Thursday, 19 April 2012

Doctors’ use of social media - some thoughts prior to publication of GMC guidance

This is taken from the GMC website. The GMC have published draft guidance on social media here. Take part in the consultation here.

This month, Dr Anne-Marie Cunningham (@amcunningham), a GP and Clinical Lecturer at Cardiff University, writes on the role of social media in doctors’ lives.
Dr Anne-Marie Cunningham
More than half the UK population now use Facebook. And more new users are over 50 rather than under 50. The dominance of Facebook means that if you are not there you are likely to miss out on what is happening with your family or friends. For most of us our use of Facebook has nothing to do with being a doctor. It is about being a mother, nephew, or friend. And it is because we want to protect these people that we care about, and ourselves, that we check our privacy settings and make sure that we are not publishing photos of our nearest and dearest to the world.
So if most of our social media use is about who we are when we are not at work do we need guidance from the GMC? What does using social media have to do with being a doctor at all?

Useful guidance or ‘moral panic’?

Some might think that the development of this guidance is a response to a near moral panic about what may be seen as the portrayal of unprofessional behaviour by doctors and medical students in their use of Facebook and other social networking sites. Breaking patient confidentiality is always wrong but these days what does it take to reduce trust in ourselves or the medical profession? Research seems to indicate that the main determinant of trust in doctors is their interaction with patients in consultations. Patients value doctors who listen to them and take their concerns seriously. They trust them. So are we worrying excessively about how the public may respond to the depiction of minor misdemeanours and hijinx which may not reflect how well an individual will carry out their professional role?

Blurred boundaries

In the past, the private life of a doctor living in a small community may have been well known to her patients. Social media facilitates this same kind of blurring of boundaries. We all have to consider how much of our private and personal lives should be revealed to the public and patients. Will ‘professional distance’ be a meaningful or helpful term in the 21st century? Medical decision making is no longer seen as objective and the role of the doctor, but as a shared task with the patient which acknowledges their values and subjectivities. Might this process be helped or hindered if patients understood our values and subjectivities too?
Doctors may also choose to use new technologies to interact with patients. What then are our responsibilities? As we have a duty to protect patients’ confidentiality we must assure ourselves of the appropriateness of any communications platform. If there are risks then we must make these clear to patients.

The importance of maintaining trust

We might also use social media to connect with other professionals. There can be many benefits to opening up the flow of knowledge within networks. Again, discussing the details of any clinical case should be done with patient consent. In the past when considering if a patient may be identifiable we tended to focus on whether others would be able to recognise the individual concerned. But if discussing a case in near real-time in a public space we have to consider whether the patient will be able to identify themselves even if no one else can. Without their explicit permission, this in itself may reduce trust in us as practitioners.

Looking forward

Will social media have a major impact on the practice of medicine? We do not know yet, but the pace of change is rapid. It took 100 years from invention of the telephone for it to reach 50% of UK households in the mid-1970s. Has the telephone radically changed medical practice? Facebook reached 50% of the UK population in 5 years. Will it be a more powerful disruptor?
When discussing technological change we have to remember that social divides also exist. Julian Tudor Hart coined the phrase the ‘inverse care law’ for his observation that those who most need good medical or social care are least likely to get it. The digital divide describes inequalities in access to information and communication technologies. In 2011, 99% of those with a household income above £40,000 had internet access, whilst only 43% of those with household income below £12,500 did. The gaps are narrowing, but if we change our practices we need to consider how the digital divide will impact on access for the poorest, and most vulnerable.
So do we need guidance on the use of social media and networks? If the publication gives us cause to reflect on how use of these technologies fit with our professional roles and our professional practice then this can only be a good thing.


  1. Thx for overview.

    I am irritated that yet another aspect of my life is being scrutinised because of overly cautious regulatory body.

    It is my view that social media democratises knowledge so threatening the monopoly of knowledge which has been a pillar of how a profession defines itself.

    Guidance for doctors engagement with social media is not about patient rights. It is a battle to control information. Why else do we see guidance on this topic being published almost simultaneously by professional bodies world wide?

    The crusty and conservative "elites" who run the country cannot countenance the bypass of traditional top down information flow. At least that is why I think there is a rush to control doctors (and other HCPs) use of social media.

    Sadly there seems no urgency by GMC to improve digital literacy of medical students despite the advances in mobile devices. Nor directives for undergraduate curriculum to include education and training in clinical coding. This

    Digital literacy is an integral part for getting UK out of the economic mess we are in. A pity GMC is not interested in helping the economy as much as it is hobbling the medical profession.

