Social media: how to reap the benefits and avoid the pitfalls

The number of people posting, tweeting, and uploading grows daily. This year, the number of monthly active users of Facebook passed 1.1 billion for the first time.1 Twitter now has 288 million active users every month, and is the fastest growing social network in the world by active users,2 while YouTube has one billion unique visitors every month.3

Doctors are no different from other individuals when it comes to enthusiastically embracing social media, and they use it in various ways, from tweeting about health conferences to posting about personal interests. But, unlike many other people, doctors are particularly vulnerable to the pitfalls of such online activity because of the sensitivities associated with the work they do. Difficulties associated with doctors using social media sites can involve potential breaches of patient confidentiality, as well as patients starting arguments or upsetting people—including doctors—by posting inflammatory messages.

Doctors may also receive Facebook requests from patients and not know whether to refuse them. They might also reveal too much about their personal lives on social media sites, or post pictures that could have a detrimental effect on their professionalism.

Some doctors have already caused problems for themselves through their use of social media. In 2009, members of staff at a hospital in Swindon, including doctors, were suspended after being pictured on Facebook lying face down on resuscitation trolleys, ward floors, and on an air ambulance helipad. There was also the case of a junior doctor suspended for posting comments on the doctors.net.uk discussion site that were viewed by senior doctors as being abusive. In an open letter on the site, the doctor called for Carol Black, the former president of the Royal College of Physicians, to resign and described her perceived role in the roll-out of the Medical Training Application Service and the development of Modernising Medical Careers (MMC) as “shit.” The doctor was suspended by his trust for six weeks, despite the posting being promptly withdrawn and an apology offered.

As social media become an increasingly popular forum for doctors to air their views, various bodies representing the interests of doctors have published guidance on the use social media, including the BMA, Medical Defence Union (MDU), Royal College of General Practitioners (RCGP), and General Medical Council (GMC).

When the GMC published its guidance in March,4 it was criticised for its stance on anonymity. Some doctors disliked being told: “If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name.”

Simon Wessely, chair of psychological medicine at the Institute of Psychiatry, King’s College, London, says that it is “unfair that double standards are being imposed on doctors using social media.” “The GMC says you should identify yourself but why should doctors be different from anyone else?” he comments.

“While it’s not clever, doctors are entitled to behave badly on social media if they want to as long as they’re not at work,” he adds. “They’re entitled to a social life and, if they want to show pictures of themselves drunk, it’s silly—but it’s not an offence.”

Doctors may think it is unfair that they are under pressure to restrict their use of social media and that they are particularly vulnerable to its pitfalls by virtue of the work they do. But they are also taking advantage of the potential benefits.

Some doctors who initially had concerns about using social media, such as whether it might prompt negative comments, have since become avid users. Wessely has gained 1900 followers on Twitter since he started using it in January 2013. He was worried that joining Twitter might prompt a spate of negative comments, “but I have been pleasantly surprised,” he says.

He finds Twitter is “a good way to engage with other doctors” about personal interests and uses it to discuss psychiatry, military health, and contemporary history. He also tweets links to medical papers, and comments on major events and debates associated with psychiatry.

Doctors say that they like the immediacy of Twitter and that it gives them an opportunity to share their views with like minded individuals. Clare Gerada, a London based general practitioner and chair of the RCGP Council, has 18 500 followers on Twitter. She says that she enjoys tweeting because “it’s quick, informative, and means I am involved with a network of people who have similar views to me.”

Senior doctors find social media useful for keeping up with developments in medicine. Humphrey Scott, head of the school of surgery at Health Education Kent, Surrey, and Sussex, says: “I like to use Twitter to keep up to speed with what is happening in the medical world and to share that information.”

Trainees are also taking advantage of the benefits social media can offer to help them progress their careers. Natalie Blencowe, a general surgery specialist registrar in Bristol, who is currently working on a PhD, says she finds Twitter “helpful from a clinical and academic perspective.” “There are lots of benefits to Twitter,” she comments. “It can help connect you with other clinicians or academics working in the same area as you, who highlight interesting research that unless you read every single journal, could take months to know about. And it’s a great way to work with other doctors to collaborate on research.”

