The Perils of Social Media

I am a GP trainee & last year during hospital placements I came close to disciplinary measures following an incident on Facebook. Facebook is something that the majority of people including doctors use these days & so I wanted to raise awareness of the potential risks and pitfalls when used by people in the medical profession.

Another doctor in the hospital posted a photo taken of a section of a patients notes onto Facebook. The notes did not state the patients name or where they’d come from. However they gave a detailed description of a review written by a junior doctor on ward cover.  Myself and numerous other colleagues wrote a ‘comment’ underneath this photo displaying a variety of responses.

A while after this event it came to surface that through Facebook many people had seen this photo & someone reported it to the trust. Myself and all other people who made a comment were then required to attend a meeting and give our opinion on the event. After a very stressful time waiting to hear the outcome, fortunately things went no further for me. However there are certainly some important things to take away from this.

It’s easy to forget that Facebook is seen by so many different people. Despite adequate privacy settings, still photos & comments can find their way around to people you don’t even know via other peoples pages. Certainly something such as posting patients notes is a clear breach of patient confidentiality. However even other things such as making a comment, or updating your status regarding something you’ve seen at work or a patient you saw could be seen by countless people and taken in the wrong way.

When using Facebook it is worthwhile just thinking twice about what you’re posting. Remember that it could be seen by people you weren’t intending to see it & there may be consequences for this. Undoubtedly anything which breaches confidentiality or comments which could make doctors or the trust look bad/unprofessional to the public should be avoided. 

I’ve certainly learnt from my mistakes following this event. I still use the website to keep in touch with friends, but I’ve made the decision to not mention or be involved with anything to do with work on Facebook now.  I hope that this entry can raise the awareness of the potential risks of Facebook in the medical profession and hopefully help other people avoid the same mistake I made.

What's on your iPad?

I have recently been called before senior Deanery members and faced the potential of disciplinary measures as the result of my actions and inactions with respect to recordings of consultations. I would like to share with others so they might benefit from the lessons I have learned.

I had experienced some problems with the playback of consultations on the recorded media at my practice. As a result I was worried that I would not be able to provide recordings for various training events where they were required and requested of me. I decided to record two consultations on my iPad as I knew that this would be able to successfully play-back if all else failed.

My supervisor asked that I should transfer the recordings onto DVDs which I tried but it was not successful so they remained on my iPad. After I had used the recordings on the iPad I had intended to delete them directly but could not remember if I had done so. I rushed away on holiday and took the iPad with me. This was potentially a significant error on my part and one I accept responsibility for and I cannot excuse. I am still unsure whether I had deleted the files or not. I think this is just one of the problems about using something like an iPad, as deleting files is not as tangible as shredding a DVD for example.

Unfortunately the iPad was stolen from the boot of the car whilst I was on holiday. The theft took place within the 90 seconds of me leaving and then returning to the locked car.

Unfortunately at the time of the theft the iPad was not PIN protected which I now deeply regret, as it means any recordings which had not been deleted, were as accessible as if they had been a DVD or Video Recording. I have been and remain deeply sorry and upset for the patients who put trust in me to keep safe the recordings that they had consented to. The GMC guidance is clear that we are responsible for all recordings and that they should be treated with the same level of protection as patient’s notes and other records. I have let those patients down and also my practice and Supervisor. The PCT have had to be notified and the Practice will come under their scrutiny for information governance. Apart from the potential for enormous fines for data loss, the practice and partners could also suffer from the loss of the trust of patients and also any negative publicity something like this could cause the practice. I feel deeply sorry and responsible for the hassle and upset I have caused to all concerned.

I would advise everyone to think twice about recording anything on a personal device of any sort. A personal device is not the place to have these recordings, pictures or any sort of patient information. You should use the devices and recording media provided by your practice. If you take recordings out of the practice, as we are regularly instructed to do for teaching purposes, you should ensure that you can protect it like patients notes and if you can’t do this then don’t expose them and yourselves to the risk. I would encourage people to learn from my errors and to treat all recordings with due reverence. Please remember that just like any action or inaction which results in harm to a patient, you will be judged in the cold light of day. If you cannot satisfy yourself that they are safe then you owe it to the patients to make the right decision and do the right thing.

On a very practical level I have discovered through my experience that with iCloud it is possible to track iPads and iPhones by enabling the findmyiPhone/iPad function. It is also possible to remotely wipe them; deleting all the files on the device if it is somehow opened and connected to the internet. It is best of course not to be in this position at all.

I was unsure whether I had deleted the recordings so I reported this to my supervisor. This was escalated to the Deanery and I have had several meetings with senior members of the Deanery team. As my actions and inactions have potentially breached GMC guidance I have had to face the potential of being referred to the GMC with ultimately the consequence of disciplinary action, suspension or even loss of my licence. This has been an utterly terrible month and one I would not wish anyone else to endure, yet I obviously understand and accept that I must be investigated appropriately. The worst thing about it is that I may have hurt or upset patients or caused their trust in their doctor to be severely challenged or broken. I am deeply sorry for this and hope that in writing this I can help others to avoid a similar situation.

