e-Professionalism refers to “the way you engage yourself online in relation to your profession, including your attitudes, actions and your adherence to relevant professional codes of conduct.”1 It is important to recognize that your responsibilities as a professional include your actions even while not actively treating patients. Similar to off-duty conduct which results in a criminal conviction, health professionals who engage in unprofessional conduct off-duty via online means can also be subject to disciplinary action from their regulatory body.
This article will provide three examples of health professionals blurring professional boundaries, eroding public trust in their professions, and breaching patient privacy during online interactions. All of these examples involve health professionals using social media inappropriately, so this article is a reminder of your duty as a physiotherapist to adhere to the Code of Ethical Conduct and to all the expectations referred to in the Standards of Practice whilst participating on social media platforms whether you are on-duty or off-duty.
Case Study #1: Misinformation and the Erosion of Public Trust
The public look to health professionals to give them guidance on their health and to help them recover from injury or disease. For the public to obtain good health outcomes they must have the knowledge to make good health choices. Physiotherapists have a role in the use of social media to educate the public, but they also have a responsibility to do so with honesty, integrity, and transparency.
The College has a role to protect the public from physiotherapists who choose not to abide by the Standards of Practice and Code of Ethical conduct. Purposefully advertising or promoting services that are not supported by research or best practice is a form of misinformation to the public and can erode the public’s trust in the physiotherapy profession.
During COVID-19 the Federation of State Boards of Physical Therapy posted a statement on misinformation which I think nicely sums up the role physiotherapists play in the public-eye.
“Healthcare professionals who generate and spread misinformation or disinformation about the COVID-19 vaccine are putting the public at risk. Because of their specialized knowledge and training, licensed Physical Therapists and Physical Therapist Assistants possess a high degree of public trust and therefore have a powerful platform in society, whether they recognize it or not. They also have an ethical and professional responsibility to provide health care in the best interests of their patients and must share information that is factual, scientifically grounded, and evidence-based for the betterment of public health. Spreading inaccurate information contradicts that responsibility, threatens to further erode public trust in health care, and puts all patients at risk.”2
What drives health-care practitioners to engage in this behaviour? In the article above used as an example for this discussion, Timothy Caufield, who is a well-known advocate of combatting misinformation, comments on the unknown reasons as to why the physician would be purposefully spreading misinformation
“Is it for notoriety, is it because of ideology, is it because they think their practice is going to benefit from it? Who knows? I think sometimes it’s all of the above.”
When examining some of the issues more pertinent to physiotherapists it is wise to think about what drives some of the poor decisions health professionals can make around e-professionalism for the sake of notoriety or financial incentives. Issues can arise from physiotherapists trying to increase their brand or visibility in the public eye to gain popularity or it could be more financially driven. Increased online popularity can lead to an increase in the number of patients that physiotherapist sees, the price charged for a service and the sale of products. All of these drivers speak to the potential financial motivation that exists. Using social media platforms to voice misinformation or purported benefits of a type of treatment or product is one way that we see inappropriate use of social media in physiotherapy.
If a physiotherapist’s main motivation is to increase their brand’s visibility it means that a pressure exists for them to produce content that would drive likes and engagement with what they post. So occasionally health-care providers opt to engage in behaviour that isn’t in alignment with professional standards. Getting into a heated argument on social media, using profane language, or other forms of unprofessional behaviour online can result from that drive to gain notoriety, but unprofessional behaviour can also erode the public’s trust and lead to disciplinary action by the regulatory body.
Physiotherapists using their popularity on social media platforms to promote another business or brand for kickbacks is also an example of social media use which contravenes our Standards of Practice. For those of you familiar with certain “famous” online physiotherapists and their daily content you might see the amount of brand promotion they engage in. Free giveaways and other promotional content exist in almost every YouTube video they have posted. These actions would not be within the Standards of Practice for physiotherapists in Alberta and should be avoided. It is important to realize that conflict of interest exists not only within your practice but within social media as well. Physiotherapists should be aware of how to mitigate or avoid those conflicts of interest.
Case Study #2: Strom Vs. Saskatchewan Registered Nurses Association. A matter of context.
Strom was a registered nurse on maternity leave who was dissatisfied with the care her family member was receiving in a long-term care facility. After her grandfather passed away, she posted comments on her social media account identifying herself as an RN and criticizing the competence and professionalism of the staff including other nurses involved in her grandfather’s care. The post was initially done privately but she then decided that as an advocate and an RN she needed to post it publicly and directed the post towards the provincial health minister. Making it public was a key step in this being a larger issue for Strom as the comments’ presence in the public domain triggered a complaint. You can read more about the case, with comments from Field Law, here.
