A fifth-year student on GP placement contacted the MDU to seek advice on a social media message he had received from a doctor. A few days earlier the student had seen an elderly patient in clinic with a significantly raised tumour marker. His supervising GP mentioned that the tumour marker level was the highest he'd seen.
Later that evening, the student posted in a closed Facebook group for doctors and medical students with the suggestion that they play 'top trumps' and shared the patient's blood test result. Several other members of the group then posted the highest level of the tumour marker they had come across.
A few days later the student got a private message from a GP in the group who had seen his post. The GP explained that her father had called her with the bad news that his tumour marker was raised and was audibly upset by this.
She also explained that when she had read the student's post, she realised it was describing her father's case; the test result figure shared was the same as that which her father had relayed to her and had been posted on the same day he had received his news. She was able to confirm her suspicions by looking at the student's Facebook profile, where she was able to glean that the student was on placement at the practice where her father was registered.
She was extremely angry that her father's health and recent bad news had been used for humorous 'banter' online. She demanded a written apology and explanation to be sent to her father, with the threat of a complaint to the student's medical school if she remained dissatisfied.
Guidance and advice
The above scenario is fictional, but representative of the increasing number of queries we receive relating to social media. The GMC's 'Doctors' use of social media' (2013) outlines the general principles for doctors to consider when posting online and contains two paragraphs very relevant to this case.
13. Although individual pieces of information may not breach confidentiality on their own, the sum of published information online could be enough to identify a patient or someone close to them.
14. You must not use publicly accessible social media to discuss individual patients or their care with those patients or anyone else.
Of course, good practice begins at medical school, and the GMC has similar advice for students engaging in social media and online forums. 'Achieving good medical practice: guidance for medical students' (2016) lists a series of social media dos and don'ts for students to consider:
• Do think carefully about how others, particularly patients both present and future, might perceive your content
• Don’t share information about patients or post information that could identify a patient (pp 36-37).
Unfortunately many doctors are led into a false sense of security by the fact they are posting in a closed group which is intended solely for doctors. The illusion of security is often supported by the fact that some groups ask for prospective members to provide their real name and GMC number by way of checking they are actually a doctor.
In addition, while there may be the expectation of camaraderie from fellow doctors it is worth bearing in mind the statistics in the GMC's The state of medical education and practice in the UK report: 2016. According to this report, 9% of complaints about doctors in 2015 came from other doctors. The number of these complaints is now slowing, but between 2011 and 2014 the number rose by an average of 11% per year.
Top tips, not top trumps
So what should doctors and students consider before posting comments about colleagues and patients on social media?
• Many of these closed groups have hundreds, if not thousands, of members.
• Despite some requiring a doctor to provide their name and GMC number, these are easily obtained from the list of registered medical practitioners on the GMC website. As such, it is entirely possible not everyone on these sites is a medical professional.
• Even amongst fellow doctors and fellow students there will be variations in opinion on what is humorous and what is unprofessional.
• Be mindful of how a patient may be identified even if their name is not given, and how posting may unintentionally breach their confidentiality.
• Similarly, when sharing copies of letters written by colleagues or others, just redacting the identifiers on the letter may not be enough to protect the patient or sender's identity.
• Consider how the individual the post is about would feel if they read your comments. Patients go to doctors with the expectation of confidentiality.
Many doctors are led into a false sense of security by the fact that they are posting in a closed group which is intended solely for doctors.
While all of the above points may seem obvious, and while it is tempting to blow off steam in the virtual company of other students and doctors, it is important to recognise the potential problems with inappropriate social media posts, particularly those about patients.
There have been several cases reported in the media where doctors who have made derogatory comments about colleagues or patients have been reported to regulatory bodies by other social media users.
Before posting online, even in closed groups, consider what the purpose of the post is, who may read it and how easy it is for someone to take a screenshot of your post and forward it on.
The student was given advice on how to approach this complaint, and after providing a written response and meeting with the patient and his daughter, no further action was taken. The daughter was able to explain to the student in person how unprofessional and disrespectful she had found his post, particularly at a time when her family had received bad news.
The student appreciated this and sincerely regretted the distress his post had caused.