A GUIDE TO SOCIAL MEDIA & MEDICAL PROFESSIONALISM:

A GUIDE TO SOCIAL MEDIA &

MEDICAL PROFESSIONALISM:

The tips and traps every doctor and

medical student should know

Introduction Version as of 13/12/2019

2 2

The use of social media by the medical profession is common and growing.

It has changed the way we can communicate with each other and the wider

community.

We can now share information, create content, have meaningful social interactions, and

collaborate in real-time for professional and personal benets.

However, social media has the potential to blur the boundaries between private and

professional.

There can be immense professional benets by having an active presence through

the proper use of social media, but inappropriate online behaviour has the potential to

undermine professional integrity, doctor-patient and doctor-colleague relationships,

future employment opportunities, and public trust and condence in the medical

profession.

As doctors and medical students, our professional standards remain the same whether

communicating through social or traditional media, and social media can raise some

ethical dilemmas that you might not have thought about as part of your everyday use.

The revised guide to social media and medical professionalism will help ensure you can

enjoy using social media while maintaining the standards of ethical and professional

conduct expected of doctors by the profession and wider community.

This guide has been reviewed and endorsed by the Australian Medical Association (AMA) and its Council

of Doctors in Training (AMACDT), the New Zealand Medical Association (NZMA), the New Zealand Medical

Students’ Association (NZMSA), and the Australian Medical Students’ Association (AMSA) with input from the

Avant and MDA National.

INTRODUCTION

3 3

Have you ever...

Googled yourself? Are you

comfortable with the results

that are shown?

Posted information about a

patient or person from your

workplace on Facebook or

Twitter?

Become a member of any group

or ‘liked’ a page that might be

considered racist, sexist, or

otherwise derogatory?

Put up photos or videos of

yourself online that you would

not want your patients,

employers or people from your

workplace to see?

Checked your privacy settings

on Facebook?

Felt that a friend has

posted information online

that may result in negative

consequences for them? Did

you let them know?

Checked whether there is a

social media policy where you

work or are on placement?

Added patients as contacts on

social media?

Made a public comment online

that could be considered

offensive?

4 4

1. You’re always a doctor ......................................................................... 5

2. Condentiality matters, and identiers are everywhere. ......................8

3. Consider who you friend or share information with on social media. ....11

4. Maintaining your professional reputation online. ................................ 13

5. You are responsible for your advertising. ............................................ 16

6. Managing negative patient comments online. .....................................18

7. Using social media for advocacy. ........................................................20

8. Further reading. ................................................................................... 22

contents

5 5

YOU’RE ALWAYS A DOCTOR

+ Think carefully about

publishing something on

social media if you would

not be comfortable having

your patients/colleagues/

employers see it.

+ Take care not to post images

or comments that might

be endorsing activities

or behaviour that could

damage your professional

reputation or be in breach

of your professional

obligations.

+ Remember the content you

post may be discoverable.

+ Never assume that you will

be able to delete something

that you have posted online.

+ Think about not using your

full name and ensuring

photos that can easily

identify you are not visible to

the public.

+ Where possible, try to control

what and when photos of

you are posted online.

+ Be aware of your

professional and employer’s

social media policies.

KEY TIPS

Social media is designed to connect people. Different

people use social media in different ways and we’re

constantly fed mixed messages abo

ut using social media.

Professional capacity? Personal capacity? Not at all?

Some use it solely in a professional capacity while others

use it personally, and many use a mix of the two. While you

may think your personal and professional profiles are

different and separate, often they’re connected.

The reality is that no matter what happens privately, you are

always a doctor and need to consider how you present

yourself. Your professional character may be judged by the

way you conduct yourself online.

If you post significant amounts of personal information on

social media, you need to consider who has access, and

what impact this might have on your professional

reputation and relationships.

Unlike other media, social media can quickly spread

information to a vast number of people globally.

6 6

While not illegal, situations like the ones described in these

case studies may be damaging professionally for you and/

or your employer. You may also nd yourself the subject of

a complaint to your registration authority.

Case study 1: Unprofessional comments

A doctor in training posted some impulsive comments on an

online forum about a TV program on transgender adults.

The person who was the subject of the derogatory

comments clicked on the doctor’s prole which identied

the hospital they worked at and they were able to make a

complaint to the hospital.

