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Social media has been designed to help people stay connected and in today’s society is such a common form of communication. The Sensis Social Media Report in 2018 recorded that eight in ten people use social media. ¹

Medical practitioners have professional and privacy obligations when using social media. Not only that, recent case law has determined that posts on a medical practitioner’s personal social media accounts can lead to suspension where the views published pose a risk to the way that a practitioner practises medicine and therefore the public.

What is social media?

In November 2019 the Medical Board of Australia released some guidelines, entitled Social media: How to meet your obligations under the National Law (the Guidelines).² These guidelines are designed to help registered health practitioners understand and meet their obligations when using social media.

These days social media covers numerous platforms including Facebook, Instagram, Twitter and LinkedIn. Together with discussion forums, media sharing, WhatsApp, blogs and virtual reality and gaming, to name a few.

Many practices also now have an online presence for business purposes. When used in a business sense it is important that practitioners and staff recognise and understand the difference between information that is appropriate for the public and therefore can be on social media and information that should be kept confidential.

Social media and you

An issue that arises for medical professionals is that your social medial profile will often connect your private and personal identities. Therefore, you must be comfortable with what you are posting.

The Good Medical Practice: a code of conduct for doctors in Australia (the Code) provides that whilst “individual doctors have their own beliefs and values, there are certain professional values on which all doctors are expected to base their practice³”. The Code goes onto say that doctors have a responsibility to protect and promote the health of individuals and the community.

It is important to remember, that you do not stop being a doctor, even when posting on your personal social media account. Where relevant, National Boards may take into consideration social media that you use in your private life if it raises concerns about your registration.

Privacy and Confidentiality

Doctors have a responsibility to ensure that their use of social media is consistent with their ethical and legal obligations with respect to protecting a patient’s privacy.

It is important to be careful when sharing information, including comments or photos, so that you do not inadvertently disclose any patient information.⁴ For example, you should always check what is in the background of any photos before you post them to ensure that there isn’t personal information unintentionally being disclosed in the background⁵.

Advertising

AHPRA’s Guidelines on Advertising regulated health services⁶ provides that social media includes work related and personal accounts on social networks.

If you are using social media to promote your practice, for example on a business page, you should be aware of your obligations surrounding patient testimonials i.e. the Guidelines prohibit testimonials in advertising regulated health services.

The Guidelines also confirm that you are responsible for content on your social media accounts even if you were not responsible for the initial posting of the information or testimonial⁷. You should always review material posted regularly to ensure it is compliant with your obligations.

Ellis v Medical Board of Australia⁸

Dr Ellis, a 76-year-old practitioner, holds a Bachelor of Medicine and Bachelor of Surgery from the University of London. He was a member of the Royal College of Physicians and a member of the Royal College of Surgeons. According to his online biography he is an Integrative Physician, Futurist and Peace Worker.

A practice manager made a notification at a practice where Dr Ellis was working. The notification prompted an investigation into his use of social media. AHPRA issued a notice of proposed immediate action which included extracts of Dr Ellis’ social media commentary including posts containing information and opinions on vaccines, chemotherapy, COVOD-19 and opinions about certain religions and other groups. Dr Ellis had his registration suspended by the Medical Board and he appealed the decision to the Victorian Civil and Administrative Tribunal (the “Tribunal”).

In considering this matter the Tribunal looked at the Code of Conduct for Doctors in Australia, specifically referring to part 1.4 ( 2.1 in the current version) as follows:

“Patients trust their doctors because they believe that, in addition to being competent, their doctor will not take advantage of them and will display qualities such as integrity, truthfulness, dependability and compassion. Patients also rely on their doctors to protect their confidentiality.”

The Guidelines issued in November 2019 note that the inappropriate use of social media can result in harm to patients and to the profession. Information stays on social media indefinitely, it is often impossible to remove or change and it can be circulated widely, easily and rapidly. ⁹

Further, the Guidelines specifically state that whilst you may hold personal beliefs about the efficiency or safety of some public health initiatives, you must make sure that any comments you make on social media are consistent with codes, standards and guidelines of your profession and that you don’t counter public health campaigns¹⁰. Further, comments that promote personal views about social and clinical issues may impact on someone’s sense of cultural safety¹¹.

In relation to Dr Ellis, AHPRA described his posts as commentary that expressed and encouraged views regarding vaccination, chemotherapy and other health topics that were contrary to accepted practice. Other posts were described as demeaning to certain religions and communities. Dr Ellis expressed remorse and noted that mainly he was re-posting information that was sent to him in the interests of promoting discussion. As soon as he received the AHPRA report he closed down his Facebook pages and promised not to repeat the conduct.

The Tribunal considered whether the conduct of Dr Ellis posed a serious risk to the public. Ultimately they determined that his conduct did pose a serious risk to persons. It was the Tribunal’s view that there was a real possibility that Dr Ellis would engage in conduct that could be harmful to patients, whether by publishing statements similar to the ones that gave rise to these proceedings or carrying out his practise of medicine in accordance with the views he expressed in those statements, as opposed to in accordance with proper clinical basis or in accordance with current accepted medical practice¹². In summary, the practice of medicine is not limited to the physical acts involved in treating patients and includes the discussions that a doctor has with their patients¹³.

In the end the Tribunal suspended the registration of Dr Ellis as he “failed to display integrity and truthfulness and he has failed to protect and promote the health of individuals and the community¹⁴”. He contradicted public health campaigns, failed to display compassion and lacked respect for the beliefs and cultures of others.

Conclusion

With respect to social media for medical professionals, the take home message is that you have to be aware of your professional obligations and relevant legislation. The Medical Board of Australia puts it quite simply, “While you may think you are engaging in social media in a private capacity because you do not state you are a registered practitioner, it is relatively easy and simple for anyone to check your status through the register, or make connections using available pieces of information”¹⁵.

Top Tips

1. Be aware of your privacy settings and constantly review them for each different forum you use.
2. Never assume that you will be able to delete something that you have posted online.
3. Consider having separate professional and work accounts.
4. Consider who you friend or share information with on social media.
5. It is advisable not to extend friend requests to patients.
6. If you are unsure about it, don’t post it!

Useful Resources

AMA, A Guide to Social Media & Medical Professionalism: The tips and traps every doctor and medical student should know

Social media: How to meet your obligations under the National Law

AHPRA Guidelines for Advertising Regulated Health Services (Advanced copy – new Guidelines come into effect 14 December 2020)