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SOCIAL MEDIA BOUNDARIES
The evidence suggests that managing the interface between professional practice and social media has been challenging for doctors; 28 GMC investigations took place between 2015 - 2017 related to doctors’ use of Facebook, Twitter or WhatsApp. In many ways, the nature of boundaries in social media is different from the nature of those in other areas of professional life; social media communication is not boundaries in the same way as real-life communications are. Online interactions can happen at speed and the forming of relationships is less formal, the interactions are less hierarchical, and the power differentials are less clear (Cooper and Inglehearn 2015). Arguably, this means that professionals are more at risk from developing relationships where the boundary of professional relationships drifts from therapeutic, to social, to malign. The GMC (2013) in their guidance ‘Doctors’ use of social media’ make it clear that:
The standards expected of doctors do not change because they are communicating through social media rather than face to face or through other traditional media. However, using social media creates new circumstances in which the established principles apply.
Social media has also been described as creating ‘context collapse’. In our day-to-day life, communication occurs in a context we can see and make sense of. For example, doctors acting in a caring role with patients understand the context of that communication and interaction, they have colleagues around them whose expectations help clarify their role , there are cues which influence their professional practice; however, they may behave differently if they see the same patient later, away from the clinical setting, in a social context e.g. in a pub. Usually, understanding the context of the communication helps us to understand how to make the interaction professional and safe. So, let’s return to one of our original questions about ‘Should you accept a social media invitation from a patient?’
In the following interactive exercise, the GMC presents a patient - doctor relationship which demonstrates a potential blurring of a professional boundary (click the interactive tab below):
In the following interactive exercise, the GMC presents a patient - doctor relationship which demonstrates a potential blurring of a professional boundary:
https://www.gmc-uk.org/gmpinaction/case-studies/dr-walker/scenario-01/
Undertake the interactive exercise and consider your own responses to the range of social media boundary dilemmas presented. We will focus on Scenario 1. Dr. Walker tries hard to establish an appropriately friendly professional relationship with Farrah. However, the advice in the GMC guidance, ‘Maintaining a professional boundary between you and your patient’, highlights the importance of protecting vulnerable patients, and Dr Walker is right to carefully and sensitively refuse her Facebook friend request as Farrah’s age means she is vulnerable, she is 15 years old. He does helpfully offer to refer her to another service for treatment of her eating disorder.
It might be useful to reflect upon the following questions with regard to your social media use:
- Do you have the right settings on your accounts to ensure you manage your personal boundaries?
- Can you use the support of others to help you to respond if necessary, to a conversation that might be going wrong?
- Do you know how to avoid escalating a difficult conversation on social media?
- Do you know how to take screen shots if you think it might be important?
- Do you know how to access the appropriate guidelines for the sites you are using?
The GMC guidance also considers the importance of identifying yourself as a doctor if you are commenting on health matters on social media. If you are using social media to talk about your recent football game, you do not need to identify yourself. This goes back to our original discussions about the trust in the medical profession and this trust should not be exploited for monetary gain. If there is any conflict of interest between what you are writing about and commercial or monetary gain, then you would need to be overt about this and say it at the beginning of the post. If you don’t do this, patients who view the posts could think that your views are the same as the whole profession.
Another emerging area of concern for some doctors is patients who record overtly or covertly consultations. This fills some doctors with horror, but others are quite used to it, for example those working in on line consultation services. In this case the consultation is filmed, and the patient is given access to this for their own records.
The GMC has guidance on ‘Making and using visual and audio recordings of patients’; it states that as a doctor you need to ask for patients’ consent to make recordings for use their care, but also for research or education purposes. However, it does not specifically deal with the issues of patients recording doctors’ interactions.
Although the GMC expects doctors to obtain patients' consent to make a visual or audio recording, patients do not need their doctor's permission to record a consultation, because they are only processing their own personal information and are therefore exempt from data protection principles.