Today Jaimie Andrews shares the last blog post in our series on ethics, this time tackling the very current concerns of confidentiality and consent on Facebook, Twitter and Instagram.  Happy reading!

Ethical guidelines on social media: Guidelines related to confidentiality and consent.

Full disclaimer (as is my ethical responsibility, of course): while I do use the WhatsApp to send text messages, images, photographs, Word documents, PDFs and even voice-notes to my clients and colleagues, I know less about Facebook walls than the one Humpty Dumpty fell off, less about Twitter handles than I do about door-handles (which isn’t much in the first place), less about Insta-posting than the fine-motor activity of coin-posting and more about how to tell time than how to TikTok…

I am not typical of my generation of early 30-year-olds at all! Never having owned a Kindle, iPad, tablet or FitBit, even pre-schoolers are schooling me every day on the latest communication technology. That now being out in the open, let’s all learn together about social media in and outside of our workplace – be it at a hospital, government institution, private practice, school, community clinic, or NGO, etc. Social media is without such geographical boundaries. That is what makes it so incredible and simultaneously so dangerous. As it is often quoted: “With great privilege comes great responsibility” (debatable source).

Social media is making such fortunate freedom of communication more and more accessible to the general public. This means that those in positions of power, authority and influence(r) all need to take more and more responsibilty for their social media presence, representation, endorsements, affiliations, etc and be accountable for it too.

Social media is defined in the HPCSA Ethical Guidelines’ Booklet 16 as “the online tools and electronic platforms that people use to share content such as opinions, information, photos, videos and audio…social networks, content-sharing platforms, personal and professional blogs, internet discussion forums… comment sections or websites.” (page 6, Pretoria, September 2016).

Booklet 16 then goes on to list the pros (+) and cons (-) of using social media for health professionals:


PRO’s: CON’s:

(+) staying updated with the most recent research and advancements in healthcare via legitimate online sources(+) developing supportive community with colleagues

 (+) educating both the public and health profession by spreading relevant content fast; far and wide


(-) blurring boundaries with TeleHealth/ Tele-Medicine

(-) complicating storage of client’s (digital) data

(-) risking accidental breech of client’s confidentiality

(-) possibly appearing as though unfairly advertising and/ or touting for services



Unsurprisingly, Booklet 16 emphatically reminds us to double-, triple- and quadruple-check exactly what information our clients/ parent(s) of minor (underage) clients have and have not consented to us sharing with others – be they fellow health professionals treating the same client or distant relatives seen once annually. This needs to be specified in no uncertain terms in our contracts with our clients. Seeking professional legal advice, especially now in the time of POPIA, is recommended to ensure all our professional communications are fully covered.

When it comes to posting something – anything! – on any social media platform (including WhatsApp, YouTube, Twitch, etc.), there are a few very important and specific questions we must ask ourselves before doing so. They are similar to the social rule: THINK before saying or doing anything – is what I’m about to say or do True, Helpful, Interesting, Nice and Kind?

We must, therefore, ask ourselves – before posting, forwarding, sharing, retweeting, commenting, liking, hash-tagging or even taking a screenshot – which details of our clients do we have and not have C-O-N-S-E-N-T to share. We need to ensure that we have not unintentionally shared sufficient detail for the reader/ viewer of our social media post to guess the identity of our clients without us naming them.

As a result, we need written consent from the client/ parent(s) thereof for us to share any but especially specific details of her/his case before doing so. This means that it must be made explicitly clear what information will be shared and, therefore, what information will remain confidential, the format in which it will be shared and, of course, the social media platform(s) on which it will be shared by the health professional.

The above stands regardless of the clients age and even post-discharge from our treatment services. This means that, even after terminating the professional relationship with the client, we may not ever share anything of hers/ his without prior written consent, even after death. I would imagine the next of kin would have to be approached for consent should it be deemed worthy.

If nothing else, we must think of our reputations – not just as professional individuals, but as representatives of our Occupational Therapy profession, as well as larger community of Allied Rehabilitation and Health Professionals. Furthermore, we must continue to consider not just our professional selves, but our personal profiles on social media platforms. Our clients and colleagues will most certainly be looking up our names and histories via all online search engines, when referred on to us.

Remember, like most interactions (whether in-person or online), social media platforms are a two-way street: as much as you’re looking up, at, through another person’s profile, others are doing the same to yours.