Where does duty of care start and end in social media spaces?

Where does duty of care start and end in social media spaces?

Where does duty of care start and end in social media spaces? This was a question I was asked by clinicians at a workshop I recently ran for an eating disorder service. They were referring to the duty which all NHS practitioners have to care for their patients in a safe and professional manner and to ensure they do not suffer harm.

 “What if I recommend an app and my patient has a bad experience?”

“What if I blog an opinion piece about a new treatment and a patient takes an action as a result which causes them harm?”

“What if I recommend a Twitter chat and it triggers their distress?”

Managing expectations

This reminded me first and foremost about the importance of practitioners being clear about their own boundaries, as well as managing expectations of others, carefully and professionally in social media spaces (just as you would do in other contexts).

The online/offline comparison test

Secondly it struck me that the issues are similar, if not the same, to those arising in offline contexts – maybe it is unfamiliarity with social media that results in nervousness from some practitioners.

For example, what would a practitioner do when helping a patient find opportunities to share support with people who have similar experiences – perhaps a support group?  They might do a bit of research – find out who runs the group and get recommendations from other people. They might talk through the pros and cons of attending the group so the individual can make their own informed choice. They might then check in with them at a follow up appointment to see how useful it has been.

The same approach can equally apply to an online support group, although there may be additional factors to consider in relation to confidentiality and privacy/public.

Being familiar with social networks

Practitioners routinely support people to take positive risks as part of their recovery. Social media offer new opportunities for building relationships and sharing support. There are also risks. But because practitioners are often less familiar with social media they are less confident in helping people they care for think through the pros and cons. This is why I think it is so important for practitioners, whatever their personal attitudes, to familiarise themselves with online social networking.

How should practitioners respond to changing expectations?

The Royal College of General Practitioners (RCGP) social media highway code acknowledges that people’s expectations of seeking health information and advice is changing and it is likely that people will increasingly expect clinicians to respond to online requests for advice:

Over the next decade, the provision of information and advice to the public through online tools will be an interesting area of evolving professional practice and further research into this area would be welcomed.

They suggest that practitioners needs to find ‘professionally acceptable’ ways of responding to this shift in expectations and suggest that not doing so could disadvantage people who face barriers in accessing traditional health services.

This is a fascinating area for me, particularly as we recently received for the first time, a crisis tweet from someone using our NHS Trust services. It appears that people are increasingly willing to share highly personal information on public social networks in order to access help and support.

A few tips

The RCGP have some useful tips which I’ve summarised below:

  • Avoid personalised advice in favour of general comments and signposting
  • Direct people to appropriate channels for information and advice
  • If you get an urgent request that requires an immediate response you should act in the best interests of the patient and follow your professional obligations.

And I would add:

  • Make it clear in your social media biography that you don’t give individual advice
  • Help people you support think through pros and cons of digital tools and social networks
  • Review this conversation on a regular basis.

 What do you think?

 Is this reasonable advice and does it go far enough? Are there other issues I haven’t considered? Let me know what you think J

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