Using WhatsApp and social media

The scenario

Jim, AOP member

"I am a locum optometrist, often working in practices with one testing room where I am the sole optometrist working that day. With no other clinician around to discuss case findings with most of the time, I am thinking about joining a WhatsApp group with my peers for clinical support, allowing me to discuss findings and management options. What should I keep in mind when joining, sharing and using the advice shared in such groups?"

The advice

Dr Peter Hampson, AOP clinical and professional director

Before joining one of the many WhatsApp groups or other social media forums that exist for optometrists, there are several things to consider.

Patient consent

The first is, if you are planning to share information, what information you are sharing and whether you have patient consent to share images. Anonymised information should be safe to share, but you should ask the practice owner or manager in advance for their agreement, and you must make sure you don’t provide any patient identifiable information.

Even anonymised information may be traceable to a specific patient if the condition or presentation being discussed is rare. The easiest way to ensure you are permitted to share is to get patient consent and make a note of that on the records.

You should then carefully redact the records, before sharing the images. You should also consider how these images are redacted. The AOP has seen complaints where someone has taken an image of the screen on their phone and then used markup to obscure patient data. In that complaint, because the markup could be removed afterwards, it was suggested that a locum had removed patient sensitive data from the practice.

Trustworthy advice

The next consideration is over who is providing the advice, and how you know whether it is accurate. Forums and WhatsApp groups contain a mix of people. Some are very knowledgeable, and others may sound knowledgeable, but in fact aren’t. The only way to know for certain is to read around the subject yourself, which to some extent defeats the purpose of the interaction that is being sought.

Sharing an interesting case is a great form of peer learning, but it’s important to ensure that it is helpful and supportive and doesn’t introduce risk

Even those who are knowledgeable may not have all the information needed to provide good advice. More importantly, would they be prepared to stand by that advice in the event of a claim or complaint? It’s also worth considering how a defence in front of the General Optical Council or a court of “Someone on WhatsApp said it was…” would look.

This is even more magnified in the case of medicine prescribing decisions, and the risk rises further with the severity of the condition. Choosing to prescribe a medicine without clear clinical guidelines, or an established evidence base, because someone else anecdotally reports a successful outcome, is very risky and would also be incredibly difficult to defend if things go wrong. While that might be unlikely for a new ocular lubricant, for any disease where loss of sight is more likely it could be a genuine risk for the patient and practitioner.

That doesn’t mean that WhatsApp groups, social media and forums don’t present an opportunity for learning, but this is better done in retrospect and by sharing interesting cases, rather than crowd sourcing real-time advice and guidance. Reflecting on and sharing an interesting case is a great form of peer learning, but it’s important to ensure that it is helpful and supportive and doesn’t introduce risk. Discussing the case once the patient has been successfully managed and considering where you could potentially do better next time is invaluable, and sharing that learning process with colleagues can help everyone to learn.