Many people use social media apps and platforms to connect to one another, maintain friendships and search for potential romantic partners, but unfortunately, such non-medical use often spills into the healthcare setting with a subsequent blurring of professional boundaries.
For this reason, it is important that healthcare practitioners (HCPs) manage their social media profiles, cyber presence and digital posts to minimise their medico-legal risk, writes Dr Volker Hitzeroth, medico-legal consultant at Medical Protection Society.
Hitzeroth writes:
Not only is social media an important aspect of most people’s daily life, but its use is rapidly increasing as more people familiarise themselves with its functionality, newer technology is developed and much of our “traditional” life is becoming digitised.
HCPs are regulated by various ethical rules and must abide by these when conducting themselves in a clinical context, but also after hours and when off duty. There is therefore a risk that their private and personal social media profile clashes with their professional and public persona, resulting in blurred boundaries and creating significant medico-legal risks.
Adding to such risk is the online disinhibition effect, identified by John Suler in 2004. He noted that individuals say and do things online that they would not ordinarily do when conversing with someone face-to-face. Some people overshare or act out more frequently or intensely when online or in cyberspace than they would in person.
He explained that people tend to be more disinhibited, impulsive and less restrained when interacting in the cyber world. Suler specifically identified six factors that interact and contribute to online disinhibition:
• Dissociative anonymity: digital users believe that they remain hidden behind usernames, passwords and emails; all interactions occur quasi-anonymously, and their online persona is distinct and separate from their real-life person.
• Invisibility: because people cannot see each other and remain physically invisible, they can be more forthright and less cautious.
• Asynchronicity: social media contact does not have to occur in real time and is characterised by delayed responses and longer pauses, which means that there is no natural or immediate verbal or non-verbal feedback affording an opportunity to temper one’s comments and posts.
• Solipsistic introjection: when using social media, users rarely have a clear representation of other users’ reality, personality, looks or character. This means it is easy to assimilate the other users into their own worldview and psyche according to their own wants, needs and desires, with a subsequent alteration of the self-boundaries.
• Dissociative imagination: social media users may easily slip into a make-belief world that is separate and apart from life’s demands and realities where a user’s online presence is thought to be exempt from the societal rules, norms and values directing our daily interactions.
• Minimising of authority: in the online world there is an absence of the usual social cues and there remains a perception that everyone is equal. Individuals with specific knowledge, expertise or authority may not be immediately obvious or identifiable and everyone seems to be part of a happy peer group.
Another area of risk is when an HCP receives a request from a patient for non-medical/social contact. Such approaches can occur through formal social media channels as a digital “friend” request, or as an informal bedside request to exchange contact details.
These situations are fraught with risk and ethical dilemmas and require sensitivity and caution. HCP may be flattered by the kindness and gratitude expressed by their patients, while patients may be pleased and proud to have an HCP as a member of their friendship circle.
On occasion both parties may secretly wish for a closer relationship, but you should be careful not to attract unnecessary attention to yourself or your practice. Be careful about how you engage or connect to patients online and what personal information you divulge to them.
Finally, if you receive a request to exchange personal contact details or befriend a patient, you should always politely explain that it is your practice policy not to engage with patients on a personal or private basis. You should also direct the patient to your professional or practice profile where they can contact you.
It is also common practice for patients to use search engines to find out more about their HCPs. Your private posts on various social media platforms may inadvertently be accessible to the public – and your patients may stumble upon one of your posts that was not intended for public viewing.
Occasionally, when your posts are interpreted as offensive, rude or insensitive, such a scenario can lead to a more formal complaint before the HPCSA, a disciplinary hearing at your work, or even a social media backlash with disastrous consequences for you and your career. Therefore, it is important to regularly check your privacy settings, be thoughtful in what you post and sensitive to other views.
Also, remember that nothing in cyberspace is ever completely private and may not remain confidential.
Do not underestimate the power of “likes” or forwarding or sharing a post. What you “like” and what you share – and how you respond to someone else’s post – will be seen as a reflection of you, your character, and your values.
Some people may find your sense of humour offensive, your decisions to be misjudged, and your taste crass. Occasionally, some individuals may believe that you and your posts bring the profession into disrepute.
Without the usual interpersonal face-to-face contact, many of the subtle, but critical, conversational cues are lost (e.g, body language, facial expression, broader conversation, context) and the linguistic nuances of humour, sarcasm and irony can easily be misinterpreted. In the age of AI deep-fakes and the increasing politicisation of social media, it is especially important to review all content critically to ensure its authenticity.
If patients can see that HCPs have interacted with AI misinformation online, then it is likely to undermine their confidence in the doctor’s ability to use AI in their practice responsibly.
Doctors also need to be cautious about advertising their practice or service. The HPCSA expects clinicians to be professional and truthful, and not deceptive, misleading, or cause consumers unwarranted anxiety that they may be suffering from a health condition.
Canvassing and touting are also prohibited. Canvassing is defined as “conduct which draws attention, either verbally or by means of printed or electronic media, to one’s personal qualities, superior knowledge, quality of service, professional guarantees or best practice”.
Touting is defined as “conduct which draws attention, either verbally or by means of printed or electronic media, to one’s offers, guarantees or material benefits that do not fall in the categories of professional services or items, but are linked to the rendering of a professional service or designed to entice the public to the professional practice”.
You need to be particularly cautious when deciding on a marketing strategy, as the services that you offer and any discounts or special offers that you wish to publicise, should not breach any of the HPCSA guidance. Similarly, you must be truthful when clarifying whether you are a specialist or a generalist with an interest or experience in a specialist area.
Last, you may not use the word hospital or clinic or institute unless your practice is truly registered as such an entity.
At Medical Protection we have seen several instances where an HCP posted a seemingly innocuous opinion or response to a digital complaint – which found traction with the public and subsequently went viral, escalating into a major social media pile-on with a significant impact on the practitioner’s reputation, practice and income.
References and further reading:
• Suler, John: The Online Disinhibition Effect. Cyberpsychology & Behaviour. Vol 7, No 3. 2004.
• HPCSA: Ethical Guidelines on Social Media (Booklet 16).
• HPCSA: The General Ethical and Professional Rules of Conduct (Booklet 2)
See more from MedicalBrief archives:
Social media complaints and how to deal with them
The risks and hazards of social media for doctors