient to be identified.

Case example

A GP registrar posted on a closed Facebook group for doctors in training about an interesting and rare case they had seen in surgery, including an extract from a radiology report. Unfortunately, some patient details were still visible on the report and another individual in the group took a screen shot of the post and reported the matter to the GMC, who commenced an investigation. The GP registrar responded to the GMC admitting the error and apologising, stating that they had intended to redact all of the identifiable information but had accidentally left some in place. They further set out their reflection on the GMC’s confidentiality and social media guidance, and how they would put this into practice in future. The GMC reviewed the doctor’s response and concluded no further action was necessary.

This case highlights the potential risks of sharing cases online – especially when including extracts of investigations – and that it is not possible to predict what another member of the group may do with the information that has been provided.

There have also been some instances where derogatory comments about patients have been posted on social media groups thought to be private, but these posts have been shared publicly by another member of the group, leading to criticism of the original author(s) and risk of both disciplinary and regulatory action.

Respect for colleagues and professionalism

The GMC expects that Good medical practice is adhered to online, including ensuring that a doctor’s conduct justifies both the trust of patients and the trust of the public in the profession. Good medical practice also states that colleagues should be treated “fairly and with respect”.

In their social media guidance, the GMC goes on to state:

“…You must not bully, harass or make gratuitous, unsubstantiated or unsustainable comments about individuals online.

“16 When interacting with or commenting about individuals or organisations online, you should be aware that postings online are subject to the same laws of copyright and defamation as written or verbal communications, whether they are made in a personal or professional capacity.”

Case example

A GP used their Twitter account, which clearly stated they were a doctor, to give their personal political and religious views, which included a number of derogatory statements about religion and people who hold religious beliefs. Over a period of time, further offensive statements were made not only about religion but also about patients and colleagues, and that COVID-19 was made up by the government to manipulate the population. A patient at the practice saw the posts and made a complaint to both the practice and the GMC. The practice instigated their own investigation into the matter under their disciplinary policy, and the GMC also investigated, ultimately leading to an MPTS hearing. The allegations all related to the posts the GP had made, with no concerns being raised about clinical care.

At the hearing, where they were represented by Medical Protection, the doctor accepted that the Tweets were inappropriate and unprofessional and that they should not have made such comments on social media. The GP said the posts had been made during a time when their personal life was difficult. They explained they regretted making the comments and thought the posts had been visible to his followers only. They explained that they felt shame and remorse when reading what they had written, and accepted the posts had the potential to adversely impact on the doctor’s own reputation, the GP practice, and the medical profession in general.

The GP outlined a number of steps they had taken to remediate their conduct, including using social media sparingly and never using it to express personal beliefs. The doctor was able to demonstrate they had engaged with their employer’s investigation and apologised to those colleagues they had made inappropriate remarks about. They had attended a course on professionalism and given a teaching session to GP registrars about the importance of exercising moderation and caution when using social media. They also provided a number of positive testimonials from present and former colleagues, which outlined there were no concerns about the GP’s clinical skills and that there was no evidence to suggest they had treated patients differently as a result of their religious views.

The GMC argued that the Tweets could seriously undermine public confidence in the profession and that it was clear the doctor should have been, or perhaps had been, aware of privacy settings and who the Tweets were visible to, as they appeared experienced in the use of Twitter and had, once concerns were raised, changed the settings to private. The GMC also stated that the doctor’s personal circumstances were not a defence and suggested that they may be evading full responsibility for their actions, especially as the Tweets had been posted over a period of four years. The GMC, however, did accept that there was no evidence any patients had come to harm as a result of the Tweets, and that there was no suggestion the doctor had been treating religious patients differently or had expressed their views to patients in the context of a consultation.

Even so, the GMC considered that a reasonable and well-informed member of the public would not expect a doctor to air such views in a public forum and that both Good medical practice and guidance on social media use had been breached.

The tribunal concluded that the doctor’s fitness to practise was impaired by way of misconduct and imposed a three-month suspension.

This case highlights the importance of carefully considering your social media posts and whether your comments are appropriate for a public forum. Failure to do so may lead to disciplinary and regulatory action should concerns be raised about the material you are publishing online. It is often easy to use a social media account to vent frustrations after a difficult day, or to express deeply held personal and possibly controversial views, but it is prudent to consider, before posting, the potential consequences of your material should it be viewed by a wider audience than your followers or friends – such as patients, colleagues, employers or your regulator. 

Maintaining boundaries

It would not be appropriate to accept social media friend requests from patients, and if they contact you regarding their care, you should direct them to your professional profile if applicable.

Complaints published on social media sites

It is not uncommon for Medical Protection to be contacted by GPs or practice managers to say that individuals or the practice have been criticised a patient on social media. The temptation by clinicians or the practice is to respond to such posts, especially if they feel the post is inaccurate or unfair.

However, this can lead to greater trouble – matters may be inflamed resulting in an escalation of the complaint or confidentiality may be inadvertently breached. Even if the patient has posted their personal information online, any reply must ensure that no confidential information is published or confirmed.

In the event the practice opts to reply on social media, the GMC recommends that this is usually limited “to an explanation of your legal and professional duty of confidentiality”.

It may be appropriate to give general information advising the complainant of the practice’s complaints process while ensuring that no personal information about the patient is revealed, either directly, by omission or by inference. Such a breach could include, for example, confirming that the patient had an appointment at the practice on a certain day.

Can a complaint on social media be defamation?

The Defamation Act 2013 came into force on 1 January 2014 and sets out that a statement cannot be considered defamatory unless it is deemed untrue, is published to a third person and that publication has caused (or is likely to cause) serious harm to the reputation of the person being written about.

When considering if serious harm had or was likely to occur, the courts have previously considered:

• The gravity of the statements
• The extent of the publication
• The position of the claimant
• The position of the author.

There are a number of defences to an allegation of defamation that a patient complaining on social media could use. One of these is that the comments are truthful and another is that the comments are provided as an honest opinion. It may be that the individual would use one of these defences if an action in defamation was brought. It may also be difficult to demonstrate that the comments have caused serious harm.

Other defences to defamation include that it is a matter of public interest, or it is common law qualified privilege – where the courts consider the ability to communicate freely is more important than the protection of individuals’ reputations. This defence can apply even when what was said is not true.

When an action in defamation is brought, this can result in adverse publicity for the individual involved as it often generates public and press interest, which may bring the negative comments to the attention of more people than would otherwise have seen them.

If you or your practice have been made aware of social media posts that may amount to defamation, contact Medical Protection for further advice. In some circumstances a solicitor can be instructed to write to the patient to request the removal of the posts, and in extreme situations it may be that civil action could be brought against the patient for defamation; however, this always requires careful consideration of the potential risks and benefits.

What about WhatsApp?

This case study is a final cautionary tale to warn you nothing online is truly private or secure. A GP partner had a long-standing WhatsApp conversation with a non-clinical friend. The GP made a number of remarks in relation to pornography sites, including offensive sexual comments about some activities they might like to undertake with particular patients.

Although this conversation was not publicly available, it was discovered by police when the GP’s friend’s electronic devices were seized during investigation into a possible serious crime. The police were concerned about the nature and tone of the messages, and referred the GP to the GMC. The GMC investigated and issued the doctor with a warning, which would be publicly available for two years on their entry on the medical register.

Summary

Be aware of GMC guidance and mindful of your social media use and messaging applications.

Be conscious of your online image and how it may affect your professional reputation.

It is prudent to avoid saying anything online that you would not say to someone in person.

Assume anything you post could potentially be read by anyone, including friends, family, patients, employers, NHS England, NHS Scotland and the GMC…the list goes on.