10 tips: Social Media Highway Code for doctors

New technology has often been risky. Consider the 1865 Red Flag Act in the U.K. that required all self-propelled motor vehicles to travel at a maximum of 2 mph in towns, and to carry at least three people – one of whom was required to walk ahead of the vehicle with a red flag to warn pedestrians and horse-drawn traffic.

This caution was necessary because cars were so unfamiliar to the majority of road users – except for those we’d now call the “early adopters” of automotive technology.  When cars were first introduced, there was no shared understanding of the rules of the road (or highway code) to help guide people on how they should behave. And so avoidable accidents happened frequently.

But as more and more people bought cars, the principles of safe driving became codified, shared and widely understood. Road safety was correspondingly improved compared to the chaos that had necessitated the implementation of the Red Flag Act.

In many ways, the experience of social media use has much in common with these early days of the motor car, according to the physicians who have drafted the new Social Media Highway Code being launched for U.K. doctors and other health care professionals by the Royal College of General Practitioners (RCGP).

The guide authors remind us that for younger doctors, the use of social media is already the norm. For example, a 2011 survey found that 100% of medical students had Facebook accounts.

These kids have likely been uploading their drunken party photos to Facebook and Tweeting their Starbucks orders long before they got accepted into med school.

Speaking of med school, nearly every accredited medical school now maintains its own Facebook profile too (Kind et al, 2010). But of those, only 13 of 128 med schools surveyed by Kind reported writing any social media policies to support its usage.

Stony Brook University in Long Island is one school that did announce last summer that it was developing a revised social media ethics policy after a medical student there posted a photo on Facebook of a classmate posing with a thumbs up next to a dead body.

For many young people like this, there may emerge some surprises about just what’s appropriate or inappropriate on social media.

So here’s one basic tip for the clueless: don’t post thumbs-up shots of people posing with dead bodies.

Other social media pitfalls for med students and doctors alike might include:

  • loss of personal privacy
  • potential breaches of confidentiality
  • online behaviour that might be perceived as unprofessional, offensive, or inappropriate by others
  • risks of posts being reported by the media or sent to employers

The chances of these things happening are actually surprisingly high, according to a 2011 survey* of doctors’ social media use reported in the British Medical Journal, in which 88% of medical students and 80% of residents reported having viewed colleagues behaving “unprofessionally” on Facebook. See also (no, I am not making this up): Distracted Doctoring” – Updating Your Facebook Status in the O.R.

I’ve written here previously about the oft-cited case of 48-year old E.R. physician Dr. Alexandra Thran who learned the hard way that she really shouldn’t be chatting about her patients on social media. She was fired from her Rhode Island hospital and subsequently reprimanded by the state medical board because she had posted personal information online about one of her trauma patients. Although her Facebook post did not include the patient’s name, she violated the patient’s privacy rights by writing enough that others in the community could easily identify the patient, according to the board filing.

The U.K. doctors who drafted the Social Media Highway Code explain that it’s often younger, less professionally-experienced doctors who “may need to consider how to adapt their habitual online behaviours to take account of their less familiar professional responsibilities”.

Conversely, senior and more experienced doctors “may have a responsibility to become more technically skilled and social media-savvy”.

The new Social Media Highway Code boils down to these 10 principles:

1.  Be aware of the image you present online and manage this proactively

2.  Recognize that the personal and professional can’t always be separated

3.  Engage with the public but be cautious of giving personal advice

4.  Respect the privacy of all patients, especially the vulnerable

5.  Show your human side, but maintain professional boundaries

6.  Contribute your expertise, insights and experience

7.  Treat others with consideration, politeness and respect

8.  Remember that other people may be watching you

9.  Support your colleagues and intervene when necessary

10. Test out new ideas, learn from your mistakes – and have fun!

The RCGP has also set up a Facebook page for the new Code. The draft of the  Social Media Highway Code is now available online.


* 6 Osman A. Is it time for medicine to update its Facebook status? BMJ 2011; 343: d6334

See also:


Q: Do health care professionals need a guide like this to inform their social media usage?


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