Social media: How to meet your obligations under the National Law

Social media is a term that is constantly evolving but generally refers to internet-based tools that allow individuals and groups to communicate, to advertise or share opinions, information, ideas, messages, experiences, images, and video or audio clips. They may include blogs, social networks, video and photo-sharing sites, wikis, or a myriad of other media, used for¹:

• social networking (Facebook, Twitter, WEChat, Weibo, WhatsApp)
• professional networking (LinkedIn) 
• discussion forums (Reddit, Whirlpool) 
• media sharing (YouTube, Flickr, Instagram) 
• content production (blogs [Tumblr, Blogger] and microblogs [Twitter]) 
• knowledge/information aggregation (Wikipedia) 
• virtual reality and gaming environments (Second Life), and 
• booking sites and apps (HealthEngine, Whitecoat, Podium).

¹Not an exhaustive list - adapted from: Social Media and Health Care Professionals: Benefits, Risks, and Best Practices.

Ahpra and the National Boards recognise the freedom of expression for practitioners and their right to communicate, including advocating for causes via social media, provided their activities do not involve the abuse or discrimination of others, or present a risk to the public.

While everyone has the right to lodge a notification if they are concerned about the social media use of a registered practitioner, there are only limited grounds on which Ahpra and the National Boards would investigate or consider taking action.

Registered practitioners will not be investigated purely for holding or expressing their views on social media. Regulatory action may be considered if the way a practitioner expresses their views presents a risk to public safety; provides false or misleading information or breaches privacy or confidentiality; risks the public’s confidence in their profession; or requires action to maintain professional standards.

All notifications to Ahpra are assessed according to their individual merits and circumstances to determine if they reach the threshold requiring an investigation or regulatory action.

Following heightened interest in social media content of registered practitioners, Ahpra and the National Boards have collated the following examples, based on real cases, as an indicative guide for practitioners and potential notifiers. The examples are grouped to illustrate cases that would generally be closed quickly, without the need for regulatory action (eg: cautions, conditions on registration), and those that will likely require an investigation and may need regulatory action.

Practitioners who use social media are expected to:

• comply with confidentiality and privacy obligations
• comply with professional obligations as defined in the relevant Board’s Code of conduct
• maintain professional boundaries
• communicate professionally and respectfully with or about patients, colleagues and employers, and
• not present information that is false, misleading or deceptive.

Social media activities that are unlikely to warrant investigation

Example 1

Advocating for a peaceful resolution of a war or conflict.

A practitioner posts content on social media that calls on governments to use United Nations and other processes to bring about an end to hostilities or a war. A notification is made about the practitioner alleging that their post could evidence a lack of respect for the cultural characteristics of one of the parties to the hostilities. The post is a political statement advocating peace.

The National Board will close the notification if the social media activity:

• does not present a risk(s) to public safety
• does not risk(s) the public’s confidence in the profession
• does not require(s) action to maintain professional standards

Example 2

Urging for protection of health workers and health facilities who may be caught in a conflict or war.

A practitioner posts content on social media stating that health workers should be protected when providing health and emergency treatment in a war zone. The post advocates that governments, including the government involved in the conflict, afford this protection and ensure health facilities are protected from attack. A notification is received from a member of the public concerned that the post takes a side in the conflict and is culturally insensitive.

The National Board will close the notification if the social media activity:

• does not present a risk(s) to public safety
• does not risk(s) the public’s confidence in the profession
• does not require(s) action to maintain professional standards

Example 3

Calling for accuracy, truth and impartiality in reporting on a conflict or war.

A practitioner criticises a media outlet’s coverage of a political tension or war. It calls for truth, accuracy and impartiality in journalistic coverage.

The National Board will close the notification if the social media activity:

• does not present a risk to public safety
• does not risk the public’s confidence in the profession
• does not require action to maintain professional standards

Social media activities that are likely to warrant investigation

Example 1

Political content that calls for inappropriate action.

A practitioner posts to social media a condemnation of citizens of a country, or a cultural or religious identity. The post includes a call to action, such as signing a petition or attending a protest march, specifically aimed at denigrating or discriminating against a population or group. Depending on the specific circumstances or events being reported, this is potentially discriminatory and could be a breach of the code of conduct and social media guidance.

