Rules of consent and about respecting patient practitioner confidentiality always apply, even when you’re using social media.
What happens when you have a patient present with unusual pathology… you have never seen it before and you know that within seconds, a clever Facebook friend would help you diagnose and manage it, or an optometry Facebook group would give you an expert opinion in their subspecialty field of expertise?
Potentially, if it’s a rare life threatening pathology, by posting it, you’ve cut through the one month waiting list at the ophthalmology practice, and your quick thinking may have saved their lives! Does the end justify the means?
Alternatively, what happens when, bursting with excitement having helped a patient, you are keen to share the news with others on Facebook? What are the rules of consent and about respecting patient practitioner confidentiality?
… it’s important to be aware of social media etiquette and rules and responsibilities to make sure that you don’t unwittingly break patient practitioner confidentiality…
Whether you are constantly over-refreshing your newsfeed and over-sharing, or you’re still learning the ropes on Facebook, Twitter, Instagram and LinkedIn, it’s important to be aware of social media etiquette and rules and responsibilities to make sure that you don’t unwittingly break patient practitioner confidentiality, Optometry Board of Australia (OBA) or Australian Health Practitioner Regulation Agency (AHPRA) Guidelines.
Posting a Patient’s Case or Details
Even if it helps you with your patient’s diagnosis and management, strictly speaking, any images you share with others, require you to obtain express consent before sharing them. Even when consent is obtained, efforts should be made to keep details revealing the patient’s identity strictly confidential. Be careful about names contained in images that can be inadvertently revealed.
Ideally, consent should be written or recorded to protect you. As further protection, some optometry industry professionals suggest changing the patient’s initials or using a different name, age and gender, and changing any details that are irrelevant to the diagnosis being presented to reduce the patient’s chance of being identified.
AHPRA’s Social Media Policy1 makes it very clear that sharing unauthorised photos without patient consent is a definite breach of the patient’s privacy and confidentiality and should not be posted on any website or social media, no matter how ‘private’ or ‘invisible’ the group may be. When sharing any case studies, you must have express consent from the patient to share, and photos and information must be completely de-identified.
Most patients understand that sharing information with other professionals may help in their diagnosis and management and many respond very positively when asked for permission.
Social Media Optometry Group Rules
As well as acting in our patient’s interests, it’s also worth considering how we, as eyecare professionals, communicate with and treat each other online.
As professions go, it seems as though we are going through a phase of our angsty optometry teen years, as our mode of practice continues to diversify. And much like many angsty teens, it seems we are finding comfort in cliques.
Yet, if we are united in helping patients by delivering eyecare, why waste precious time infighting about practice types. Surely the quality of eye care that someone delivers should be our guiding principle, not the practice or store they work at. The famous early Greek philosopher, Lucius Annaeus Seneca, was attributed to saying, ‘One of the most beautiful qualities of true friendship is to understand and to be understood.’
Seek to understand and respect others for our commonalities and we stand to benefit in our common purpose.
There are no written guidelines from AHPRA or the OBA, as far as I am aware, about inter-professional social media rules. However, as a general rule of etiquette, being respectful to fellow colleagues should be an unquestionable, essential part of our online interactions. It’s important to think before you post… online bullying over any platform, social media or otherwise can cause some serious harm.2
Different social media groups have different site administrators, so any issues should usually be reported firstly to the group administrator. Any offensive or discriminatory comments can also be reported to the social media site directly (if it’s Facebook, right click the mouse on the comment or post to report it).
Fitzgerald vs. Escape Hair Design
In the case of Fitzgerald vs. Escape Hair Design,3 an employed hairdresser posted on her Facebook expressing discontent about working on Christmas without pay. She wrote, “Xmas Bonus, alongside a job warning, followed by No holiday pay!!! Whooooo! The Hairdressing industry rocks man!! AWESOME!!”
Her employer dismissed her from her position and considered it a fair dismissal given she posted a public display of dissatisfaction on Facebook and it could have affected the business’ reputation. The employee brought an unfair dismissal claim against her former employer.
The court accepted that internet interactions, even completely outside of work, are capable of bringing the employer’s reputation into disrepute, and could be considered connected with the duties of the employee.
Fortunately for the employee, only her friends were permitted to view her Facebook posts. The employer was unable to prove that any of her Facebook friends were clients of the hairdressing firm, and the court took into consideration that there was no exact mention of the business name, which limited the damage the comment could have made to the particular business question.
Had the employee’s Facebook profile been inadvertently set to ‘public’, a different outcome would have been likely.
What You (Should and) Shouldn’t Say
Luke Arundel, National Professional Services Manager at Optometry Australia, said optometrists need to carefully consider who might see their post and remember their professional obligations.
“We have had patients commence disciplinary proceedings or sue members for defamation over comments and images posted on social media. Please think before posting and don’t write something you wouldn’t say to someone’s face. There is no writing on the internet in pencil – even if you delete a post later on, that ‘hilarious’ comment you posted after a few drinks may have already been shared by friends (and then friends of friends), cached or a screen shot taken of it.
“Remember that online sites will often have the default option as ‘share publicly’ and can update or change privacy settings without notification, so it can be useful to review your publicly available profile regularly (or have a work/public account and a pseudonym for personal use).”
“We are also now living in an age when you can be fired from your job for conduct outside work hours… courts are guided by whether an employee’s conduct is likely to damage the employer’s interests, and an employee’s contract may be terminated.”
“Large companies now have social media policies and I would encourage smaller business owners to make sure they have a written policy in place so that staff understand expectations for personal and professional social media use. Our AVANT legal team has written a practice note for members which discusses this further, and it’s available on the Optometry Australia website.”4
Margaret Lam is an optometrist in theeyecarecompany practices in greater Sydney and Sydney CBD and an Adjunct Senior Lecturer at the School of Optometry and Vision Science at UNSW. She also works as the Head of Optometry Services for George and Matilda Eyecare. Margaret practises full scope optometry, but with a passionate interest in contact lenses,retail aspects of optometry and successful patient communication and management. She has extensive experience in specialty contact lens fitting in corneal ectasia, keratoconus and orthokeratology and is a past recipient of the Neville Fulthorpe Award for Clinical Excellence.
Margaret writes ‘mipatient’ on alternate months with Jessica Chi.