It has been reported that numerous complaints were anonymously made, and some related to online posts within private or closed groups. While every complaint is required to be investigated by Ahpra, it has indicated that none of its investigations (at the time of writing) had necessitated a formal inquiry. Following a meeting between the Australian Medical Association (AMA) and the Medical Board of Australia, the AMA stated that “any doctor making respectful statements on social media advocating for peace and the protection of healthcare works in war zones should feel confident that they will not be reprimanded by the regulator”.1
With social media being an integral part of our professional and personal lives, the medical profession finds itself navigating the blurry boundary between freedom of speech and meeting its professional obligations.
The guidelines for doctors’ online behaviour
Ahpra and the Medical Board have established guidelines for the online behaviour of doctors, aiming to maintain ethical standards and safeguard public trust.
Section 2.2 of the Medical Board’s Good medical practice: a code of conduct for doctors in Australia states:
Public comment and trust in the profession
The community trusts the medical profession. Every doctor has a responsibility to behave ethically to justify this trust. While there are professional values that underpin good medical practice, all doctors have the right to have and express their personal views and values. However, the boundary between a doctor’s personal and public profile can be blurred. As a doctor, you need to consider the effect
of your public comments and your actions outside of work, including online, related to medical and clinical issues, and how they reflect on your role as a doctor and on the reputation of the profession.
The Ahpra and Medical Board’s social media guidelines state:
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.”
Ahpra and the Medical Board emphasise that doctors should uphold professional standards, even in the virtual realm. Tension arises from the ambiguity surrounding what constitutes a breach of guidelines. Doctors must balance expressing themselves freely while avoiding actions (including ‘liking’ and thereby endorsing online posts) and comments that might be perceived as unprofessional or
damaging to public trust.
The risks are real, as even an unintentional misstep, or statement taken out of context or from a ‘private online group’, could result in disciplinary action, potentially affecting a doctor’s reputation and career.
A primary concern is the potential impact of a doctor’s online presence on patient trust. Patients increasingly ‘research’ doctors and turn to the internet for accessible information, so a doctor’s online conduct can influence patients’ perception of their professionalism and competence.
Helpful strategies for doctors
Doctors can adopt several strategies to help them align with the Ahpra and Medical Board guidelines while safeguarding their right to free speech.
First, a clear understanding of the guidelines is important – and that understanding must be refreshed, including keeping up with updates to the guidelines. Moreover, doctors might also consider establishing separate personal and professional accounts on social media platforms. This delineation may help maintain a level of privacy, while ensuring the professional persona aligns with the established guidelines. However, it must be appreciated that the content and conduct of personal accounts may also impact on a doctor’s professionalism and patient trust.
Doctors must take care in the online world – a world that never digitally forgets a post, comment or like; and for which the author is always identifiable. An online world with the trappings of informality, familiarity and short-hand expressions inherently presents greater risk of miscommunication and misinterpretation, and for comments to be taken out of context under a regulatory microscope – and in the case of a regulatory assessment, the subjective intent of the doctor is not determinative or even relevant; what will matter is the objective interpretation of the actions and words, and their impact on
professionalism and patient trust.
A vigilant and measured approach to online communication is obviously prudent. Doctors must be conscious of the potential impact their words may have on patients, colleagues, and the broader community. Doctors engaging in respectful and constructive dialogue, while refraining from offensive or inflammatory language, helps foster an online environment that reflects positively on themselves
personally, and on the medical profession.
Regular self-audits of online content are also recommended. Periodically reviewing posts, comments and shared content can help doctors minimise the risk of being subject to complaints by identifying and rectifying any potential breaches of guidelines. A proactive and diligent approach in this regard demonstrates a commitment to professional standards and responsible online conduct.
Conclusion
The tensions between Ahpra and Medical Board guidelines on social media and the principle of free speech create a delicate balancing act for doctors.
While the need for professional standards is clear, doctors should be able to responsibly enjoy their democratic right to express personal opinions without offending their professionalism, integrity and the public’s trust.
The difficulty lies in reconciling these objectives and striking an appropriate balance. The problem is that while there is a sensible need for ‘blurriness’ in the standards and guidelines to cater for all sorts of potential scenarios, that ‘blurriness’ also contributes to regulatory risk and adverse consequences for doctors.
The AMA recently called for a national conversation about doctors’ freedom of speech.2 The subsequent context of the Israel-Gaza conflict, and the complaints and concerns it has generated within the medical community with the professional regulation of social media use by doctors, is likely to accelerate that conversation.
After the date of writing this article, Ahpra modified its social media guidelines to provide some examples of social media posts relating to war and conflict that would not be notifiable, and some that would be notifiable, to provide greater clarity.
References:
1. AMA Victoria, Communications and Advocacy Update: 25 January 2024.
2. “Review needed into Doctors Freedom of Speech: AMA President’, The Limbic, Geir O’Rourke, 31 August 2022.