The hospital considered it a serious lapse in professionalism

and took disciplinary action against the doctor.

Example provided by MDA National.

Case study 2: Professionalism and

hospital policies

A surgical registrar was talking to a scrub nurse at the gym

and they decided it would be funny to pose for some cross

t activities in the operating theatre at the hospital using the

theatre equipment.

Photos were taken of the poses and the registrar posted

them on the gym’s Facebook page with a comment that

identied both the hospital and the registrar.

The hospital administration became aware of the photos

(after they had received more than 120,000 Likes on the

gym’s Facebook page).

The registrar was asked to attend a meeting and was

reprimanded for using the hospital and its equipment in a

manner that was not appropriate and warned not to do it

again.

Example provided by MDA National.

The hospital

considered it a

serious lapse in

professionalism

and took

disciplinary

action against

the doctor.

01 – YOU’RE ALWAYS A DOCTOR: A GUIDE TO SOCIAL MEDIA & MEDICAL PROFESSIONALISM

7 7

Your personal social media activities could impact negatively on how

patients, colleagues and/or others perceive you.

Consider how you portray yourself on your personal social media proles

and how easy it is for patients to nd you. Not using your full name and

ensuring photos that can easily identify you are not visible to the public

are two ways to prevent patients from nding you on social media.

Check what your prole looks like to someone who isn’t your friend and

remove any photos or posts that you do not want the general public to

see.

Before posting, always ask yourself “What would my patients/

colleagues/employers think if they saw this?” and “Would this be in

breach of my employer’s policies, my employment conditions and/or my

obligations under the regulatory authority?” If in doubt, re-evaluate your

post!

... ask yourself “What would my patients/

colleagues/employers think if they saw this?”

01 – YOU’RE ALWAYS A DOCTOR: A GUIDE TO SOCIAL MEDIA & MEDICAL PROFESSIONALISM

8 8

CONFIDENTIALITY

MATTERS, AND IDENTIFIERS

ARE EVER

YWHERE

+ Obtain written and specific patient

consent before you post patient

information or images online.

+ Protect patient information by de-

identifying the information and/or image

you post.

+ Remember it may still be possible to

identify a patient, staff member, or your

employer from the information you post;

for example from the timing of the post,

from information that remains in the

background of an image or in the

metadata of an image.

+ Check your employer’s policies about

posting on social media. Even with

patient consent, you may be prohibited

from posting content by hospital

policies.

+ Be wary about the secondary use of

data. For example, granting permission

for an online social platform to access

your profile or other information on your

device e.g. address book, may allow

access to confidential patient details.

Check the terms and conditions before

signing up.

+ As a precaution, turn off auto-upload of

pictures to social media or back up sites.

KEY TIPS

Doctors have a responsibility to ensure that

their use of social media is consistent with their

ethical and legal obligations to protect patient

condentiality. It is important to remember

that breaches of patient condentiality online

can ha

ve far wider implications because of the

reach of social media and permanency of digital

information.

Maintaining patient condentiality upholds the

public’s trust in the medical profession and

maintains our ability to treat patients effectively.

Breaching condentiality can result in complaints

to your employer or medical registration authority

(with potential disciplinary action, including loss

of employment/registration), the involvement of

the Privacy Commissioner, or even legal action

(including civil claims for damages or criminal

prosecution depending on the content).

9 9

What about sharing clinical images online?

Maybe you’ve shared a clinical image taken on your phone

in a professional and/or closed online forum for clinical

and/or educational purposes.

Remember that clinical images are “health information” and

must be treated with the same privacy and condentiality

as any other health record or information.

Never use a clinical image in an online forum unless you

have the patient’s consent to do so, or if the patient would

reasonably expect you to use the image in this way, or if

you are otherwise permitted by law to do so.

If you send a clinical image to the wrong person or post

an image online that you later believe breaches patient

condentiality or your professional or employment

obligations, seek advice from hospital management, your

employer or your medical defence organisation as soon as

possible.

On some forums, you may be able to delete the image or

the post immediately. However, you should be aware that

even when the image is deleted from a forum, it may live

on as a cached le or archived content on a search engine.

This means that the content is still searchable, but when

the link is clicked, nothing will appear. You may submit a

request to remove cached content from services such as

Google after you have conrmed that the original content

has been deleted on the forum or another site.

