Health Professional or Influencer?

Questions for health professionals to reflect on before posting on social media.

Reviewed by Michelle Quirk

Key points

• Health professionals must adhere to professional ethics and standards when extending their practice online.
• Professional social media presence becomes an extension of the consulting room.
• Health professionals need to be mindful not to join the online influencer culture.

Social media has become a popular platform for health professionals and therapists to advertise their services, develop professional networks, and disseminate health information to the public.^1,2 While social media is not a substitute for individualised medical advice or therapy provided by a qualified health professional, social media can be a rich source of information for the public, assisting individuals in understanding their health care needs and gathering information about the specific services provided by health professionals. However, the informal nature of social media, along with a lack of clear guidelines, means there is a risk of health professionals leaving their professional ethics in the consulting room and joining the influencer culture that is so pervasive online.

In Australia, the Australian Health Practitioner Regulation Agency (AHPRA) provides clear information regarding the expectations of personal social media use by registered health professionals. However, it does not explicitly cover the ethics of conduct in regard to public-facing professional social media accounts.

In this post, we propose five considerations regarding ethical conduct for health professionals when stepping into the world of social media and creating professional content for the public.

1. Consider your professional online presence as an extension of the consulting room

Question: Would I behave in this way in the consulting room?

When we choose to create a professional social media presence, our page becomes an extension of our presence in the consulting room. We can assume our audience is a combination of patients, colleagues, and the general public, and our conduct should reflect this. If we wouldn’t share particular information about ourselves, wear certain clothes, or offer incentives to our patients in the consulting room, then it follows that we should not do so on social media. This is not about having our voice and choices restricted but is instead about upholding professional standards, minimizing harm, and maintaining public trust in health professionals.

2. Ethical guidelines about advertising and incentives still apply

Question: Would I promote or advertise this product or service in the consulting room?

While influencer culture is full of product placement, incentives with kickbacks, and advertising partnerships, professionals are still required to comply with professional codes of ethics around advertising when creating online content. A quick ethics test is to ask yourself whether you would promote or advertise a product or service in the consulting room or in your clinic. For example, is it appropriate to offer your patients vouchers for a meal delivery service, knowing you will get paid for each patient that subscribes to the service? Spoiler, the answer is no. Likewise, would you tell your patients about the new underwear you are wearing, or the face cream or vitamins you use, and offer them a discount code to also buy these? If the answer is no, then this conduct is also not appropriate on social media.

Further, in Australia, the National Law bans testimonials (recommendations or positive statements about the service) or purported (i.e., fake) testimonials used to advertise regulated health services or a business that provides a regulated health service. Testimonials can be misleading as they are not usually a balanced source of information (they often include a selection of positive comments about experiences and do not tell the whole story), and the public may not have the expert knowledge to assess if the information is accurate.

While health professionals cannot control unsolicited online patient reviews, it is unethical for health professionals to solicit such reviews (i.e., by asking friends and family to write reviews or incentivising patient reviews). Similarly, it is unethical for health professionals to buy fake social media followers as this may give a false sense of public standing. Manipulating public image to attract users to the health provider or encourage the use of the health provider’s service is both misleading and deceptive, which clearly violates the advertising guidelines of regulatory bodies, such as AHPRA.

3. Be mindful of boundaries when combining professional and lived experience

Question: Would I disclose this lived experience indiscriminately to all my patients in the consulting room?

Integrating our lived experience into our professional role can be valuable, while remembering to reflect on the depth, breadth, and frequency of sharing our own experiences. A quick ethics test is to ask yourself whether it would be responsible and appropriate to share this same information directly and indiscriminately with every patient you see in the clinic (because this is essentially what we are doing when we share on public professional social media accounts).

Sharing information from a lived experience perspective and discussing evidence-based information relevant to that experience is vastly different from frequently sharing specific content about our own experiences and personal lives on a professional account. While it is commonplace for social media influencers to share personal information with their followers to build a connection with their audience and boost engagement, health professionals are expected to use self-disclosure with care and only when it is considered in the best interest of the patient to do so.

Simply labeling content as "lived experience" does not address the ethical issues that can arise from self-disclosure of personal experience. Even if you are engaged in mental health or disability activism and want to change the existing systems, the reality is you are currently situated within them. To make change from the inside, it is key that we honour the ethical guidelines we are bound to professionally, and conduct ourselves online in a manner that is consistent with the standards of the profession.

4. Focus on factual information, rather than your opinions

Question: Would I consider it appropriate to indiscriminately share this opinion in the consulting room?

We all have opinions, and some of us are just itching to share them. If you are a health professional, this is best done through your personal social media accounts. Even then, you are still required to adhere to standards of professional conduct when posting on your personal social media account and commenting in public spaces. Sharing any opinion or information that brings disrepute to your profession can still result in action from regulatory bodies.

When we are sharing information as part of our professional role, we are required to share information that is credible, factual, and evidence-based, in line with the standards of our profession. We might share a professional opinion that is based on research and industry-specific knowledge, with a clear caveat about the part that is our professional opinion. It is generally not appropriate to share personal opinions, and if we do, we must have a solid rationale about how it benefits the general public and doesn’t risk harm.

5. Maintain boundaries in regard to patient interaction with your social media accounts

Question: What boundaries and security features do I need to have in place to maintain professional boundaries and patient confidentiality?

When we start public-facing professional social media accounts, it is highly likely that our patients will find and follow us. When we have private, personal social media accounts, we can simply decline friend requests from patients. However, this becomes less clear-cut when our content is available to the general public. It is our responsibility to maintain boundaries around appropriate communication in a way that does not disadvantage our patient or breach their confidentiality. For example, if a patient comments on a public post, it is generally appropriate to respond (or not respond) as we would to any member of the general public. It is not appropriate to respond in a way that identifies the commenter as a patient as this is an inadvertent breach of their confidentiality. It is also important to be aware of the limitations of online security when a patient tries to establish contact via social media. Many professionals will avoid direct messaging with patients to maintain appropriate limits around their own availability and to reduce risks around the limitations of online security.

If you are a health professional using social media as part of your professional practice, we recommend incorporating regular reviews of your social media activity as part of your clinical supervision or establishing a peer reflection group to discuss these issues and hold each other accountable. Further, we recommend ongoing professional development in the area of social media use and staying up-to-date with current guidelines on social media use within your profession.

When in doubt, we recommend erring on the side of caution and reflecting on the first question: Would I behave this way in the consulting room?