Firstly apologies for the slow updates of late. I am ‘away from the desk’ so to speak, having a lovely time and all, but there are certain restrictions on internet access!
Anyway……..the GMC guidance has arrived.
Most if not all doctors should have received an email from the GMC today regarding an update to General Medical Practice which is the code of conduct for all doctors registered in the UK. If you haven’t read it already you really should as it serves two major purposes in my opinion.
- 1. It tells you what you should be doing as a clinician.
- 2. It tells you what you should not do if you want to stay working as a clinician.
That may sound ominous but as doctors we hold priviliged positions in society and it is important that we behave in the best interests of our patients. So have a read, but in particular have a look at the explanatory notes regarding doctors use of social media as I believe that this is an area that worries many social media active docs, even those that I really repect like Jeremy Harrison.
@EMManchester Hmmm ... Should I stay or shall I go? Not really bothered about personal vs professional before. Now wondering what to do.— Jeremy Harrison (@resusdoc) March 25, 2013
One of the big changes will be that doctors are instructed not to use pseudonyms on social media types like twitter. This will mean a big change for many docs who prefer to separate the two. I took the advice of Mike Cadogan last year (@sandnsurf) that it is best to tweet with my real name as it can be traced back anyway and it you’re less likely to say something stupid if it has your real name attached. That works for me, but not for all people in this space and I suspect we will see some great contributors leaving (though hopefully they might return with real name intact).
Thankfully and wisely the majority of the advice in regard to social media use is largely a reflection of the GMC’s advice in all other areas, though it recognises that the environment of social media means that new circumstances exist in which traditional principles apply, but where they might need clarification.
So, this is mostly a reiteration of old guidance re-organised to reflect social media environments and that’s fine. What is particularly important to me, and I think to many others are those areas where the relationships with patients might be compromised. Foremost here is the re-iteration of the rules around confidentiality. They are worth repeating……
12 Many doctors use professional social media sites that are not accessible to the public. Such sites can be useful places to find advice about current practice in specific circumstances. However, you must still be careful not to share identifiable information about patients.
13 Although individual pieces of information may not breach confidentiality on their own, the sum of published information online could be enough to identify a patient or someone close to them.
14 You must not use publicly accessible social media to discuss individual patients or their care with those patients or anyone else.
If you spend a lot of time communicating with colleagues in other health systems around the world you will soon realise that the rules with regard to confidentiality do differ depending on your area of practice and your local regulator and I see this is a potential area where UK doctors could get caught out. A look over my twitter timeline on any day of the week would find examples of international colleagues potentially breaking elements of the above and I can imagine that it would be all too easy to join in with a local patient story that strays across into a breach of confidentiality. In particular point 13 alludes to unintentional linking of information such as times and places that are often revealed through twitter. A common example might be ‘a patient has just walked in with X wrong with them’, in general it is pretty easy to work out who posted this, where they work, and what kind of work they do. All too easily it can then be linked to a patient and trouble ensues.
So what are we to do? Doctors and indeed all clinicians have used patient stories to teach and learn since the time of Hippocrates and we still do, though usually in closed spaces that are bounded by time and place (the traditional grand round for example). However, with the potential sharing of real cases in the social media space and even via the broadcast (webcast) of traditional meetings we do risk allowing what was once enclosed information to seep out through the porosity of social media, sometimes far beyond where it was first intended and with the potential to deliver harm to patients, relatives and colleagues.
“To study the phenomenon of disease without books is to sail an uncharted sea,
while to study books without patients is not to go to sea at all.”
Well, like clinicians of old we feel that if cases must be used to deliver key teaching points (and they often are) then the way forward is for them to be created, imagined, developed and perhaps inspired by reality but that they should remain distant from the truth and not reflect people or circumstances that link them to individuals. Whilst this may arguably detract from the fidelity of any story it seems that this is the sensible and safe way forward for ourselves and colleagues who seek to improve patient care through social media. This is essentially the same process as writing for text books for publication. It is presumably fine to talk about typical presentations and circumstances but not in a way that risks revealing a person, time or place.
However, I am still a little concerned about the potential for misinterpretation and coincidence though. We had a case on St.Emlyn’s (non clinical) where a colleague thought that it was talking about them. It was not and but was in fact based upon a made up scenario, but like all the best made up scenarios it was believable – so believable in fact that it mirrored the identity of a different physician. This was entirely accidental and resolved quickly through professional conversation. However, such a co-incidence might be more tricky to manage with patients. For example if I started a case with…..
“A woman in her 20′s is brought to the ED following a fall whilst intoxicated. She has
fallen onto her outstretched hand and is complaining of pain in the wrist……’
Clearly there have been many such cases, you can also work out where I work, and I might associate an anonymised X-ray of a scaphoid fracture as an illustration to invigorate a blog post on imaging for occult wrist fractures. Could this land a blogger in trouble? There are two questions for me which are not covered in the guidance.
- 1. To break confidentiality does the ‘patient/doc/colleague/relative’ have to notice or can such a breach be reported by others (important as there are people out there who might enjoy reporting bloggers).
- 2. Is co-incidence a defence, because if it isn’t then I suspect William Osler might be spinning in his grave.
So, these are interesting times, with a range of media that might catch out the unwary. I also wonder if this is the start of a much wider debate, in days past the authorities found it difficult to silence the printing press, but in the meantime my advice is to think carefully before posting.