The National Board might take action in response to the notification where the post:

• presents a risk(s) to public safety
• risk(s) the public’s confidence in the profession
• require(s) action to maintain professional standards

Example 2

Political content that is deliberately biased and not factual.

A practitioner shares intentionally misleading content about citizens of a country, or a cultural or religious identity that is biased, inflammatory and has the potential to incite racial hatred, intolerance. The content is intended to influence and persuade and is not factual.

A member of the public makes a complaint that the content is derogatory, slanderous or offensive, and that it is not factual. Depending on the specific circumstances or events being reported, the content may be a breach of the practitioner’s code of conduct and social media guidance, and a review of the matter reveals that the non-factual material is a repost of private political sentiment that is posted to gain traction against a target group.

The National Board might take action in response to the notification where the post:

• presents a risk(s) to public safety
• risk(s) the public’s confidence in the profession
• require(s) action to maintain professional standards

A primary objective of the National Registration and Accreditation Scheme (the National Scheme) is to protect the public. Community trust in registered health practitioners is essential. Every practitioner has a responsibility to behave ethically to justify this trust.

Inappropriate use of social media can result in harm to patients and the profession, particularly given the changing nature of privacy and the capacity for material to be posted by others. Harm may include breaches of confidentiality, defamation of colleagues or employers, violation of practitioner–patient boundaries or an unintended exposure of personal information to the public, employers, consumers and others. Information stays on social media indefinitely. Information published on social media is often impossible to remove or change and can be circulated widely, easily and rapidly. Therefore, it's important that you are very careful about what you like or post online-regardless of where in the world the site is based or the language used.

When using social media, just as with all aspects of professional conduct and behaviour, you need to be aware of your professional obligations and other relevant legislation, such as privacy legislation.

Where relevant, National Boards may consider social media use in your private life (even where there is no identifiable link to you as a registered health practitioner) if it raises concerns about your fitness to hold registration.

While you may think you are engaging in social media in a private capacity because you do not state you are a registered practitioner, it is relatively easy and simple for anyone to check your status through the register, or make connections using available pieces of information.

Take care when using apps and sites to ensure you do not inadvertently post or communicate publicly, while thinking you are communicating privately. Make sure you know and understand the relevant security and privacy settings.

The following are examples of when activity on social media could trigger someone to make a notification about a registered practitioner. These examples do not imply or assume that these matters would reach the threshold for a Board to take regulatory action.

Patient confidentiality

Take care when sharing information, including comments or photos, that you do not inadvertently disclose patient information. Check what is in the background of a photo before sharing it and make sure that information you share does not unintentionally disclose personal information about individuals (because someone might use available information to work out who you are talking about). Although individual pieces of information may not breach confidentiality, the sum of published information online could be enough to identify a patient or someone close to them.

Example 1

A mother posts an update about her daughter’s admission to hospital, following a car accident. The mother tags her friend, a health practitioner, who happened to be on the ward the night the daughter was admitted. The tag is complimentary about the care received at the hospital. The nurse responds publicly to the comment, thinking it was a private message and inadvertently provides information about the daughter’s recovery and the status of the other passengers in the car.

Parents of the other passengers make a formal complaint about the privacy breach.

Example 2

A radiographer proudly posts a selfie of his first day on the job – in front of an x-ray he had taken earlier, showing an open, compound fracture. The radiographer thought he wasn’t compromising patient privacy but was unaware that the name of the patient could be read, if the image were enlarged.

Cultural awareness, safety and practitioner and patient beliefs – social and clinical

As a registered health practitioner, your views on clinical issues are influential. Comments in social media that reflect or promote personal views about social and clinical issues might impact on someone’s sense of cultural safety or could lead to a patient/client feeling judged, intimidated or embarrassed.

Example 1

A health practitioner, who works in a small town makes their religious views about sex before marriage and homosexuality public by tweeting: ‘Abstinence is the best way to avoid HIV. Not sure why we are investing public dollars into developing vaccines. Just do what the bible tells us to do’. A patient sees this and now feels concerned they cannot reveal their sexuality to the practitioner, thereby compromising their health and safety. They make a notification about discrimination.