Social media can be a useful means for doctors to raise awareness about medical politics, and become involved in it themselves. Clive Peedell, a consultant clinical oncologist at James Cook Hospital, Middlesbrough, and member of the BMA council, started using social media eight years ago. He posted messages on doctors.net.uk about MMC, which he says helped to galvanise 12 000 doctors to march in London in protest against it.

He now takes advantage of the benefits of social media, particularly Twitter, to promote the National Health Action political party, which he co-leads.5 “To get into medical politics these days it’s now essential to use social media—and Twitter is crucial,” he says. “The National Health Action party, which aims to keep the NHS in the hands of the public, now has 11 500 followers. Thanks to the power of Twitter, membership has been boosted and it has also allowed us to build a party infrastructure.”

Health organisations are also using social media to raise awareness about healthcare issues and the work they are doing. According to Gordon Fletcher, the BMA’s social media manager, the BMA sees social media as providing “an opportunity to interact with other doctors, the public, journalists, politicians, and stakeholders to share accurate healthcare information and influence debate.”

Fletcher says that Twitter is a useful way for the BMA, which has 25 000 followers, “to get prompt feedback from doctors about policy issues and to encourage members to talk to each other.”

Not every doctor is a fan of social media. Keith Hopcroft, a general practitioner in Essex, refuses to go on Twitter. “I think it’s a narcissistic, self indulgent, and a potentially inflammatory time waster,” he says.

Although he acknowledges that social media might have a few advantages, his “overwhelming fear is that it could provide yet more ways of patients contacting doctors—generating work and costs rather than efficiency.”

Social media may also cause difficulties for doctors when the line between their personal and professional lives becomes blurred. Fletcher advises doctors using social media sites not to befriend patients, because “it means that they [patients] can potentially know things about your life which you wouldn’t disclose as a doctor.”

Doctors should always bear in mind that posts can be reported in the media and read by colleagues or patients. “It is also important to respect patient confidentiality and not get drawn into posting material that could be perceived as unprofessional, offensive, or inappropriate,” says Fletcher.

Natalie Hayes, medicolegal adviser for the MDU, stresses that, even if doctors set their security settings to the maximum levels available, “you can’t be 100 per cent sure of your privacy.” “Bear in mind not to post anything on a social media site that you wouldn’t be happy for anyone to see,” she says. “If you feel a patient or colleague might be uncomfortable with what you have posted that’s an indication it probably shouldn’t be out there,” she comments.

Although a wealth of guidance is available to support physicians on how to use social media, doctors have also developed their own personal set of rules to help avoid its pitfalls.

Gerada advises: “Never tweet when drunk, always assume what you say is in the public domain, don’t engage with patients on a clinical level—it’s a boundary issue—don’t tweet something you can’t substantiate, and know where the delete button is.”

Wessley stresses the importance of not reacting to people who are abusive online. “Be polite, be civil, and often you will find others will ‘police’ offensive comments and the ‘abuser’ will drop out of the conversation.”

Having several Twitter accounts is a useful way of promoting distinct interests, as Sarah Burnett, a radiologist in London, has found. “I have a straightforward medical account in my name, which I use to tweet general lifestyle and health tips,” she says. “It’s very positive, and totally non-political. This means it’s also rather boring, and has fewer followers than any other account. I also have an anonymous account, my friends know it’s me, but no one could find me by searching for my name. I have a further account to promote my jewellery, which I make and sell for charity, and even one for my dog.”

Burnett’s top tip for doctors using social media is: “if your friends are prone to tagging you in photos, remind them to check that it’s ok with you first. No one wants to see a picture of their gynaecologist drunk in Ibiza.”

Doctors considering using social media should be aware of not only the dangers, but also the many benefits it can offer. Blencowe says: “No matter what kind of doctor you are, there will be some benefits for you—so give it a go.”