Anecdotes, clips and pics; the blurry professional boundaries of Social Media?

We’ve all seen it; some may have done it.  Quick little one-liners “Oh my goodness, I can’t believe my patient did X….”, the ‘asking for help’ “84yr old Female, fell over her cat and *this* is the wound on her hip what would you do…?” or the educational “Look at this very unusual ECHO finding what is it <Insert Poll here>”.

Patients are interesting.  Patients have conditions that are really, seriously, impactfully educational.  Sometimes they present with something unusual and why not use the power of twitter to consult with experts; after all it’s the patient who will benefit in the long run, right?

Social media guidance varies by profession.  But I’m a nurse so let’s go with that one for now.

Nurses, midwives and nursing associates may put their registration at risk, and students may jeopardise their ability to join our register, if they act in any way that is unprofessional or unlawful on social media including (but not limited to): • sharing confidential information inappropriately; • posting pictures of patients and people receiving care without their consent; • posting inappropriate comments about patients; • bullying, intimidating or exploiting people; • building or pursuing relationships with patients or service users; • stealing personal information or using someone else’s identity; • encouraging violence or self-harm; and • inciting hatred or discrimination.

NMC Social Media Guidance

We have access to information that maybe nobody else does.  But what we do with that information is incredibly important.   Daily we weigh up and decide what to do with this information including how to act on it and how to record it.  Using this sort of information has long been an acceptable form of self-directed learning/ reflection and also educationally to help others in our profession.  How is this OK?  Well, we properly anonymise it and ensure we use it appropriately, respectfully and professionally.  Where possible, we gain consent from the patient and it is our responsibility to ensure that due process is followed.

Social media is tricky when it comes to privacy.  We can find ourselves being lulled into a false sense of intimacy with the person we are communicating with, especially when it comes to those long back and forth types of conversations; the paradox of personal dialogue in a completely public forum.  Some forms of social media may feel safer than others; but don’t be deceived.  There is no social media medium that is ever OK to share patient identifiable information and, I would suggest, information about a patient that is possible to trace back to it’s owner no matter how convoluted that journey may be.

So, what do we do then?  We want to enjoy social media, we want to learn, we want to share experiences that may help others.  Well, for guidance we can once again to look to our regulator which states:

“The Code emphasises the importance of putting the interests of people using or needing nursing or midwifery services first. You should always make sure that your behaviour on social media is in line with this.”

But it’s not just the law, or the regulator that govern our actions; we each have ethical frameworks we adhere to and use to influence and guide us.  Why do you want to post this particular anecdote or picture? A quip about a patient to discharge a frustration is likely to be very different in tone and content than one that is used for the purpose of education.  Can we change something about the information that still gets the general point across but reduces the chance of identification (different condition, different age, different gender, post days/ weeks after the event)?

Ensuring anonymity on social media can be incredibly difficult to achieve, especially when posting pictures.  We could be tempted to think that just because we post a picture of, for example an ECG, with no direct identifiable data that’s  OK, right?  Well, maybe. However, we rarely post run-of  the mill pictures on social media as part of the reason we post is to produce some sort of reaction even if that reaction is virtuous.  We should be careful about the possibility of identification through joining the dots  e.g. (and this is quite an extreme example!)  You post a picture of an ECG with the most dramatic ST elevation and a caption that seems fine; “Patient came into the cath labs with this ECG today, really interesting case”.  You’ve removed the ID.  All good.  Many comments from your nurse followers “Wow! look at that trace” “Is the patient OK?” “I’m surprised he survived with that ECG!!” etc etc.  The patient recovers and wants to thank the staff on the unit you work at so searches on twitter and comes across your profile.  He sees the picture, joins the dots realising that he was brought into the hospital on that date and at that time and is upset. He doesn’t want to post on the original post as it will directly link him to that data and so the first you hear about it is through a formal complaint through the Trust.  This is a hypothetical example of course; I don’t know of any case where this has happened but it’s more to think; could someone join the dots to find out that this is their picture and is this OK?  What would the consequences be if they did both for them as a patient and for you as a professional.

But I’m not *that* foolish, obviously I got consent first.  Well, great.  But there are a few things we need to consider even when we obtain consent!  Firstly, what was the consent for?  Was it for education, was it to teach others, was it to specifically post on social media?  Unless the person has a good enough understanding of social media to be able to weigh up the risks/benefits then I’d question it’s validity.  Think about where you are documenting the consent; a patient’s notes may not be appropriate especially if you are posting under a profile not connected to the Trust you work for (if you work for the NHS) with those all important words “All views are my own”…

What do you think? Do you agree, disagree? Is this all just a bit too theoretical? Please let me know! If you’re interested in finding out more, I came across this article that you might find interesting.