Example 2

A midwife makes a number of comments on her personal Twitter account saying that Aboriginal patients ‘never show up’, ‘don’t follow medical advice or take care of themselves’ and ‘is it any wonder there’s a health gap.’ A colleague sees the posts and looks at the Code of conduct for midwives for guidance. The code says that midwives must ‘provide care that is holistic, free of bias and racism, challenges belief based upon assumption and is culturally safe and respectful for Aboriginal and/or Torres Strait Islander Peoples.’ The code also states that ‘understanding and acknowledging historic factors such as colonisation and its impact on Aboriginal and/or Torres Strait Islander Peoples’ health helps inform care’ and that midwives must ‘acknowledge the social, economic, cultural, historic and behavioural factors influencing health, both at the individual, community and population levels.’ The colleague decides to make a notification about the midwife’s conduct to AHPRA.

Professionalism

The Codes of conduct emphasises that practitioners must always treat patients with respect and communicate effectively, courteously, professionally and respectfully with and about other health care professionals. This applies to any comments made in a social media context. Grievances with work colleagues or patients are best resolved privately.

Example

A physiotherapist resigns from her job, after feeling she was unfairly treated by her manager and generally dissatisfied with the workplace and level of support provided to staff. That evening, celebrating the resignation with a friend, also a past employee, they post comments about the workplace and the ill feelings they both harbour towards certain work colleagues and the manager. The posts are seen by other staff and a notification is made, claiming that the practitioner’s conduct in posting the comments on social media were contrary to the Code of conduct, in that while exercising her right to free speech the statements were not in the ethical interests of the profession and the community.

Maintain professional boundaries

Language and tone used on social media that does not reflect a professional relationship, i.e. is overly personal and familiar or includes suggestive comments, could breach professional boundaries and the Code of conduct.

Example

A practitioner starts a conversation on a dating website and soon identifies the other person as his patient. The practitioner mentions to his patient that it’s a ‘bit weird’ having a conversation on the website but continues the discussion. Because the patient has a bad head cold, the practitioner offers treatment suggestions. The practitioner comments on his patient’s physical attractiveness and offers a house-call late at night.

The patient makes a formal complaint about the conversation.

Public health messages

While you may hold personal beliefs about the efficacy or safety of some public health initiatives, you must make sure that any comments you make on social media are consistent with the codes, standards and guidelines of your profession and do not contradict or counter public health campaigns or messaging. A registered health practitioner who makes comments, endorses or shares information which contradicts the best available scientific evidence may give legitimacy to false health-related information and breach their professional responsibilities. Practitioners need to take care when commenting, sharing or ‘liking’ such content if not supported by best available scientific evidence.

Example

A nurse regularly posts anti-vaccination views on her personal Facebook profile, including that vaccinations cause autism and other information which contradicts the evidence base and public health programs. Her professional standards, codes and guidelines make it clear that using evidence in the practice of her profession, as well as supporting public health initiatives, are part of her professional responsibilities. A colleague regularly sees her posts and decides to look at the Code of conduct for nurses for guidance. The code says that ‘To promote health for nursing practice, nurses must understand and promote the principles of public health, such as health promotion activities and vaccination.’ The code also says that nurses must ‘understand and apply the principles of primary and public health, including health education, health promotion, disease prevention, control and health screening using the best available evidence in making practice decisions.’ The colleague decides to make a notification about the nurse’s conduct to AHPRA.

Advertising

The Advertising guidelines explain the advertising requirements in the National Law. The National Law and Advertising guidelines also apply to advertising in social media. For example, making false claims about the effectiveness of a treatment (i.e not substantiated by acceptable evidence) on a Facebook site that advertises a practitioner or their clinic is misleading and considered a breach of section 133 of the National Law. Advertising in social media that uses a testimonial is also a breach of the National Law.

Example

A Chinese medicine practitioner advertises on their website:

‘Acupuncture and herbs are both an integral part of Traditional Chinese Medicine (TCM), which has been proven to be a very safe and effective healthcare modality in Australia.’

A complaint is received, claiming that parts of this advertising are unqualified and/or are not supported by acceptable evidence and therefore may mislead consumers. The practitioner corrects the statement to: ‘Acupuncture and herbs are both an integral part of Chinese medicine practice, which may help patients to manage a range of symptoms including pain, stress and fatigue. Chinese medicine is generally considered to be safe but occasionally (as with all health treatments) may be associated with possible adverse reactions in individual cases.’

For more information please see the Advertising Resources page.