The pitfalls of social media usage and how to avoid them

  • Regulation

This guidance gathers learning from our GP Support team's extensive experience and points to relevant regulatory requirements.

Londonwide LMCs’ GP Support Team frequently encounters cases in which GPs have got into difficulty arising from the use of social media. The purpose of this article is to highlight the pitfalls of social media use and how to avoid them.

What is social media?

For the purposes of this article, social media covers all social network sites, messaging platforms, community or hyperlocal messaging groups, and commenting/posting on public websites, including (but not limited to) Twitter/X, BlueSky, Facebook, Instagram, LinkedIn, TikTok, Threads, YouTube, blogs, comment sections and message boards.

It also includes messaging platforms such WhatsApp, Signal, Slack, Facebook, Messenger, Skype, MS Teams, internal messaging (including tasks and emails) and any other sites/services which allow users to post content either privately or publicly.

Professional guidance

The GMC have produced guidance relating to the use of social media.

Disclosability

When a GP runs into a difficulty pertaining to their use of social media, they often say that the post was intended to be private, it is therefore important to be aware of the following:

  • Posts and/or messages made in private groups can be screenshotted.
  • Deleted posts and/or messages may have been screenshotted before they were deleted and/or may be recoverable.
  • Posts and/or messages may be disclosable under the provisions of the Data Protection Act (2018)/UK GPDR or the Freedom of Information Act (2000).
  • Historical posts and/or messages (even if they have been deleted) may be recoverable.
  • The Police and Criminal Evidence Act (1984) provides the police with the power to access posts and/or messages (if they have reasonable grounds to believe that they contain evidence relevant to their investigation of a crime).
  • The fact that a message is encrypted does not mean that it is protected from disclosure.
  • You may be able to be identified as the author even if you believe you posted or messaged anonymously.

Content

It is of course the content of the post and/or message that has caused difficulty for GPs, the following should be borne in mind:

  • It is often the case that posts and/or messages are not phrased in a professional way.
  • It is ill-advised to use profanities in posts and/or messages as this will be perceived to be unprofessional.
  • In the written word the tone, tenor and context are lost (for example – in the context of a conversation with someone you know well, you could refer to them as being an idiot in a jocular way that would not cause offence).
  • In the context of a private group a post and/or message may offend a member of the group, even though the post and/or message was not directed towards them (take the above example and add some profanity and a member of the group may be offended by the fact that Dr X referred to Dr Y as a “bloody idiot”).
  • Posts and/or messages may be used as evidence to support concerns about the conduct and behaviour of a GP.
  • Posts and/or messages can be perceived to be bullying, discriminatory, harassing or exploitative.
  • Whilst GPs have rights to freedom of belief, privacy, and expression, this should be set against the importance of maintaining the reputation of the profession and the impact that a posting or message may have (given that it has the gravitas of coming from a medical professional).
  • You should be mindful of the impact that a posting and/or message may have on patients, your colleagues, your practice, your employer (or partners) and the profession.
  • Post and/or messages about individuals and/or organisation are subject to the relevant legislation pertaining to:
    • Copyright.
    • Defamation.
    • Discrimination.
    • Harassment.
  • You should be able to justify any posts and/or messages relating to clinical issues if called-upon to do so.
  • Posts and/or messages that contain clinical opinion that is contrary to the current evidence base on the subject are likely to attract scrutiny.
  • Posts and/or messages that could be construed as incitement to a hate crime and/or terrorism are likely to attract scrutiny.

Confidentiality

You should be mindful of your obligations to comply with the relevant legislation and professional guidance pertaining to confidentiality, the relevant GMC guidance can be found here.

Whilst it is recognised that some GPs use social media (mainly messaging platforms) to seek clinical advice about a patient, this has a number of pitfalls that include:

  • It may be possible for a person to indirectly identify a patient from the information that is shared.
  • Anyone that provides an opinion would need to be suitably qualified to do so and must have been provided with all the relevant information that they require to do so.
  • It may be problematic to identify the relevant messages in the event that you are called-upon to justify an opinion that was based on advice provided in this way.
  • The messages are not aligned to the medical records.
  • Depending on the circumstances, the messages could be disclosable under the provisions of the Data Protection Act (2018)/UK GPDR in the event that the patient makes a subject access request.

