The risks of posting in closed online forums

Doctors-only online forums are becoming increasingly popular within the profession, but are they entirely safe? The MDU's Dr Nicola Lennard and Dr Ellie Mein outline the possible risks.

With GPs experiencing increasing levels of stress, social media forums can provide a useful outlet to discuss the pressures of the job - sharing ideas, voicing frustrations and raising questions with colleagues.

Many forums popular with GPs are ‘closed’ groups purporting to allow discussions in ‘members only’ areas.

But are these doctors-only forums entirely safe and is there potential for the information posted there to leak to the wider world?

The GMC guidance Doctors' use of social media outlines the general principles for doctors to consider when posting online.

The GMC emphasises the importance of patient confidentiality explaining: ‘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. You must not use publicly accessible social media to discuss individual patients or their care with those patients or anyone else.’

Closed forums

The use of a closed forum can create an illusion of security but it is important to be mindful that some of these forums will have hundreds or thousands of members. Although some closed groups will require doctors to provide their name and GMC number before they can join, it is not always possible to verify identities online and a doctor’s GMC number is readily available to all online.

Not only may this mean the forums are accessible to people outside the profession, but it is important to bear in mind that it is not unusual for one doctor to raise a complaint against another. The GMC's 2016 annual report shows that 9% of complaints about doctors received in 2015 came from another doctor.

We may share a common profession, but what one of us finds funny, another user may not. Worse, comments can be taken out of context or misunderstood and it is all too easy to inadvertently cause offence. 

Discussing patients

If you are tempted to discuss an individual case, it helps to remember that doctors have friends and relatives too, who from time to time will need to seek advice from their own doctor. Can you be sure that the case you are discussing will not be recognised? It is of course possible to remove identifying information from the post but it may still be possible for the patient to be identified by the sum of the information published.

Another important consideration is the potential for someone within the group to take a screenshot of your post,and publish it in another forum. Would you be happy for your post to be shared with a wider audience and possibly with no reference to the original context in which it was made?

There have been some high profile cases reported in the media where derogatory comments about colleagues or patients have led to doctors being reported to regulatory bodies by other social media users. Figures obtained by BMJ Careers found social media sites like Facebook and Twitter contributed to at least 13 complaints about doctors made to the GMC in 2015 and 11 in 2014.

The GMC acknowledges the importance of social media in engaging the public and the profession in discussions about health and helping to establish national and international professional networks. Doctors however need to be aware of the potential problems and risks when posting their thoughts online.

The MDU’s advice is that prior to posting, even in a closed group, consider what the purpose of the post is and who may read it. Could it potentially identify an individual and what could be the repercussions if the post was reproduced elsewhere? If you are unsure, it may be best to alter your post, or not to post the content at all.

A scenario highlights the risks

Take the following fictitious scenario, which is representative of the increasing numbers of queries the MDU sees about social media:

A GP saw an elderly patient in clinic with a significantly raised tumour marker. The GP had not previously seen a test for this tumour marker return such an elevated result.

After work the GP posted in a closed Facebook group for doctors with the suggestion that they play 'top trumps' and shared his patient's blood test result. Several other doctors then posted the highest level of the tumour marker they had come across.

A few days later the doctor got a private message from another GP in the group who had seen his post. She explained that her father had called her with the bad news that his tumour marker was raised and was audibly upset by this.

She also explained that when she had read the original GP's post she realised it was describing her father's case. She was able to confirm her suspicions by doing an online search for the GP's name which showed he worked at the practice where her father was registered.

She was extremely angry that her father's health and recent bad news had been used for humorous 'banter' online. She demanded a written apology and explanation to be sent to her father with the threat of a GMC referral if she remained dissatisfied.

The MDU member was given advice on how to approach this complaint, and after a written response and a meeting with the patient and his daughter no further action was taken. The daughter was able to explain to the GP in person how unprofessional and disrespectful she had found his post, particularly at a time when her family had received bad news. The GP appreciated this and sincerely regretted the distress his post had caused.

  • Dr Nicola Lennard and Dr Ellie Mein are medico-legal advisers at the MDU

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