A vet in general practice performs an enterotomy on a bulldog to remove a foreign body. The dog is presented to an emergency centre 24 hours later for wound dehiscence secondary to self trauma, which is treated successfully at cost to the client. A vet student completing extramural studies at the centre posts a photo of himself with the dog in recovery from anaesthesia on his Facebook page, with a caption, ‘Me with a dog recovering from a botched operation.’ The client, who is a Facebook ‘friend’ of the student, recognises her dog in the photo and demands a refund for the initial surgery because it was ‘botched’. Should the original vet provide a refund and what should happen to the student?
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Anne Fawcett graduated with a BA in philosophy followed by a BSc(Vet) and a BVSc from the University of Sydney, Australia. She works in small animal practice and is an associate lecturer in professional practice.
John Baguley graduated with a BVSc from the University of Sydney, Australia. He spent 10 years in mostly small animal practice and is currently the academic coordinator of the professional practice programme at the University of Sydney.
Issues to consider
This is a complex scenario in which there are many stakeholders, including the vet, his practice and staff, the emergency centre vet and staff, the student, the university staff and fellow students, the client and the dog. The student has breached confidentiality by publishing a photograph of a patient without authorisation. The post is, at best, a negligent misrepresentation of the facts or, at worst, a malicious untruth.
The implication is that the primary vet is incompetent and this account is credible to the client as the student is known to them. The client is understandably indignant that she has paid for a procedure that she now perceives was the fault of the primary vet. She is also concerned for her dog, which she believes has undergone an additional procedure due to the incompetence of the primary vet.
This post reflects poorly on both the original vet and the emergency centre, harming the reputation of both. The primary vet and his practice and the emergency centre vet and staff are concerned about the actions of the student and their relationship with the university. The university is concerned about its relationship with the profession and the reputation of its students.
The client is demanding compensation on the grounds that the surgery was ‘botched’ but, as this was not the case, simply refunding the cost of surgery to appease the client may be misconstrued as confirmation of the student's post. How can the reputation of the primary vet be restored? Is the client entitled to a refund from the primary vet or the emergency centre? Can the student be required to remove a post made in his own time? Should the primary vet sue for defamation?
Possible way forward
Social media are increasingly popular, but careless, malicious and otherwise inappropriate online communication can be detrimental to personal and professional reputations and relationships.
All professionals need to understand that social media blur the distinction between private and professional life. Unlike a conversation between individuals, communication via social media may be viewed by numerous people, possibly unknown to the person posting, and remains a permanent record. Furthermore, the context and tone of a post are not always obvious to all readers, lending posts to misinterpretation.
While it can be argued that individuals have the right to freedom of speech and self expression, it is equally true that clients and colleagues have the right to confidentiality. Veterinary codes of conduct require vets to maintain confidentiality and stipulate that they should not behave in such a way as to adversely affect the standing of fellow practitioners or the profession. Depending on the jurisdiction, the student may have to abide by an administrative veterinary code of conduct or an official, university student code of conduct, and hence may be subject to disciplinary action from regulators of the profession or the university at which he is enrolled.
We applied a utilitarian model to this dilemma, seeking a solution that yielded the greatest good for the greatest number of stakeholders. In this we feel it is acceptable for emergency centre staff to approach the student and ask for an explanation. Alternatively, emergency centre staff may make this request via the university at which the student is enrolled. It is appropriate to request that the post is removed from the site.
The student should be counselled on professionalism and online behaviour by university staff and the implications of his actions clearly explained, potentially through a meeting of all concerned. Although he did not use the name of the practices, the patient or the client, he may not be aware that in maintaining confidentiality he should ensure that cases cannot be identified in anyway by information posted online, including images. Furthermore, he may not be aware that he has acted improperly by effectively making a diagnosis (‘botched’ surgery). Educational resources, such as those produced for medics, are helpful in counselling students in these situations.
A written apology to the client, the primary vet, the university and the emergency centre may be the most effective way for the student to demonstrate remorse and lack of malicious intent. The student may face additional disciplinary action depending on university policies and local legislation.
Senior emergency centre and university staff should meet with the primary vet and client to explain (with the assistance of medical records if necessary) that the complication was due to self trauma, rather than negligence of the primary vet. The fact that the online posting was incorrect and unauthorised should be emphasised, and the client informed that the student responsible has been counselled. University staff should clearly explain to the primary vet, the emergency centre, the client and other extramural practices any changes to the teaching of ethics and professionalism, student codes of conduct, or policies designed to prevent similar incidents.
Those supervising the student at the time (including the university and the emergency centre) are responsible for the actions of the student that affect patients or clients, and thus must determine whether or not to refund the cost of the secondary procedure. Depending on the damage done to the primary vet's reputation, he or she may elect to sue for defamation.
Readers with views to contribute on ‘Social media menace?’ should e-mail them toso that they can be considered for publication in the next issue, or fax comments to 020 7383 6418. The deadline for receipt of comments is Thursday, April 28. Please limit contributions to 200 words.
THIS series gives readers the opportunity to consider and contribute to discussion of some of the ethical dilemmas that can arise in veterinary practice. Each month, a case scenario is presented, followed by discussion of some of the issues involved. In addition, a possible way forward is suggested; however, there is rarely a cut-and-dried answer in such cases, and readers may wish to suggest an alternative approach. This month's dilemma, ‘Social media menace?’, is presented and discussed by Anne Fawcett. Readers with comments to contribute are invited to send them as soon as possible, so that they can be considered for publication in the next issue. Discussion of the dilemma ‘Principled profit-sharing?’, which was published in the March issue of In Practice, appears on page 191.
The series is being coordinated by Siobhan Mullan, of the University of Bristol. It is hoped it will provide a framework that will help practices find solutions when facing similar dilemmas.
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