Maintaining professional boundaries

There are a number of professional boundaries issues associated with the use of social media, which include:

Direct messaging with patients

Exchanging messages (excluding messages that are sent by the practice as bulk/individual reminders) directly with patients in relation to their medical condition has numerous difficulties, which include:

  • Confidentiality – the messages may be inadvertently seen by a family member/friend.
  • Messaging the wrong patient (which could lead to a breach of confidentiality).
  • The fact that the messages are not saved to the records.
  • The possibility that the patient may send a message at a time when you are not able to see and/or respond to it in a timely way (for example – a patient seeks advice in relation to the fact that they are experiencing chest pain over a weekend).

Using social media in a promotional way

GPs may use social media to promote private services and/or to endorse services and/or products. In such circumstances it is important for a GP to:

  • Ensure that any information that you provide is clear, accurate, current, in accordance with the relevant evidence base and is not misleading.
  • Not exploit people’s vulnerability or lack of medical knowledge.
  • Accurately represent your experience and qualifications.
  • Openly declare any conflict of interest (including any potential perceived conflict of interests).
  • Not breach your contractual requirements in relation to providing private treatments to NHS registered patients.
  • Comply with all the relevant legislation and regulatory codes (which includes but may not be limited to the Committee of Advertising Practice, the Advertising Standards Authority and the Competition and Markets Authority).
  • Consider all the relevant pitfalls that are highlighted in this guidance.

Managing contact from patients via social media

If a patient contacts you via your social media profile for advice about their clinical care, you should direct them to the appropriate channels in order that they can seek timely advice.

Avoiding the pitfalls of social media use

The pitfalls of social media use are set out above and are self-explanatory.

This section is designed to highlight the types of circumstances when GPs have fallen into these pitfalls, and these can be summarised as below:

  • Posting and/or messaging whilst in a heightened emotional state – The GP Support Team have dealt with a number of cases in which GPs have posted and/or messaged in an ill-advised way when they are in a heightened emotional state. This can occur when the subject matter is triggering, controversial, provocative or if the GP is upset for other reasons and can lead to a loss of objectivity.
  • Spiralling posts and/or messages – Another common theme is an escalation of posts and/or messages that leads to a thread of dysfunctional exchanges.
  • Posting and/or messaging at unusual times of the day (for example – in the middle of the night).
  • Posting in group chats in an unguarded way – Many GPs engage in what is commonly termed banter in group chats that include friends and/or colleagues. Sometimes the chat may cause offence to one of the participants and/or could be deployed against the GP in the event of a fallout. This can be compounded by the fact that such comments are frequently posted in an unguarded way, which means that they may appear unprofessional
  • Messages with inappropriate content – There have been occasions in which GPs have posted and/or sent messages to their partners (or to others) that include content of a sexual nature and/or that could be construed as threatening, bullying or harassing. This can be particularly problematic and is prone to disclosure to the police and/or the GMC and/or NHS England when the relationship breaks down.

The following are strategies that can avoid the above difficulties.

Ask yourself, do I need:

  • To post and/or message about this matter at all (if not then do not post or message)?
  • To post and/or message about this matter now (if not then defer posting and/or messaging, if appropriate you could send a neutral holding post/message)?
  • Time away from social media and how could this be facilitated (for example – do my devices need to be in my bedroom overnight? Are you able to prescribe periods of time during the day/evening when you will not use social media etc?
  • To think of a more professional post and/or message?

Also think about whether you should:

  • Avoid posting and/or messaging if you are in a heightened emotional state.
  • Pause and think before posting and/or messaging.
  • If appropriate (and if it would not lead to a breach in confidentiality), seek the advice of a family member, friend or colleague before posting (bearing in mind that they themselves may not be wholly objective).

Apply the following test before posting and/or messaging:

Would I be happy for this post/message to be read by a patient, a colleague, my employer/partner, NHS England, the GMC, a police officer or a judge?

If the answer to the above question is no, then you should either not post or send the message or you should re-word it such that you would be happy for it to be read by any of the listed persons/bodies.