How not to sign off DOPS - why eportfolio is more than a tickbox exercise

We are two GP trainees, a few days into our ST3 year. We have been very lucky and have had some great placements during our training so far, which we have thoroughly enjoyed. However, earlier in our training, we made some silly mistakes, which could have resulted in very serious consequences. We are therefore writing this, to try to raise awareness for other trainees and to try to help in preventing anyone else from facing the potential serious consequences that we have.

During our clinical posts, we have always found the eportfolio difficult to maintain and keep up to date. We have tended to allow it to take a back seat, while our focus has been on our day-to-day jobs and patient care. We often saved up eportfolio entries and updated them in one go. We also had assessments completed in a similar manner, whereby we would ask an assessor to complete the form some time after the event and we often found it difficult to ask for assessments to be done, as we felt the assessor had more important tasks to do. We considered the forms as more of a tickbox exercise to get completed, rather than an actual assessment of our clinical skills and competencies. We felt that if our team, our consultant and our patients considered us to be good doctors and that we had performed well during that post, the forms were more of a formality.

However, we recently spent three of the worst weeks of our life learning otherwise.

During one of our posts, we asked a fellow GP trainee to complete two direct observed procedure (DOPs) assessments for each of us for 2 examinations, which we had performed earlier in the job, but that they did not directly observe. At this time, we were also asked us to complete assessments for him for procedures that we had not witnessed. We both considered that we were competent in the skills in question, having performed them many times previously. We completed the forms in the spur of the moment and did not take time to consider our actions either at the time or at any point following. Therefore, we were completely taken aback and shocked (to put it mildly), when we received an email following the ARCP panel, asking us to attend a meeting to discuss these assessments. The email outlined the issues of probity and fraud and highlighted cases of other doctors, who had been referred to the GMC. We could not believe how stupid we had been. A few minutes of stupidity and lapse in judgement could result in the career, which we love, being completely ruined. We knew that we had not meant to deceive anyone and that we had made a very silly mistake and not thought through our actions, but we now realised the significant issues that arose from this and the potential consequences that could result.

Due to the serious nature of the incidents, we did not receive an outcome after the initial meeting and were contacted by the Director of GP Education the following week. We felt incredibly relieved that both he and the Postgraduate Dean concluded that whilst we, and our fellow GP trainee colleague, had been exceptionally stupid, that it did not warrant referral to the GMC. We are very aware of how close we were to being referred and the effects that it could have on the rest of our career.

We know that we will never forget the events of the last three weeks, which have been the most stressful we have experienced in our life, and the way we have felt. A few minutes of thought and consideration of our actions and the potential consequences would have stopped us from doing what we did. We are already, and will continue to be, sure that we put into practice the lessons that we have learnt from these recent events and we have no doubt that they will continue to affect us throughout our life, both at work and away. The ARCP panels are very thorough and we would not want any other trainee to go through a similar situation.

We would therefore advise other trainees to learn from our mistakes and to prioritise their e-portfolios, as they are a vital part of our training. Please take extra care when asking for assessments to be completed: It only takes a few minutes to discuss with an appropriate assessor before you complete the assessment and then another few minutes to complete the forms afterwards but, from our experiences and having learnt the hard way, we can definitely assure others that this is time very well spent.

Commentary by Dr John Edwards, Associate Post Graduate Dean for Assessment

This case is an example of a failure by these two trainees to sufficiently recognize the following issues:

  1. Work Place Based Assessments constitute one third of the MRCGP examination process with the same standards of probity and honesty expected as for the CSA or AKT.
  2. The ARCP panel process is thorough and will scrutinise a selection of portfolios in great detail.
  3. Any suspicion of dishonesty will be investigated by the Deanery and dealt with appropriately according to RCGP regulations and GMC guidance.

Social Media Highway Code - RCGP guidelines

The Code of a Conduct for the MRCGP - the relevant excerpt is copied below.

We hope that this account will prove a useful lesson for all our trainees.

Duties of a doctor

All registered medical doctors have a duty placed on them by the General Medical Council (GMC) to be honest and trustworthy. Candidate performance in Workplace Based Assessments is reviewed by doctors who themselves have a duty to notify the GMC if they have concerns.

Misconduct before, during or after assessments or evidence of lack of competence may be referred to the GMC. Candidates whose GMC registration (or its equivalent overseas) is subject to suspension, referral or any condition must provide the RCGP with full details.

General Principles for All Trainee ePortfolio Users

The College expects all users to conform to acceptable and appropriate standards of behaviour when using the Trainee ePortfolio and undertaking Workplace Based Assessments.

This guidance is given in the expectation that users will exercise an approach consistent with standards expected by the General Medical Council, or the appropriate regulatory body, and/or your employing organisation.

Fraudulent misuse of the Trainee ePortfolio is an extremely serious offence. This would include any form of impersonation and also making entries that are deliberately misleading or malicious, particularly those that relate to assessments.

All allegations of misconduct and fraudulent misuse will be dealt with in accordance with the MRCGP Regulations