The staff at the facility filed a complaint for unprofessional conduct which went through the discipline committee of her regulatory body and she was fined. However, the decision was overturned by the Court of Appeal. The Court of Appeal felt that the disciplinary committee didn’t take context into account when they originally rendered their decision. The Court of Appeal noted the post was intended to bring exposure to end of life care and as a nurse, Strom would bring knowledge to the conversation. Secondly, the post was made by a grieving granddaughter and there were other contextual factors to consider. Lastly the court decided that the actions of Strom did not impact her ability to work professionally and did not harm the public or tarnish the reputation of the profession. The fact that the disciplinary committee did not consider these contextual factors resulted in the original decision being overturned.
There are some key points in this scenario to discuss even though the decision was eventually in Strom’s favour. The first is that during the time the comments were made, Strom was on maternity leave and therefore was “off-duty”. However, the comments were still made by a regulated health professional and being “off-duty” does not grant professionals licence to act however they wish. Part of being a professional is accepting the responsibilities that come with being in that profession and considering how your actions could affect the public’s trust in the profession.
Secondly, Strom posted from her personal social media account but clearly identified herself as an RN and used her title to lend credibility to her statements. The purposeful use of her title created a direct link to her profession and, therefore, the profession’s Code of Ethical Conduct and Standards of Practice.
When writing emails or posting through your social media channels it is important to understand that you could be viewed as a physiotherapist even if you haven’t identified yourself as a physiotherapist and are posting from a personal account. There should be caution with what you are saying, and you should hold yourself to a high professional standard even if you are posting as a private citizen. One of the key messages from this example is that having a personal account separate from your professional account is suggested in the social media guides by several regulators3 but does not necessarily absolve you from any comments you choose to make. Although the court ultimately found in Strom’s favor, she did go through a conduct proceeding which took an extended period of time to resolve – not something most professionals would choose, and the court was clear that the mitigating factors in Strom’s case were a key factor in the Court of Appeal’s decision.
Case Study #3: You Did What to Get Fired?
You can see examples of multiple infractions of both the Code of Ethical Conduct and the Standards of Practice for physiotherapists in just the two posts shown in this article. I counted 14 infractions which is quite a feat in just one video and one picture.
By inappropriately handling the infants and making them dance to the music playing in the background the nurses failed to create a safe and healthy environment for their patients. They would have violated the expectations contained within the Safety, Risk Management and Professional Boundaries Standards as well as expectations in the Code of Ethical Conduct. They lacked any respect for the therapeutic relationship, were not practicing in a safe, competent, accountable and responsible manner and failed to take reasonable steps to prevent harm to clients.
By including a post giving a baby the middle finger and calling them “mini-satans” the nurses also failed to act in a professional manner. If this conduct were done by a physiotherapist, it would violate the Standard of Practice on Professional Boundaries and Client Centred Care. They also would have failed to conduct and present themselves with integrity and professionalism and did nothing to inspire public trust and confidence.
Finally, by posting the content online the nurses failed to abide by privacy and confidentiality requirements found in the Standards of Practice, Code of Ethical Conduct and privacy legislation.
I am amazed that two professionals could create such a multitude of infractions but also find it very disturbing at the same time. In writing this article I discovered an interesting study which showed medical students frequently admitting to participating in inappropriate use of social media while acknowledging that they knew it was unprofessional or in violation of their Code of Ethics and Standards of Practice.4 The above example highlights this case of two nurses who most likely “knew better” but still failed to restrict their actions. There can be many reasons as to why this may have occurred but, in the end, as professionals the expectation is to not only “know better” but to “act better”.
Questions to Ask Yourself
As we look back at what we discussed I will pose some questions that you can ponder when it comes to e-Professionalism and your potential actions in the future.
We know there is a relation between the conduct of the professional and the profession. Are you interacting on a platform where you are identified as a physiotherapist? Are you using your title as a physiotherapist for the purpose of the interaction? If you are not using title, do those you are engaging with still know you are a PT?
Can what you are engaging in be viewed as more reprehensible due to the nature of your profession? In Jason Kully’s webinar on social media and e-Professionalism5 he discusses examples of a lawyer who steals or an accountant who commits fraud as examples where disciplinary action is sought out due to the nature of the misconduct.
Does the content of the email, post, or comment have a negative impact on the ability of you to perform your job? Or due to the nature and visibility of the conduct will there be harm to the integrity of the profession in the eyes of the public?
Keep in mind that its not only important that you know better, but to act better.
It is important to realize e-professionalism is a key component of your professional practice if you choose to engage online whether you are on-duty or off-duty. Take the necessary steps to evaluate your content from a regulatory perspective and the public’s perspective prior to posting content or comments. Avoid blurring professional boundaries, avoid unprofessional behaviours, and avoid anything that may compromise your patient’s privacy or what the public thinks of you and the profession.
- Chretien KC, Goldman EF, Beckman L, Kind T. It's your own risk: medical students' perspectives on online professionalism. Acad Med. 2010 Oct;85(10 Suppl):S68–71.