In the context of healthcare fitness to practise, the use of social media might not appear important or relevant.  However, misuse of social media by health and care professionals can lead to fitness to practise investigations and sanctions.

In this article, I will look at the relevance of (mis)use of social media, regulator’s approach to this and the sanctions that might arise from regulatory action.

Social Media and Fitness to Practise

Health and care professional regulators in the United Kingdom have four main functions: setting standards, maintaining a register, setting standards for and quality assuring education and training and investigating and hearing allegations that a registrant is not fit to practise.

The relevance of social media in the context of fitness to practise touches on a number of these functions; setting standards, investigating complaints and registrant’s fitness to practise.

Healthcare regulators expect healthcare professionals and workers to uphold their standards and codes including acting professionally and lawfully at all times.

This applies to the use of social media as much as it does to other aspects of professional conduct.  Specific standards will vary between regulators but broadly speaking, standards of conduct in relation to use of social media includes not:

  1. sharing confidential information inappropriately;
  2. posting pictures of patients and people receiving care without their consent;
  3. posting inappropriate comments about patients;
  4. bullying, intimidating or exploiting people;
  5. building or pursuing relationships with patients or service users;
  6. stealing personal information or using someone else’s identity;
  7. encouraging violence or self-harm; and/or inciting hatred or discrimination.

It is important to note that from a regulatory perspective, standards expected of healthcare professionals and workers do not change because they are communicating through social media rather than face to face or through other traditional media.

Case Study[1]

Sarah and Mohammed are third year medical students on the same course doing a clinical placement together. They are part of a WhatsApp group with other medical students on the same placement where they share stories about the patients and staff.

Mohammed took a screen shot of a particularly funny story he wrote, and posted it on his Facebook page about a patient he saw in A&E, dressed as an elf, who had injured themselves re-enacting a climactic battle scenes. He didn’t use the patient’s name but describe their symptoms and circumstances.

Other people reshared the Facebook post. Another student who was friends with Mohammed on Facebook reported the incident to the medical school.

Given the evidence, the school started a fitness to practise investigation.

Sarah was annoyed and felt she’d been unfairly treated. She said she only set up the group to have ‘a laugh’ in a private chat with her friends. She didn’t think the tone of the stories posted were inappropriate or disrespectful.

A few weeks later she met with her personal tutor again to review her thoughts on the situation and her actions. The tutor was surprised her attitude had not changed. Although she’d had time to think about her behaviour, she still blamed Mohammed and maintained she’d done nothing wrong. Her tutor was shocked by her lack of insight into why what she had done was unprofessional.

By contrast, Mohammed reflected on his behaviour and was mortified. He said he didn’t appreciate snippets of information posted online could be compiled with other details and risk breaching patient confidentiality.

What happened at the hearings?

Sarah came to the hearing and insisted she had not done anything wrong. The panel had concerns she had shown no insight into her behaviour.

After careful discussion the panel decided Sarah’s fitness to practise was impaired. They suspended Sarah for six months as a signal of the severity of her behaviour for public trust in the profession.

Although Mohammed contributed to the original group, and posted the story in question on Facebook, he had shown insight into his actions.

The panel also heard Mohammed’s testimony at the hearing and believed he showed genuine remorse for his behaviour.

The panel decided Mohammed’s fitness to practise was not impaired. They felt it appropriate to issue a warning and required him to complete a piece of reflective writing on the events.

Sanctions & regulatory action

The fitness to practise process for the UK’s health and care professional regulators is broadly similar.

If a complaint is made to the regulator about a registrant, their regulator can initiate an investigation that may result in the regulator taking action against that person’s registration.

In order to manage fitness to practise cases, all regulatory bodies record the nature of the case or the allegations within a case.  Each case that passes through the fitness to practise process will be categorised under one or more labels depending on the regulator.

In the context of fitness to practise and social media, not all healthcare regulators are equal.

Research by the Professional Standards Authority[2] found that:

“…only three of the regulators (GMC, GPhC and NMC) mention social media in their category lists. The GPhC lists it once, whilst the GMC has two specific social media categories ‘Fail to maintain trust -social media’ and ‘Breach of confidentiality -social media’. The NMC has made social media into a category with branches of sub-categories…”

Fitness to practise cases relating to social media complaints and incidents that breached standards are comparatively low.  For example, research conducted in relation to the General Dental Council (GDC) found that 2.4% of fitness to practise cases published on the GDC website over a three-year period were related to breaches of the social media guidelines[3].”

More importantly, all of the GCD cases looked at in the research were proven and upheld.  This is of course no indication of findings relating to other healthcare regulators but, the point is the significance of misusing of social media by healthcare professionals and workers should not be under estimated.  The full range of sanctions and regulatory action is available to healthcare regulators including suspensions and strike off orders.

Advice – Do’s and Don’ts

Do:

  • act professionally
  • treat people with respect
  • maintain confidentiality and privacy at all times
  • maintain proper professional boundaries
  • think before you post, privacy settings do not mean that something will remain private and a statement that these are your own views means little in practice

Don’t:

  • bully, harass or intimidate
  • unlawfully discriminate
  • post inappropriate comments
  • share information about patients or their care
  • get drawn into negative, unconstructive discussions

Regulator’s Guidance

 

[1][1] https://www.gmc-uk.org/-/media/documents/professionalbehaviourcasestudies-dc10903_pdf-73316932.pdf

[2] https://www.professionalstandards.org.uk/docs/default-source/publications/research-paper/categorisation-of-fitness-to-practise-data-december-2017.pdf?sfvrsn=684c7320_4

[3] https://www.nature.com/articles/sj.bdj.2017.765

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