Online Professionalism

The permanence, searchability, copying ease, and lack of control over audience, differentiates online networks from “traditional” public meeting places.

Examples of medical social media use

Positive results

• Using Google and Facebook to find contact details for an emergency patient’s next of kin.
• Support blogs for patients and caregivers.
• Web discussion boards for doctors, e.g. journal article and case analysis.

Adverse outcomes for doctors

• The Medical Board of New South Wales warned a doctor about “… flippant and at times derogatory comments about patients” on social media.¹
• An Australian junior medical officer (JMO) faced disciplinary proceedings for filming a hospital resident medical officer association’s picnic day skits and putting them on YouTube. This was deemed to have brought the hospital’s reputation into disrepute.*
• A JMO in the UK was suspended for six weeks after calling a senior colleague an inappropriate name on a social network.²
• Medical job and training applications have been unsuccessful because of information found online.

*Based on a real event but details altered for privacy.

How to protect your patients

Breaching confidentiality is the main risk of doctors networking online. Be aware of and abide by patient privacy and confidentiality laws. Even descriptions of a specific case or patient history without providing names or other personal information can be enough to allow others to identify a patient and violate these laws.³

Consider carefully whether the patient is truly de-identified before making an online post. Enquiring about a person’s health over social media can easily breach confidentiality and a single posting about an unidentified patient may be compromised by other postings.

Tips for safeguarding patients

• Always get a patient’s express consent (and include this in the medical record) before putting any information about them online, including photographs, and note the consent within the post.
• Viewing and/or commenting on a patient’s blog, social network or other online presence risks possible professional boundary violations and patient complaints. The recording of such information in the records without the consent of a patient should be carefully considered due to the risk of complaints.
• Do not discuss patients on social media.

Blurring of boundaries

Increased use of social media and greater availability of personal information on the internet makes maintaining professional boundaries more challenging. Patients may learn personal information about their doctors that can cause distress and affect the therapeutic relationship, e.g. a patient may Google their doctor and find they are affiliated with a religious group that is anti-abortion or may see them smoking.

Strongly avoid online networking relationships with past or present patients. “Friending” a patient online creates a dual relationship (doctor and friend; even if you think the online friendship is not truly “personal”, the patient may view it differently) which can adversely impact the therapeutic relationship.

Also be very prudent about allowing colleagues (including employers, nurses, allied health professionals, administrative staff and students) to view information about your personal life.

How to protect yourself

Anything posted online can be traced back to the person who posted it, despite usernames. Consequently doctors “… should be very careful about any information that they post, and particularly careful about making offensive comments or jokes, sharing information about unprofessional activities or content produced by others, or joining or creating groups that might be considered derogatory or prejudiced”.⁴

Irrespective of tight privacy settings, a certain amount of information about you on sites such as Facebook is always publicly available. It is not uncommon for employers to search for job applicants’ Facebook profiles and online presence generally.

An individual or organisation may be held liable for publishing comments posted by a third party that may be misleading, defamatory, or discriminatory. If it is possible for content on a website such as a Facebook page or a blog to be deleted, then the page needs to be carefully monitored and problematic content deleted or appropriately dealt with as soon as possible.⁵

Hints to help you

• If you would not say something under your name in a hard copy magazine, do not say it online.
• Check your intent before posting – social media comments are often self-serving.
• Do not ignore your online “character”.
• Keep a check on it and take control, e.g. using Facebook, LinkedIn^® or Twitter means these sites will generally appear first in search results.⁶
• Do not allow photographs of yourself that could be considered unprofessional to appear online.
• Never make belittling comments online which are any way related to your work.
• Always acknowledge conflicts of interest even if you think you are anonymous.
• Know your site privacy settings, make them as tight as possible, and check them regularly.
• Be aware of the online communication policies of organisation(s) you work for.

What about doctor review websites?

Appraisal sites are increasingly popular, e.g. RateMDs has reviews of 190,000 globally. Positive reviews are more common than negative ones.⁷

Read your reviews occasionally – they can provide good information.

If a doctor feels truly compelled to, they may post a careful response following an online patient review which is critical of them. Ensure it is patient-centred and demonstrates willingness to take on feedback. Do not respond when angry and do not breach patient confidentiality. Keep it simple, e.g. “Thank you for your feedback. I am committed to improving my practice and have taken your comments into consideration”. We strongly recommend you seek advice from our Medico-legal Advisory Service before you post any response.

Doing nothing is an option and better than doing something which may escalate the disagreement.

If you can identify the patient who wrote the review, talk to them in the “real world”. Such discussion may prompt them to take down the online post or add compliments to it.

“All new media are in the public domain and physicians must be continually mindful of privacy, prudence and professionalism when communicating online.”⁸

By Nicole Harvey, Education Services, MDA National.

1. McCredie J. Old New is Bad News for Facebook Doctors. MJA InSight, AMPCo; [updated 5 October 2010; cited 15 February 2013].
2. Australian Medical Association, New Zealand Medical Association, New Zealand Medical Students’ Association, Australian Medical Students’ Association. Social Media and the Medical Profession. A guide to online professionalism for medical practitioners and medical students.
3. Leiker M. When to “Friend” a Patient: Social Media Tips for Health Care Professionals. WMJ 2011;110:42–3. Available at: wisconsinmedicalsociety.org/_WMS/publications/wmj/pdf/110/1/42.pdf.
4. Mansfield S, Morrison S, Stephens H et al. Social Media and the Medical Profession. Med J Aust 2011;194:642–4. Available at: mja.com.au/journal/2011/194/12/social-media-and-medical-profession.
5. Keogh K. Social Media, Health and the Law. New South Wales: TressCox Lawyers; 2011. 
6. Collier R. Professionalism: Logging On to Tell Your Doctor Off. Canadian Med Assoc J 2012;184:E629–30. Available at: cmaj.ca/content/184/12/E629.long.
7. Woodward C. “Anti-defamation” Group Seeks to Tame the Rambunctious World of Online Doctor Reviews. Canadian Med Assoc J 2009;180:doi: 10.1503. Available at: cmaj.ca/content/180/10/1010.full.
8. St-Laurent-Gagnon T, Coughlin K, Canadian Paediatric Society Bioethics Committee. Paediatricians, Social Media and Blogs: Ethical Considerations. Ottawa: Canadian Paediatric Society; 2012.