Colleague Consultation · Intermediate · Communication

Addressing a Colleague's Inappropriate Social Media Conduct with Patients

Practise this PLAB 2 colleague consultation station on Professional Boundary Violation. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are a Registrar in a busy A&E department. You have been informed that your colleague Jerome Forbes Thompson has been adding patients to his personal Facebook account and engaging in casual social media interactions with them. Some messages show flirting and overly familiar language. You need to address this serious breach of professional boundaries and safeguarding concerns.

Background notes: PMH: Nil significant

What this station tests

  • Doctor-patient social media connections as boundary violations: power imbalance makes them inappropriate
  • GMC professional boundaries guidance: applies to online interactions
  • Grooming perception: a fitness-to-practise panel could interpret social media connections negatively
  • Self-reporting for reflection: educational supervisor involvement for professional development
  • Protecting career alongside protecting patients: framing as prevention not punishment

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself and your role. State the purpose of the consultation clearly.
  • 1-3 min — Present Case: Use SBAR structure. Situation, Background, Assessment, Recommendation. Be concise and relevant.
  • 3-5 min — Discussion: Discuss differential diagnosis and management. Listen to colleague's perspective. Share concerns professionally.
  • 5-7 min — Agree Plan: Agree on management plan. Clarify roles and responsibilities. Discuss escalation criteria.
  • 7-8 min — Closing: Summarise agreed actions. Confirm documentation. Arrange follow-up communication.

Consultation approach

The opening

A colleague adding patients on social media crosses a professional boundary. Jerome is 35, an A&E registrar, who has been connecting with patients on Instagram. He sees it as friendly, not inappropriate. Open with: 'Jerome, I need to discuss something that has been brought to my attention about your social media activity with patients.'

Core approach

Explain the problem. 'Connecting with patients on personal social media is a professional boundary violation. Even if your intention is friendly, the doctor-patient relationship creates a power dynamic that makes social media connections inappropriate.' GMC guidance: maintaining professional boundaries includes online interactions.

He may argue: 'It is just Instagram, I am being friendly.' Counter: 'Social media blurs the boundary between your professional and personal life. Patients may feel obligated to accept because you are their doctor. They may share personal health information on a non-secure platform. And it could be perceived as grooming by a fitness-to-practise panel.'

He must stop connecting with patients. Remove existing patient connections. This is not optional.

Closing and safety netting

Actions: he must disconnect from patients on all social media. Review GMC social media and professional boundaries guidance. Self-report to educational supervisor for reflection and learning. If any relationships have become inappropriate: escalate to safeguarding.

'Jerome, I am not trying to get you in trouble. I am trying to protect your career and your patients. If this came to light through a complaint rather than a conversation, the consequences would be much more serious.' Follow-up: confirm he has actioned the changes.

How examiners mark this station

Examiners will assess both Domain 1 (Data Gathering) and Domain 2 (Clinical Management) as primary: clarity and structure of your case presentation, appropriateness of your clinical reasoning, and whether you agree a clear plan. Domain 3 (Interpersonal Skills) assesses professional communication and collaborative approach.

Domain 1 (Supporting)

Scores well: Specific behaviour identified. Extent assessed (how many patients). Any inappropriate escalation checked.

Costs marks: Not assessing extent.

Domain 2 (Primary focus)

Scores well: Stop and disconnect. GMC guidance reviewed. Educational supervisor informed. Safeguarding if escalation. Documentation.

Costs marks: Not insisting on disconnection. Not involving supervisor.

Domain 3 (Primary focus)

Scores well: Direct but protective. Framing as career protection. Not punitive. Explaining the risk clearly.

Costs marks: Punitive. Not explaining why it matters. Confrontational.

Common examiner feedback (and how to fix it)

Did not communicate clinical information effectively

Fix: Use SBAR (Situation, Background, Assessment, Recommendation) every time. State clearly what you need from the colleague at the outset.

Did not identify the patient's problems and/or did not develop a management plan adequately

Fix: Before ending, confirm: What is the plan? Who is doing what? When will you communicate next? Document the agreed plan.

Common mistakes in this station

  1. Dismissing it as harmless: social media connections with patients are a professional boundary issue
  2. Not insisting on disconnection: existing connections must be removed
  3. Not involving the educational supervisor: this needs documented reflection

Resitting PLAB 2?

If colleague consultation stations have been challenging, practise the SBAR format until it is automatic. The most common issue is failing to clearly state why you are consulting the colleague and what you need from them. Be direct about your clinical question.

Example opening

Hello, this is Dr [Name], I'm the FY2 on [ward]. Thank you for taking my call. I'd like to discuss a patient I'm looking after and get your advice on management.

Frequently asked questions

What is the best way to structure the professional boundary violation discussion with a colleague?

A colleague adding patients on social media crosses a professional boundary. Jerome is 35, an A&E registrar, who has been connecting with patients on Instagram. He sees it as friendly, not inappropriate.

Where are marks won and lost in this professional boundary violation station?

Examiners reward: Specific behaviour identified. Extent assessed (how many patients). Any inappropriate escalation checked. Candidates are penalised for: Not assessing extent.

Where do candidates most often go wrong in this station?

Dismissing it as harmless: social media connections with patients are a professional boundary issue. Another frequent error: Not insisting on disconnection: existing connections must be removed.

Can I do well in this station without real-world experience of professional boundary violation?

Structure beats experience here. Focus on gMC professional boundaries guidance: applies to online interactions. Use the domain breakdown on this page to target your preparation, then practise the station aloud so your structure survives exam pressure.

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