Around 70% of UK adults have a social media account according to an Ofcom’s Online Nation 2019 report. It has a lot of advantages and many of us have relied on social media more than ever as a way to keep in touch with friends and family during the coronavirus lockdown. As we become increasingly familiar with it as a means of communication there may be a temptation to lower our guard and forget the potential pitfalls of expressing our views online.

We know social media is becoming more prevalent in the lives of medical professionals. Alongside the benefits, some have found themselves falling foul of the rules. The NHS disciplined over 1,200 staff between 2013 and 2018 for inappropriate use of social media and 65 people lost their jobs. Many employers have admitted they look at applicants’ social media as part as part of their recruitment screening process; it’s a quick and easy way to learn about an individual.  Between 1 Jan 2015 and 30 June 2017, the GMC closed 28 investigations into doctors’ use of social media. Two of these doctors were suspended, one received conditions, one agreed undertakings, and the GMC issued three with warnings.

The GMC has issued guidance for doctors about social media use which reminds doctors that their communication online should meet the same standards as would apply face to face. This means that patient confidentiality must be protected and doctors must not use offensive or discriminatory language that could damage the trust of the public in the profession. When identifying as a doctor in social media the practitioner should also give their name, although anonymously posted material can sometimes be traced back to its origin.

Does this restrict doctors’ freedom of expression?

In 2013 the GMC reassured doctors that it was not trying to restrict them in expressing their opinions and views. The GMC said it has no interest in doctors' use of social media in their personal lives – tweets, blogs, Facebook pages etc. But doctors mustn’t undermine public trust in the profession.

Also, Achieving good medical practice: guidance for medical students says:

“[Do] use social media to express your views, but don’t behave in a derogatory manner to other users and don’t post discriminatory content.” Ultimately, although the means of communication has changed, the expectations of the GMC and the public in relation to what doctors say has not.

What are the key things to consider?

It’s important to remember that comments made on social media can be hard to erase and they may end up being spread a lot more widely than intended. In the worst case scenario, this could have an impact on your career in medicine.  When posting online, consider the impact of the following points.

• Are you protecting patient confidentiality?
• Are you making it clear you are not providing medical advice to individuals over social media?
• Are you being upfront about your credentials?
• Are you considering how your comments reflect on the medical profession?
• Are you making sure your comments are not discriminatory or derogatory?
• Are your comments professional?

Fictional case study

The following fictional case study highlights the considerations that should be taken into account when posting on social media.

A second year medical student member of the MDU was shocked to read a news item about the conviction of a local man for possession of thousands of indecent images of children. He posted some comments on social media about this including a meme saying that if he was a doctor he would refuse to treat a child abuser. He shared this with his friends in a private group. However a friend then forwarded the meme to a public site and a complaint was made to the medical school, which considered the material to be extremely offensive. An investigation by the medical school quickly identified the student as the originator.  

Both students who posted the meme faced formal action through the medical school fitness to practise procedures. They received letters outlining the allegations against them and the guidance. They were sent a copy of the fitness to practice procedures for the medical school and informed about how to seek help from their personal tutors and the other support services available. The medical school reminded the students that the behaviour of doctors and medical students outside work could be seen to reflect on the profession of medicine as a whole. The GMC advises:

“Medical students need to behave professionally outside of work and medical school. This means you should avoid doing things that will undermine the trust patients have in doctors and the public has in the medical profession. For example, you shouldn’t make discriminatory comments about individuals or groups of people in public or on social media….”

Our member was shocked and arranged to meet his personal tutor.  He explained that he had reflected on his behaviour and realised that what he had said was unacceptable. As a doctor he would have to treat all patients fairly based on clinical need, even if they had committed a crime like this (Good medical practice, paragraph 59).

However his friend, who had shared the post publically, met with their personal tutor and said the fault lay with our member for creating the meme. The friend felt there was nothing wrong with sharing it and that the medical school had no business looking at students’ social media.

We assisted our member in writing an apology and reflections for the medical school and the matter against him was closed with no adverse finding. His friend was given conditions requiring them to document reflections and attend regular meetings with their personal tutor to gain insight into understanding why reposting the meme was wrong.