NHS in Cyberspace

The NHS in Cyberspace

February 2010


Simeon Bower

Simeon Bower

Users of social networking websites will be well aware of the presence of embarrassing photographs of friends and acquaintances but these websites also carry the risk of breaches of confidentiality.   A recent survey of American medical schools identified an alarming level of what can only be described as unprofessional conduct on blogs and social networking sites amongst medical students.

Over half of the 78 United States medical schools who responded to the survey reported cases of students posting unprofessional content on line.  1 in 10 of these contained violations of patient confidentiality. One posting contained enough clinical detail that patients could potentially be identified.

This is not a US only phenomenon.  Last year a paramedic in the UK posted an x-ray of a patient’s skull, with three nails embedded in it, on a social-networking site.   The paramedic had deleted the patient’s name and thought that because there were no personal details on the x-ray that made it anonymous.   However he failed to realise that the image was so unusual that the male patient could have been identified.  During the Trust’s investigation it was revealed that this was part of an activity that a number of staff had undertaken at the time.

There have been recent reports in the Press about a hospital worker in Scotland who was suspended after photographs of patients having operations were posted on Facebook.

Display of images on social networking sites has not been limited to patient material. Seven employees of an NHS Trust were suspended last year after pictures of themselves taking part in the Lying Down Game were posted on Facebook.

The US study acknowledged that medical students understand patient confidentiality and are aware of the ethical standards to which they will be held as part of the medical profession.  However it also identified a gap between principle and practice when it comes to social networking and internet blogging.  There is, apparently a generational divide between experienced clinicians on the one hand and medical students and junior medical staff on the other.  The study suggests that the junior staff tend more to “blur” the line between their personal and professional lives.  An alternative explanation is that young people perceive themselves as having an “internet persona” that is somehow separate from their real working life.

In practice this means that the less experienced are more likely than others to believe that their thoughts and opinions about their daily working lives were valid to post on line regardless of their potentially damaging or discriminatory impact on others.

Whilst the General Medical Council does not have specific guidance that covers blogging, all doctors and staff need to ensure that their conduct at all times justifies their patient’s trust and the public’s trust. Patient confidentiality is paramount and medical students and doctors obviously need to be very careful about any information they post on-line.

In December 2009 the Medical Defence Union warned members about the hidden dangers of social networking, citing a number of cases where patients had attempted to proposition doctors by sending them an unsolicited message on a social networking site. Members were reminded of the importance of keeping relationships with patients on a professional footing. The duty to maintain public trust in the profession extends to their private lives.

It is clearly beneficial that NHS bodies engage with staff and contractors and demonstrate the capacity to embrace new technology. Health organisations and medical schools have established a presence in the online world of Second Life. This has been both for training purposes and to engage with service users who are reluctant to access healthcare through more traditional methods. On line training packages are now very common within the NHS. Webcast seminars, discussion forums and blogs are increasingly part of this world. However it is also vital that staff and contractors are clearly aware of their obligations relating to confidentiality and that this extends to social networking sites and blogging.  NHS bodies need to be aware of these risks and policies relating to confidentiality and internet use need to be reviewed and kept up to date.

If you would like further information or if you require advice on any of the above, please contact us on: This email address is being protected from spambots. You need JavaScript enabled to view it.

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