Business Dilemmas

Dr Ellie Mein discusses the issues to consider if you are approached to partner with well-known health, exercise or sporting brands.

 

         

         

           

Dilemma 1

Is it OK to be paid for a webinar?

Q I am a consultant cardiologist who has recently been approached by a high-profile exercise brand to participate in a series of webinars on the benefits of exercise on heart health and future trends in healthcare. 

They have stated that this is a paid opportunity, but is it appropriate for me to appear in these webinars? Please could you advise? 

A It is becoming increasingly common for medical professionals to utilise social channels to increase their professional presence online; for example, to advertise their services, to help disseminate specialist knowledge to the wider public and to form professional networks with other clinicians.

As such, in recent years there has been a rise in medical ‘influencers’. 

Broadly speaking, this is an individual who is an expert in their chosen field who has access to a huge audience and can influence others to act based on their recommendations. While influencers are most commonly associated with Instagram, they also produce content on Facebook, TikTok and YouTube among others. 

Many medical influencers use social media platforms to inform and educate the general public on various health topics. Consequ­ently, many have been approached by medical, health, fitness and lifestyle brands to become brand ambassadors or to participate in brand events, webinars and so on. 

The advantage of medical professionals becoming prominent on social media and/or aligning with high-profile brands is that it can be an invaluable method of raising awareness of health campaigns/conditions and connecting the public with health education from those who have the appropriate knowledge to give it.

Encouraging engagement 

If done right, it can enhance the image of the profession, making it more accessible and encouraging people to engage with medical professionals. 

Without qualified medical professionals, health misinformation and quackery would go unchallenged on social media, so it is important that the medical profession should have some presence in these spheres to temper pseudo­science and bad medical advice. 

However, it is important to exercise caution if asked for specific medical advice by an individual, as doing so is likely to establish a duty of care and could allow a patient to pursue a clinical negligence claim if they were dissatisfied with any advice received.

Also, it is important to be upfront and honest regarding any payment you receive as a result of a brand event or any social media activity that you undertake. 

Conflicts of interest

In its guidance focusing on financial dealings and conflicts of interest, the GMC says ‘conflicts of interest may arise in a range of situations. They are not confined to financial interests, and may also include other personal interests’. 

Additionally, the GMC’s Doctors use of social media (2013) explains that ‘when you post material online, you should be open about any conflict of interest and declare any financial or commercial interests in healthcare organisations or pharmaceutical and biomedical companies’. 

Advertisements must be clearly defined as such at the start of the post, commonly with the hashtag #AD or similar. 

The Advertising Standards Authority also states that ‘if a brand gives an influencer a payment, free item or other “perk”, any resulting posts referencing the brand or their products become subject to consumer protection law, enforced by the Competition and Markets Authority and others, such as Trading Standards’.

Depending on the webinars’ content, it may be that you would wish to relay anecdotes or examples from your clinical practice. But the principles of confidentiality would apply whether you are communicating offline or online.

Get consent 

It is important not to discuss individual patients, living or dead. Posting details of a clinical case, however heavily anonymised, without patient consent would constitute a breach of confidentiality – as would sharing a photograph of a patient’s condition. 

It may also be possible for someone to identify a patient even when discussing a case anonymously. 

Also, remember to consider how any comments you make either at an event or on social media may be perceived by colleagues, patients or the general public and be mindful about whether you are revealing confidential information. Most breaches of confidentiality happen inadvertently. 

Finally, it is important to ensure that you have appropriate indemnity in place for any work done in your capacity as a doctor. 

Dr Ellie Mein is a medico-legal adviser at the Medical Defence Union

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Trying to avoid PCR test

A patient requests a letter exempting them from a PCR test before travel. Dr Kathryn Leask advises what to do.

 

 

 

 

 

Dilemma 2

Must I sign their exemption note?

Q I am a private GP and have been contacted by a patient to provide them with a letter exempting them from having a PCR test for Covid when travelling to and from the UK. 

They have family abroad and travel quite frequently. I appreciate that this will have financial implications for the patient, as they are having to have the tests done on a regular basis. 

The patient is finding the tests uncomfortable and states that the anticipation of having to have these done is causing them anxiety. The patient has also made reference to their diagnosis of asthma and how the anxiety of having to have a test done is making this worse. 

I have reviewed the patient’s notes and the only reference to a respiratory problem I can find is a post-viral wheeze ten years ago. They did not require any specialist follow up. 

The patient has been travelling for a number of months, but I have not personally seen them during this time. I have previously refused to provide them with an exemption letter for mask-wearing, as I did not believe there was a clinical indication to provide this.  

The patient was very unhappy with this decision and made a complaint at the time. The patient says they have seen a doctor in the other country about their asthma and anxiety and has threatened to complain to the GMC if I don’t comply with their request.

What should I do? 

A As the patient has expressed their dissatisfaction, their concerns should be dealt with in line with your complaints process. This should include an explanation for the decisions you have made so that the patient understands your reasoning.

You can make reference to the Government’s advice on the wearing of face coverings, PCR tests and quarantining during travel to and from the UK, which is available on its website. This page refers to those who may be exempt from having to have a Covid test for medical reasons, which include:

 For urgent medical treatment or are accompanying someone who is travelling for urgent treatment, and it is not reasonably practical for you to obtain a negative Covid test in the three days before leaving;

 If you have a medical condition which means you cannot take a test – you must present a note from a doctor at check-in and to Border Force staff on arrival in England.

In its guidance Good Medical Practice (2013), the GMC states that you must take reasonable steps to check information is correct when you complete or sign documents and must not deliberately leave out relevant information (paragraph 71). 

Justify your position

If you provided a letter for the patient, you need to be in a position to justify your decision bearing in mind the wider public interest in travellers complying with the Government’s advice. 

The patient has mentioned referring their concerns to the GMC and, therefore, it would be important to explain to the patient that you would need to be able to rely on supporting evidence from their records in order to provide such a letter, which does not appear to be available. 

It is possible that you could be criticised if you provided an opinion that the patient should be exempt from having a test without any evidence to support this.

As you have not seen the patient or been in a position to examine them, you may feel that the doctor whom the patient has seen abroad would be better placed to provide such an exemption letter, if they felt this was appropriate. 

Dr Kathryn Leask is a medico-legal adviser at the Medical Defence Union 

• See ‘When you must confess to the GMC’