Are you proud of your digital footprint? Do you think it reflects well on you as a professional? Are you even aware that you have one?

These questions are important for anyone using social media who cares about their reputation, and that means most medics, since the majority of them have joined the more than 1.3 billion people actively using Facebook.

Reassuringly enough, navigating the world of social media does seem to have raised concerns for doctors and medical students. The GMC’s State of Medical Education and Practice report shows that social media was one of the top ten topics covered by its Regional Liaison Service in 2013, and the third most common subject requested by medical students.

Top 5 requests to RLS
Top 5 requests in 2013 for sessions with the GMC Regional Liaison Service. State of Medical Education and Practice Report 2014

Avoiding pitfalls

This probably reflects the increasing coverage given to the inappropriate use of social media by professionals. An article in the BMJ notes that policemen, nurses, students and doctors have all been taken to task for posting inappropriate content.

Cases in the United States have seen healthcare workers disciplined for posting pictures of patients with lewd or derogatory comments attached, or for taking to social media to vent frustrations. In a survey, 60% of U.S. medical schools reported incidents of students posting unprofessional content online, with profanity, discriminatory language, depictions of drunkenness and sexually suggestive material all common.

In the UK, the GMC has taken action against the registration of doctors who had used social media to make inappropriate contact with patients or colleagues, posted inappropriate pictures or made derogatory comments about patients on line .

Developments such as these have led the GMC to produce guidance [PDF] for doctors and medical students to help them avoid these pitfalls. The basic message is that “The standards expected of doctors do not change because they are communicating through social media.”

Kim Tolley, Regional Liaison Adviser with the GMC, running a workshop on social media use with Doctors
Kim Tolley, Regional Liaison Adviser with the GMC, running a workshop on social media use with Doctors

Thought and deed

This, you might argue, is fairly intuitive. And it also seems to be well understood on a rational level: A study of healthcare students in Canada found for example, that a majority agreed that it would be unprofessional to post material showing the use of alcohol or drugs, crime, obscenity, sexual content, criticism of others or confidential patient information. But then nearly half of the sample reported having seen this sort of material posted by a colleague, and a third had done so themselves.

So what causes this divergence between thought and deed? Some cases might be explained by ignorance. In an admittedly quite old study, only a third of U.S. medical students had managed to set their privacy settings correctly to prevent public access.

Some doctors may also fail to see that patients or colleagues can be identified from descriptions, images and even by location data from a mobile device stored at the point a post was published, whether or not the person’s name is left out.

False security

But this excuse belies a more fundamental point about the rapidly blurring distinction between our public and private lives, and perhaps a false sense of security given when we interact directly with a computer, rather than a real person.

The Human Rights Act grants us the right to a private life, but when our comments and images are posted online they have a permanence and accessibility to others that they would never have had if spoken to a colleague in private, and this brings these posts very much into the public sphere.

Whether or not a post was intended for public consumption won’t be a factor limiting its circulation, as an article on the ethics of journalists using material gathered from Twitter “conversations” explains.

But for those whose posts and profiles have already started to make them squirm, there is some hope. A recent European court ruling that individuals have a “right to be forgotten” has led Google to take down hundreds of thousands of links to content on sites such as Facebook and YouTube following requests from individuals who were presumably not very proud of the activities or sentiments recorded.

The analogue situation

A single off-hand comment about a colleague may not justify action on a doctor’s registration, since the GMC looks to act following serious or persistent failures to meet the standards set out in Good Medical Practice. But employers can (and do) take action themselves, and even without this the reputational consequences for inappropriate postings can still be severe.

Christopher Pell, a psychiatrist working in Tayside, is quoted on the GMC site as saying that doctors should be mindful of a need to act professionally in all public arenas:

A good rule of thumb is to always consider the analogue situation. Would you be confident speaking the content of your post to a public lecture theatre? Would you hang that photo you have as your profile picture in the reception of your practice or ward?

Toby Reynolds

Toby Reynolds is a trainee in anaesthesia from North East London, currently placed at the GMC for a year through the National Medical Director’s Clinical Fellow Scheme. He is writing this blog in his personal capacity, rather than as a representative of the GMC .