... even when the

image is deleted

from a forum, it

may live on as

a cached le or

archived content

on a search

engine

02 – CONFIDENTIALITY MATTERS, AND IDENTIFIERS ARE EVERYWHERE:

A GUIDE TO SOCIAL MEDIA & MEDICAL PROFESSIONALISM

10 10

Should I use my own

phone to take a clinical image?

Before using your own phone to take a clinical image or sharing any

image online, familiarise yourself with your organisation’s policy on

clinical images and social media.

Security of communication about patients between

medical colleagues

When medical students (and junior doctors) join a medical team for

a new term, they are often added to the team’s ‘group message’ for

communicating such as WhatsApp.

While this is not public messaging, security of these mobile apps

has been raised recently

and some hospitals are creating their own

secure mobile messaging platforms to replace them.

If you do need to communicate with a colleague about a patient,

check if there is a platform endorsed by your hospital/employer rst

rather than using social media.

... If you do need to communicate with a

colleague about a patient, check if there is a

platform endorsed by your hospital ...

02 – CONFIDENTIALITY MATTERS, AND IDENTIFIERS ARE EVERYWHERE:

A GUIDE TO SOCIAL MEDIA & MEDICAL PROFESSIONALISM

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CONSIDER WHO YOU

FRIEND OR SHARE

INFORMATION WITH ON

SOCIAL MEDIA

+ Consider separating your online

professional and personal prole

and content.

+ It is advisable not to extend friend

requests to patients.

+ Respond to friend requests from

a patient by directing them to a

professional social networking

page.

+ If you pay a company to manage

your social networking prole/s,

make sure the company

understands the professional

standards and guidelines you are

bound by. Remember you are still

responsible for any material they

post on your behalf.

KEY TIPS

Doctors and medical students have a duty to

patients and the community to maintain professional

boundaries.

A power imbalance exists between do

ctors and

patients, and the maintenance of clear professional

boundaries is important to the integrity of the doctor-

patient relationship and protects patients from

exploitation.

Friending or following a patient, former patients or

close relatives of a patient on social media can make it

difcult for doctors to maintain clear professional and

personal boundaries as patients can connect with you

on a personal, rather than professional, level and this

may be misinterpreted by patients.

While it is advisable not to establish online friendships

with patients e.g. not accepting friend requests from

patients nor sending friend requests to patients,

doctors working in small communities are likely to

have friends who are patients, former patients, or close

relatives of patients, and may need to think carefully

about the best possible way to maintain professional

boundaries online.

You could think about creating an online prole that

is maintained as a professional page only or join a

professional social networking site.

Patients can become friends or fans of your

professional page, which only provides information

relevant to the professional practice of that doctor.

12 12

An uncomfortable hypothetical…

You get a friend request on your personal

social networking site from someone

whose name sounds very familiar, but

they have a photo of a dog as their

prole picture. You accept the request.

After looking through their prole page,

you realise that it is one of your patients.

The patient sends you a message to let

you know that they cannot make their

next clinic appointment but would like

to know their histology results from a

test ordered while the patient was in the

hospital. The patient also throws in a

cheeky comment about some photos

they saw of you wearing swimmers at

the beach.

If a patient does request you as a friend

on your personal social networking site,

a polite message informing them that

it is your policy not to establish online

friendships with patients would be an

appropriate response. You could also

consider directing them to a professional

social networking page.

03 – CONSIDER WHO YOU FRIEND OR SHARE INFORMATION WITH ON SOCIAL MEDIA:

A GUIDE TO SOCIAL MEDIA & MEDICAL PROFESSIONALISM

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MAINTAINING YOUR

PROFESSIONAL

REPUTATION ONLINE

+ Did you know:

• the information you post on your

personal profile can be linked back to

you professionally.

• any information you post

anonymously can be linked back to

you.

• anything you post in a closed group

can be copied and shared.

+ Think carefully about whether beco

ming

a member or fan of a group might be

considered racist, sexist, or otherwise

defamatory.

+ Consider whether “liking” or “following”

groups that contain potentially

controversial topics or images could

reflect poorly on you as a doctor and the

profession.

+ Browse through all the groups that you

have joined and consider whether these

are an accurate reflection of the person

you are, and the values that you hold.

Report inappropriate content to site

administrators and request that it be

removed.

