I was taking part in a nursing debate on Twitter yesterday evening, and the subject came around to boundaries, and nurses who had sexual relationships with their patients or their relatives. I was actually quite shocked when two students (one a student nurse, the other on an access course for social work) who took the view that this would be okay “so long as they’re in love”. When I remonstrated that it’s simply not allowed, I got replies like this.
“but we are human and can reflect and do it in a way that won’t harm!”
“yes I agree if you fall in love then you fall in love sometimes it happens”
“I’m going by feelings not a rule book!”
and most worrying of all…
“my best friends parents were formally teacher and pupil!Been together 30 yrs only just split up”
The person later confirmed that they had been teacher and pupil when the relationship started. Not only unethical but also illegal.
Despite the stereotypes about nurses romancing their patients (though how anyone can feel romantic after 8 hours of running around a hectic medical ward is beyond me) this is a strict no-no and is specifically banned by the Nursing and Midwifery Council Code. If it’s a current patient, their carer or relative then it’s always inappropriate. If it’s a former patient then it’s “often” inappropriate, though the NMC seems a little hazy on what defines “often”. I presume it would depend on things like how long ago they were a patient, whether they’re a vulnerable person, and so on.
I hope those two students wise up before they qualify.
Okay, we’re talking there about very clear and obvious boundary violations – obvious to all but the occasional numpty student, anyway. But what about in social media, where boundaries can be ill-defined?
I’ve been using social media for some years now to talk about mental health issues. Interestingly, as the years have gone on, the regulators have become more and more detailed in their guidance with regard to social media. The first mention they made of it that I recall was an article in the NMC News (gratifyingly, they recommended my then website, the now-defunct Mental Nurse, as an example of good practice.) Then actual guidance appeared, and this guidance got longer over time. A couple of years ago my NHS trust brought out a trust policy for social networking sites, which all staff had to read and sign.
Although my views have evolved to a degree as the guidance evolved, much of this guidance is actually fairly basic common sense. Don’t use social networking sites to breach confidentiality or slag off your colleagues. Don’t add your patients on Facebook. Don’t bring your profession into disrepute.
There’s a reason why all this guidance has developed – professionals have got into trouble because of social media. Again, a lot of these incidents have been what you’d expect. People forming inappropriate relationships through Facebook, or tweeting stuff that breaching confidentiality. There’s also been some odd ones. For example the doctors and nurses who got disciplined for posting pics on Facebook of themselves playing a lying down game while at work. There was also a recent case where a clinical scientist reported a doctor to the GMC for peddling dubious therapies, and she counter-complained about him to the Health Professions Council for making “derogatory and/or misleading comments” about her on the Bad Science forum. The HPC (possibly a tad harshly) decided that this was misconduct and sanctioned him. However, there’s some signs the HPC weren’t impressed by her complaint, as “derogatory and/or misleading comments” got amended to simply “derogatory comments”, and they imposed a two-year caution order, the lowest possible form of sanction. Basically a slap on the wrists and told not to do it again.
Hmmm, maybe I shouldn’t have called those students numpties.
In among all these pitfalls, it’s important to recognise that social media can be a force for good. I and other professionals have used this site and others to talk to people about mental health issues, many of whom are mental health patients. I don’t think that’s wrong or unethical. If I were expected not to speak to someone just because they have a mental health condition, then I’d have to actively avoid one in four of the population. At the risk of stating the obvious, people with mental health problems are not some separate “other”. They’re our friends, colleagues, loved ones, relatives. In some cases they’re mental health professionals as well as patients.
In my view, this absence of difference becomes particularly acute in social media. To quote One in Four Magazine editor Mark Brown, social media “creates a situation for mental health where it is less ‘them and us’ and more ‘just us’. There is something hugely satisfying in seeing someone who offline would be seen as a ‘patient’ discussing online with someone who would be seen as an ‘expert’ and both learning from that experience.”
What I wouldn’t do, of course, is use social media to talk to someone who’s my patient. A patient-professional relationship is one which involves a great deal of power. In talking to someone who’s a patient but not my patient online then that relationship either dissolves or never existed in the first place – hence why it becomes ‘just us’, as Mark says. If it was with one of my patients, then the power can be become magnified or distorted in all kinds of nasty ways.
I’ve never had one of my patients try to add me on Facebook, or start talking to me on a blog. If they did then I’d have to refuse the contact. There’s some fuzzy areas to consider. For example, there was a recent online debate by health professionals about Twitter. Although people tend to mostly read just the Twitter accounts they follow, unless it’s private then (theoretically, at least) your account could potentially be read by everyone in the world. I haven’t made my Twitter account private, but I also wouldn’t follow a patient or former patient on Twitter.
Social media is still very much evolving. My guess is that in future there’ll be more and more opportunities, dilemmas and risks in terms of the way it’s used between professionals and patients.