The release in 2012 of a preliminary consultation paper on a social media policy for health professionals by the Australian Health Practitioner Regulation Agency (AHPRA) prompted a fast and fierce social media storm.

As Croakey reported at the time, the document – which was later revised – took a fairly dim view of social media, focusing mainly on its potential to breach laws and guidelines relating to the advertising of regulated health services.

Active tweep and Victorian surgeon Jill Tomlinson says she is now dismayed that the “lack of understanding of social media communication” shown by the AHPRA then has now “spilled over” into the Medical Board  of Australia’s proposed guidelines for advertising regulated health services that will take effect next month.

Of particular concern, she says, is the requirement that medical practitioners will need to ask any individual who writes online about their clinical care, or any website that hosts the online comments, to remove the comments – despite the regular flouting to be seen of existing AHPRA advertising guidelines.

Dr Tomlinson has written an open letter to the Medical Board of Australia, saying the new guidelines demonstrate a lack of understanding of Web 2.0 technologies and communication , threaten to censor patient feedback, and risk changing the landscape of Australian healthcare social media. She asks, perhaps only a little rhetorically:

“When practitioners follow the new Guidelines, how far should they go with their “reasonable attempts” to have the offending posts removed?  If Google or a major forum fails to act according to my request, should I hire a forensic computer scientist, obtain a Supreme Court search warrant, and sue?”

***

Dr Tomlinson writes:

“Dear Medical Board Members,

RE: Proposed “Guidelines for advertising regulated health services”

In 2012 the Australian Health Practitioner Regulation Agency (AHPRA) released a consultation paper on its proposed social media policy. Feedback from the Australian healthcare social media community was swift andnegative. I am relieved that AHPRA has subsequently revised its proposed policy, but I am dismayed that AHPRA’s lack of understanding of social media communication has spilled over into the Medical Board’s proposed “Guidelines for advertising regulated health services” that will take effect on March 17, 2014.

According to Section 6.2.3 of the proposed Medical Board advertising Guidelines, from next month medical practitioners will need to ask any individual who writes online about their clinical care, or any website that hosts the online comments, to remove the comments.

The existing AHPRA advertising guidelines are regularly flouted online. I frequently see examples of advertising that AHPRA has deemed “unacceptable”. For example, a competition where liking a Facebook Page gives you a chance to win $2,000 of cosmetic injectables. Facebook Pages with hundreds of testimonials. Online advertising of a competition where buying $50 of alcoholic drinks at a bar gives you a chance to win an overseas breast augmentation holiday. Facebook posts featuring solicited glamour photographs of women who have allegedly had breast augmentation performed by the surgeon behind the Page. Articles and social media posts that do not contain the “necessary warning statement” for surgical or invasive procedures. Claims that a practitioner provides superior services to other practitioners (An example: “Dr XXX is the best surgeon in Australia without a doubt! What an amazing experience…absolutely life changing …the best surgery I’ve ever had. No bruises…and very minimal pain. Best treatment and the best staff…thank you from the bottom of my heart”). A doctor’s website that says that testimonials are not permitted but provides a direct link to a website containing 22 patient reviews on his profile page. All of these examples breach s.133 of the National Law.

Advice that I have received from AHPRA about how to apply the existing guidelines suggests that there is confusion about how and when they should be applied. In 2012 I telephoned AHPRA asking if I needed to provide a warning statement on educational articles on my business website that describe hand fracture treatment. I felt it was unnecessary to advise individuals who were reading about hand fracture treatment that “Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.” The AHPRA representative checked with the “medical team”, then informed me that the guidelines did not apply to this situation. I was advised that it was not possible for AHPRA to provide this advice in writing. I received no response to two website enquiries I submitted to AHPRA regarding this matter.

I have two medical practice Facebook Pages that I keep free of testimonials, as required by the existing guidelines. I have specifically selected a type of Facebook Page that does not offer people the opportunity to rate my business out of 5 and provide a review. I have deleted positive feedback that my patients have placed on the Pages. I feel uncomfortable about deleting unsolicited and heartfelt feedback posted by my patients, as it seems rude and unappreciative. However, I must do so to remain compliant with s.133 of the National Law. The lack of common sense in section 6.2.3 of the proposed Guidelines has me questioning whether I should instead apply the Guidelines selectively according to my own logic and whims.

When practitioners follow the new Guidelines, how far should they go with their “reasonable attempts” to have the offending posts removed?  If Google or a major forum fails to act according to my request, should I hire a forensic computer scientist, obtain a Supreme Court search warrant, and sue? I think that’s probably above and beyond the call, but I also recognise that my logic is not concordant with that of the Board’s. Will reporting a patient’s positive Facebook status update as “harassment” suffice if I keep a screenshot of the Support Dashboard as evidence? And what do I do if my doctor-patient relationship is adversely affected by these attempts at patient censorship?

Online feedback offers doctors an opportunity to reflect and to change their practice where indicated to improve the care provided to future patients. What is the purpose of asking all patients and websites to remove online patient feedback? Do you wish to censor patients? Are you trying to keep the medical profession shrouded in secrecy? Has a recent internal review suggested that the Medical Board needs to create additional compliance and administrative work for doctors? No other Medical Board in the world has seen fit to propose such a requirement.

Research shows[1] that the main reason Australian health professionals choose not to engage in social media for healthcare and practice promotion is a lack of understanding of Web 2.0 technologies and communication. I suspect the proposed Guidelines reflect the Board’s lack of expertise in this area. You wouldn’t implement clinical practice guidelines that were developed by individuals who have no experience or expertise in the field. So why would you again propose to implement Guidelines pertaining to Web 2.0 communications that have been developed by individuals who have no experience or expertise in this field?

Please reconsider the proposed Guidelines. Remove the requirement for doctors to attempt to censor patient feedback. And in the future, please consult with individuals who have expertise in the field before introducing guidelines that will change the landscape of Australian healthcare social media.

Sincerely,

Dr Jill Tomlinson
MBBS(Hons), PG Dip Surg Anat, FRACS(Plast), GAICD
Plastic, Reconstructive and Hand Surgeon

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