+ Safeguard your online reputation. If you

have not created an online profile,

search engines like Google may do it for

you and it may not be a profile you like!

Google your name on a regular basis to

see what comes up.

KEY TIPS

Be aware that any material posted online, even

anonymously can be traced to the original author.

Exercise sound judgement when posting online

and avoid making gratuitous or unsubstantiated

comments about individuals or organisations. This

could be viewed as a breach of your professional

obligations under the regulatory authority and be

subject to allegations of bullying.

Professional codes of conduct specify that doctors

should not engage in behaviours that can harm the

reputation of colleagues or the profession.

Defamation is the communication or publication

of false information about a person or certain

organisations that damages their reputation.

Material posted online by individuals or

organisations that are false, untrue, misleading or

deceptive can have signicant legal and nancial

consequences.

Be mindful about any comments you make about

colleagues (medical or otherwise) and employers

and consider whether it could breach your

professional obligations or policies held by your

employer, organisation or regulatory authority.

14 14

Online comments should always be respectful.

Think carefully about whether you should post

anything online if you are angry or upset.

If you see content that has been posted by

other doctors that may be harmful to patients

or the public and/or appears unprofessional,

you should bring it to the attention of the

individual and/or report it to your regulatory

authority. You may also flag harmful content

for removal on sites like Google and Facebook.

Should I post anonymously?

If you are posting as a doctor, our advice is to

avoid posting anonymously and to use your

own name.

If you are posting personally, it’s up to you but

as a rule, if it’s something that may impact on

your professional integrity, it might be better to

avoid posting it online in the rst place.

Clearly identifying yourself can lend credibility

and accountability to online communications.

When posting professionally, consider posting

your credentials. It’s also a good idea to state

whether you are or are not representing your

employer or institution.

Case study 3: Posting

anonymously

In August 2018 the NHS England Director

of Primary Care and Deputy Medical

Director resigned following revelations

he had posted anonymously on an online

forum used by GPs under the pseudonym

‘Devil’s Advocate’.

While his intention had been to provoke a

balanced discussion about contentious

issues by acting as the ‘devil’s advocate’,

his comments were found to be in breach

of NHS policy and offensive to colleagues.

The NHS determined the postings had

severely compromised his integrity and

that his position at NHS England was no

longer tenable.

Is it ok to tag colleagues?

Always be courteous when communicating

with colleagues over social media, particularly

when in public view. When sharing social

media posts with colleagues or ‘tagging’ them

to draw their attention to it, be mindful that

they may not wish to be associated with it in a

public forum.

Clearly identifying yourself can lend credibility and

accountability to online communications

04 – MAINTAINING YOUR PROFESSIONAL REPUTATION ONLINE: A GUIDE TO SOCIAL MEDIA & MEDICAL PROFESSIONALISM

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Understand and review your

privacy settings

What about closed groups?

Closed professional groups allow peers to engage

and discuss issues in a private environment.

Administrators must approve members and only

group members can see posted content.

Closed groups can be useful in bringing together

people with a common interest and can create a

sense of community. They can be a great way to

engage with your peers or enact change – either

socially or in the workplace.

They can also be used as a platform for advocacy o

important issues.

But, it is still important to be mindful of your

behaviour as many closed groups may not be as

private as they appear, and non-medical people may

also be members. Consider how the public would

perceive your interactions in these groups, even if it

is intended for medical professionals only.

Remember that anything you post in a closed group

might be copied and shared,

and that the same

professional standards apply to your behaviour as

part of a closed group.

It’s your decision on how secure you want to make

your social media accounts, but privacy can never

be guaranteed and there is always the risk that what

you post could be shared.

It’s worthwhile reviewing your social media content

regularly to ensure you’re happy with what’s

displayed.

+ Understand the privacy and

security settings of your

social media platforms and

review these regularly.

+ Don’t post information which

could be used for identity

theft or used inappropriately

by a third party.

+ Keep your passwords

secure.

+ Consider encryption.

+ Deleting information does

not provide absolute

protection – it is almost

certainly still stored

somewhere in cyberspace,

and theoretically

permanently accessible.

KEY TIPS

04 – MAINTAINING YOUR PROFESSIONAL REPUTATION ONLINE: A GUIDE TO SOCIAL MEDIA & MEDICAL PROFESSIONALISM

16 16

YOU ARE RESPONSIBLE

FOR YOUR ADVERTISING

+ Whether you are using traditional or

social media, you are responsible for

your advertising.