  2. Hi David,
    Have you read the guidance? What did you think suggested scrutiny? To be honest it seems very uncontroversial to me.
    Please share what your issues are if you feel comfortable doing that.
    And what do you think about the points I made here?

  3. Anne Marie

    The GMC or its agents will gain permission yto monitor all social media if the guidance is ratified. I am not comfortable permitting this intrusion.

    The advice seems patronising and shows how out of touch the GMC is with people like you and me. There is no need for this document. Good Medical Practice the, and confidentiality guidance are sufficient.

    Meanwhile your short essay is a mature and non-judgemental assessment which deserves to be read by all medical students!

    1. First of all thanks for your kind comments on my piece. I'm not paying you, am I? ;)
      Next, I don't see why you think social media will be monitored. Is every letter you send to a paper monitored? Is every telephone call you make monitored? Are all your letters monitored? Are all your face to face interactions monitored?
      I don't actually think that the guidance is patronising. Above I have raised the question of moral panic. But I wrote this before I had seen the guidance. Reading it I can see no evidence that there is any moral panic. My understanding is that some people asked for this guidance to be produced. I did not! But I do not think that there is any harm in the fact that it not exists.
      So far there has not been very much discussion of it anywhere. That suggests to me that it is quite innocuous but I may be wrong!
      Thanks again.

  4. Lessons from history suggest the most innocuous guidance/regulations can have the most disastrous effects. We ought to be asking why GMC is minded to make guidance on social media while ignoring Digital Literacy.

    This is why I worry.

    Our letters etc can be used as evidence of professional trouble at any time if asked for by GMC and probably CQC. Including all social media in remit of GMC is dangerous and intrusive on my liberty as a citizen.

    1. As I say above I think there has been a near moral panic about social media and health professionals. But thank goodness this guidance does not inflame things at all. It doesn't to me seem to be any of the things which people feared it might be.
      But because of all the concern I presume that the GMC did feel that they should produce something that was going to clarify where there boundaries would be. I thought you would find it reassuring, but I'm wrong.

  5. The use of Social Media is set to grow,and of course the lines will blur personally/professionally online. I was very sceptical initially abt twitter and inhibited about interacting with strangers,but the more I ve been online,I ve realised that people by and large are not that different,and we share a lot more inspite of cultural differences and as healthcare workers our experiences have so much in common

    1. Thank you. Although we can learn about how we are similar we can also learn about how we are different and how to manage with that. That is the real strength I think.

  6. There is no way I would ever write to the GMC about this but I'm happy enough (at the behest of Anne-Marie) to comment here - which, of course, shows the value of social media.

    My first thought is that this advice comes much too late. A quick check shows I first blogged in 2006. That's when I needed this advice.

    My second thought is that this advice doesn't really facilitate anything. I learnt the hard way that it was difficult to put clinical vignettes online without risking a breach of confidentiality. At first I started changing dates/times/sex and I kept myself anonymous but if the condition is rare that doesn't help much. As a result, I concluded that using a blog as a way of teaching on real clinical cases was unwise. Yet we have been publishing such cases for centuries. The GMC provides no solution – not with this guidance anway. My guess is that most patients would not mind and might even be pleased to have their case publicised but how do I get their permission reliably without falling foul of the regulator?

    As for identifying oneself when acting in a professional capacity, I am not too comfortable with that. But what is meant by a “professional capacity”? Even if I did put my real name how would anybody know that I am really a doctor and really who I say I am? There are people on Twitter who claim to be well-known people who are imposters. None of this has been addressed. And what is a “professional capacity”. Is moaning about the GMC or Mr Lansley’s policies operating in a professional capacity or do they just mean things related to patient care? And if I used my real name wouldn’t that be inviting patients to contact me in my area of special expertise (which I hope I have kept largely under wraps)? That’s not something I want to do and, it would seem, nor should I.

    The GMC tells us not to give medical advice so why do we need to identify ourselves? Requests for medical advice are, in any case, surprisingly rare. Patients as well as doctors seem to know where to draw the line. But only days ago somebody asked urgently whether an overdose of a particular drug was dangerous and whether he should take action. Thinking of the GMC advice that “you must not use social media to discuss an individual patient”, I held back. Fortunately others did not and promptly gave appropriate advice. I think if they hadn’t I would have done the same. It was the GMC that deterred me. As it happens the police were called and hopefully the patient was OK – though I don’t know.

