Principle 4 - Maintain and protect patients' information

Naomi

Naomi is a student dental therapist in her first year of study and wants to ask her fellow students if they have had experience with serious decay in a patient’s teeth due to their dietary habits and how they have dealt with it.

Naomi has a 23 year old patient with badly decayed teeth. Two molars have abscesses. The problem was caused by excessive consumption of sugary carbonated drinks. Naomi is very shocked at the amount of decay and wants some advice and support from fellow students. She posts a radiograph of the affected patient on her social media page ensuring that privacy settings are restricted to fellow students she knows. The radiograph shows the name and date of birth of the patient. The reaction to the amount of fizzy drinks the patient consumes causes a discussion on social media between the students. One of the group shares the story with student friends outside the course and shows them the radiograph to highlight the state of the teeth. One of the friends then messages Naomi to tell her that she has left the patient’s name and date of birth on the radiograph. The patient is unaware that her confidentiality has been broken.

What do you think Naomi should do next?

Select an option: 

• Remove the image from her social media account and ask her friends to do the same as this will solve the problem.
• Tell the patient what has happened.
• Speak to her supervisor about what has happened.

See what Naomi did next...

Naomi removed the image from her social media account and asked her friends to do this. However, the ex-partner of the patient had discovered the online discussion about his previous partner. He posted the image on his social media account, making cruel jokes about his previous partner. The patient found out and was very upset and complained to the dental school.

Breaking patient confidentiality is an extremely serious issue. Naomi’s supervisor explained that it doesn’t matter what security settings you have, something you post can be shared outside of a group and so you should always assume that anything you post is public and will remain in the public domain even after being deleted. In this case the implications were very serious. Although Naomi had not intended this to happen and had thought she had the appropriate security settings she had still broken patient confidentiality.

Naomi immediately apologised to the patient. Her supervisor had to call the student fitness to practise of Naomi and the student in the group who shared the post in to question. Naomi and the other student received a short suspension from the course and remedial tuition. Naomi had to declare this on her GDC application form. The sanction was serious because of the impact on the patient and the fact she hadn’t immediately informed her supervisor.

GDC principles

4.2 Protect the confidentiality of patients’ information and only use it for the purpose for which it was given.

4.2.1 Confidentiality is central to the relationship and trust between you and your patients. You must keep patient information confidential. This applies to all the information about patients that you have learnt in your professional role including personal details, medical history, what treatment they are having and how much it costs.

4.2.3 You must not post any information or comments about patients on social networking or blogging sites. If you use professional social media to discuss anonymised cases for the purpose of discussing best practice you must be careful that the patient or patients cannot be identified. 

Other guidance 

• GDC social media guidance 
• External 
• NHS guidelines on social media

Discussion points 

• How would you feel if someone shared something confidential about you on social media? 
• Have you thought about how easy it might be to accidentally let confidential information become public? 
• Do you think it would have been okay for Naomi to post the radiograph if there had been no reference on it to identify the patient? 
• What do you think the repercussions might have been for the dental school? 
• Was Naomi breaking the law? 
• Have you ever posted something on social media and then wished you hadn’t?
• How could you avoid this?

_Disclaimer

_{These fictional case studies are for illustration purposes only and should not be relied on to make clinical decisions. Their aim is to put GDC guidance in context, exploring how some of the principles might work in practice.}

_{The case studies cannot be relied on to be clinically accurate. Nor do the case studies intend to show the "correct" interpretation of GDC guidance, only one (or more) possible interpretation(s).}