+ Consider whether you want your

website and other social media

platform settings to allow users to

leave comments. If you don’t, then you

can disable the comment section.

+ You must not use a testimonial,

solicited or unsolicited, that refers

to a clinical aspect of care in your

advertising, including on your website

and social media account.

+ Be careful about posting comments or

images about your skills and services

online as they may inadvertently

contravene advertising guidelines.

+ You must not edit an online review

that is negative to make it positive or

no longer accurately reflects all the

reviewer’s feedback.

+ If you do nd comments that could

be considered as testimonials on your

website or social media platforms,

you should remove them to avoid

potentially being found to be in breach

of your professional obligations under

regulatory guidelines.

KEY TIPS

Advertisements for medical services can be useful

in providing inf

ormation for patients.

Doctors advertising through social media should

review their content regularly to make sure that all

material complies with their obligations under the

National Law and Australian Health Practitioner

Regulation Agency (AHPRA) Guidelines for

advertising regulated health services in Australia

and the Medical Council of New Zealand Statement

on advertising.

Remember you are responsible for the advertising

that you publish or that is under your control. You

are not expected to monitor social media for things

that may be written about you in forums you don’t

control.

You are also expected to comply with the AHPRA’s

social media policy, the Medical Board of Australia’s

Code of Conduct in Australia, and in New Zealand,

the Medical Council of New Zealand Statement on

the use of the internet and electronic

communication and Good Medical Practice if you

are active on social media.

17 17

Beware advertising testimonials

Consumer and patient information sharing websites that

invite public feedback/reviews about their experience of

a health practitioner are not considered “advertising of a

regulated health service” under AHPRA’s guidelines.

However, it is important to be aware that it is not

acceptable to use testimonials in your own advertising,

such as on your website or Facebook. This means you

can’t use or quote testimonials on a site or in social media

that is advertising a regulated health service, including

patients posting comments about a practitioner on the

practitioner’s business website.

Doctors should therefore not encourage patients to leave

testimonials on websites they control and should remove

any testimonials or positive reviews that are posted there.

Sponsorship of personal social media

accounts

It is becoming common practice for people who are

popular on social media to be approached to feature

products on their account. This is particularly prevalent

on Instagram. Medical professionals should be mindful

of how accepting sponsorship on personal social media

accounts and/or supporting products for nancial gain

may reflect on them as a doctor and/or influence them in

their practice.

Doctors should make themselves aware of any regulations

that relate to the advertising of therapeutic goods by health

professionals.

... It’s not

acceptable to

use testimonials

in your own

advertising

05 – YOU ARE RESPONSIBLE FOR YOUR ADVERTISING: A GUIDE TO SOCIAL MEDIA & MEDICAL PROFESSIONALISM

18 18

MANAGING NEGATIVE

PATIENT COMMENTS ONLINE

+ If you receive a negative

comment from a patient or

a close relative of a patient

online, resist the temptation

to immediately reply angrily or

defensively.

+ Seek advice from a colleague

and/or AMA or medical defence

organisation about the most

appropriate way to respond.

+ If you can identify the person

who posted the comment,

consider whether it is

appropriate to contact the

person to discuss and address

their concerns.

+ If you nd messages from

someone upsetting or

distracting, consider blocking

or muting them. Persistent

harassers can be blocked from

contacting you or be reported to

the site.

KEY TIPS

Negative comments about you professionally or your

practice in online forums can cause distress and

frustration. There are several ways you can respond:

Ignoring the comments and waiting until further

reviews move the negative one down the page.

If you can identify the author/s of the comments,

politely ask them to withdraw them or have them

removed from the website.

Requesting the forum host to remove offending

comments.

Having your practice respond.

If the comments about you are false and have caused

you reputational damage, consider instituting legal

proceedings.

19 19

Certain online forums have policies and methodologies

for the removal of inappropriate or fake comments. For

example, Google Maps allows users to flag inappropriate

reviews on business listings, which will be assessed by

Google and possibly removed. Likewise, Facebook has

a flagging function for public posts as well as personal

messages for abusive content.

If you do choose to respond to a negative online

comment:

It is important that you don’t inadvertently breach

patient condentiality and that you do so within

professional boundaries.