    What if somebody tweets: “I have severe crushing chest pain”? Do you tell them that you cannot discuss their problem and that they should call their doctor for advice? Or should you tell them to call an ambulance? Or do you pretend, as I did, that you hadn’t seen the tweet. These issues have always been around. I was taught as a medical student how to deal with requests for medical advice at a cocktail party. Twitter is not very different really. The advice I was given then holds good for Twitter now.

    I don't welcome this advice at all because it won't be long before the GMC start prowling around the social media. Doctors won't be able to be people. They will have to be professionals. The only safe thing to do will be to stay away. Doctors will become social media lepers.


    1. Thank you JG.You are making some very interesting points which in the main I agree with. I'll start with where I disagree. You may think I am a naive fool but I don't feel worried about the GMC prowling round social media. What warrant would they have to do that? It stays away from talking about upholding trust in the profession and ourselves 'at all times'. I had the impression that this is one of the things that people were most worried about- that this would be a license to snoop. But there is no mention of it. And I am glad of that- as the piece I have written above might suggest that I would be.

      Next, is the guidance too little too late? Some people think that there has never been a need for it and never will be, and you are saying that it has come too late. What should our expectations of guidance be? Blogging as a doctor (even using Twitter) are quite niche activities. At what stage should the decision be made that there is a need to help practitioners negotiate these tools?

      The point that I have tried to make is that most people do now see their use of social media as part of their professional practice? Do you? It's hard for me to draw boundaries around different parts of my work but if I worked as a full-time GP I think that I would have significantly less to share or to participate with in social media. Maybe I'm wrong about that.

      Others will say that the GMC should be telling us how to use social media well in our professional practice but I don't think that we have many great examples of that yet either. They will come and we should be prepared to share them freely. The GMC might put some of that together for us but I think it is up to us to share our learning just as you have done above.

      Next, where are our boundaries in an emergency? I think you are right that this is not covered well enough. It is one issue that I thought was important to address and I did try to flag it up. But my reasoning was different to yours. I'm aware that Good Medical Practice tells me that I am obliged to respond in an emergency anywhere in the world. That is something that I don't think doctors in other countries hold as a principle. So my issue was would I be negligent if someone sent me a message about a crushing chest pain and I didn't do anything about it. Would that mean that I was never off duty? I can only be in one physical place but I could be called upon to help out in a medical emergency anywhere in the world on Twitter. Yes, that may sound a little bizarre but it is one issue where social media really does throw up a new dilemma and it is not addressed in this guidance.

      But the great thing is that we can respond! I know you don't want to respond to the official consultation but thank you for raising your points here. I really appreciate your trust.

      Have a great weekend!

  7. I love the format of GMC guidelines. Basic and adequate. Certainly a foundation on which to build should things change.

    A nervous group thinking that this basic guidance represents an intrusion. But I don't understand the situation across the pond.

    1. I'm not sure why it is thought to be an intrusion either. But I guess we will see more discussion.

  8. Not allowing "Junior Doctors" to describe themselves as "Doctors" on any social media. Or even better no disclosure at all, the remystification of medicine is supported by this idea of having to tell the world and his wife that you are a "Doctor".

    So called "Doctors" allowing all to see pictures of their OR work via photos open for all to see on Facebook. Yes! This is out there.

  9. Great post. The post on publication of GMC policies has raised a heated debate. I think what is most important to doctors and physicians is that they should post information online having mind that they are doing this to help patients online to understand their medical conditions. The policies could be "harsh" but one thing we have to understand is that they are not implemented as a trap.

    Erick Kinuthia
    Team MDwebpro

  10. I wish I could be as sanguine as you on these matters, but my experience and natural disposition tells me that this is being driven by certain people in the GMC (that we are no longer allowed to vote in or out) for their own agenda.

    I think the GMC will be prowling around the social media, at the behest of the Department of Health, and those of us who are critical of these organisations will be the first to experience this.

    I think, Anne Marie, you are a lovely and genuine person who sees the best in people. I wish I could be as sanguine as you - but I can't.

  11. I think the bottom line here, especially from the more experienced medics, is that most of us don't trust the GMC and have little confidence in them. Once they start having an interest in a part of our lives they then will find a need to have more and more access, because we aren't to be trusted post-Shipman/Bristol/%name-your-scandal%. Countries where regulatory bodies involve themselves in all aspects of the lives of their citizens are not usually renowned for their Freedom.

    Sorry, I am sure you feel genuinely about this but past experience makes me reach for my extra-long bargepole.

    A.N.O. Nymous


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