Think carefully about what the implications for the

doctor-patient relationship might be.

Keep it simple and take as neutral a tone as

possible, for example: Thank you for your feedback.

I am committed to improving my practice and have

taken your comments into consideration.

Unwelcome online reviews…

A doctor googled their name and

came across the following review:

“The worst doctor I have ever

seen. I took my daughter to see

him when she was very sick. He

missed the diagnosis and was

deliberately rough with her because

he was hassled. It was like we were

imposing on his time. I’d ask a taxi

driver for medical advice before

seeing this animal of a doctor.

Never see him if you are ill – or

well.”

The doctor was very distressed. He

did not know who had made this

comment about him. He wanted to

know what he could do to have the

online comment deleted.

Example provided by MDA National.

Certain online forums have policies and

methodologies for the removal of inappropriate

or fake comments

06 – MANAGING NEGATIVE PATIENT COMMENTS ONLINE:

A GUIDE TO SOCIAL MEDIA & MEDICAL PROFESSIONALISM

20 20

USING SOCIAL MEDIA

FOR ADVOCACY

+ Comment within your

scope of practice.

+ Post content that is well

informed.

+ Abide by your professional

code of conduct.

+ Be aware of your

employer’s policies about

posting on social media.

+ If speaking on behalf of

an organisation, be aware

of their policies regarding

acting as a spokesperson.

KEY TIPS

Using social media to communicate and engage with others can

have potential benets to doctors and the community in general.

Many doctors and medical students want to have a better

connection with the public, journalists, their colleagues, business

leaders and politicians and are using social media to do it.

If you are going to use social media as an advocacy tool,

consider the following.

Identify whether you are speaking as an individual

or on behalf of an organisation

It is important to state whether you are speaking on an issue

in an individual capacity or on behalf of an organisation. If

speaking on behalf of an organisation, make sure you identify

the organisation and have permission to act as a representative.

When presenting a personal opinion which is contrary to the

generally held opinion of the profession, you should indicate

this is the case in order to ensure the community is properly

informed.

Declare any real or potential conflicts of interest

Be upfront in declaring real or potential conflicts of interests.

This is not only in line with professional standards, but also may

protect you from any subsequent criticism. This applies even if

you post anonymously. Any material written in a professional

capacity or by authors who represent themselves as doctors

is likely to be viewed by the public as such and taken on trust.

Failing to declare conflicts of interests could undermine public

trust, compromise the professionalism of authors and in turn risk

referral to the regulatory authorities.

21 21

Be aware of your professional

obligations if raising concerns in

relation to a specic health service

If you believe the health service or environment

that you work in is inadequate or poses a threat

to health, you should alert appropriate authorities

rather than raising these issues through social

media. You should be aware of your employer’s

policies regarding the use of social media to raise

concerns that may be critical of, or reflect poorly

on, your employer or wider health service

Post content regularly and develop an

informed, clear narrative

If you are going to use social media as a tool for

advocacy and campaigning and want to make

your voice heard on a particular topic, deliver

relevant content that is engaging, thoughtful,

balanced and well-informed.

Monitor content, conversations and

engage

Being able to engage with campaigns and

conversations that are happening online creates

momentum but is obviously going to bring you to

people’s attention. Be aware of your influence and

abide by your professional code of conduct.

Avoid unproductive or inflammatory

arguments online

It is quite common when advocating online

that all sorts of people respond, some with a

well-informed counter-argument, but others

may respond in an emotional way or may be

blatantly seeking to start an argument. While it

can be tempting to engage in a ery debate, it

is best to not respond when it is clear someone

is not willing to have a reasoned and informed

discussion. Doing so may reflect poorly to others

who may be reading the discussion.

Leverage the experiences you have

as a professional in your sphere of

influence to create change

Often the public wants to know and understand

what doctors think on a particular health

issue. Think about the content you post, if it is

appropriate to do so in a professional capacity

and abide by your professional obligations

regarding patient condentiality.

Be authentic

Make sure you stay true to yourself as a

professional and what you stand for. Engaging

in genuine conversations about topics you are

passionate about will help to support what you

are trying to achieve on social media.

07 –USING SOCIAL MEDIA FOR ADVOCACY: A GUIDE TO SOCIAL MEDIA & MEDICAL PROFESSIONALISM

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