Over the last two decades, social media has become an integral part of modern communication, content creation and consumerism, offering healthcare professionals (HCPs) opportunities to learn, educate, advocate and connect with peers, students, mentors, teachers, colleagues, patients and the public.^1,2,3,4 Yet, its use carries legal, ethical and professional responsibilities. In South Africa (SA), the Health Professions Council of South Africa (HPCSA) has issued clear guidance on responsible online conduct, most notably in Booklet 16: Ethical Guidelines on Social Media, which was updated in March 2025 (hereafter referred to as Booklet 16).⁵

Social media describes ‘any online tools and electronic communication platforms that are used for social networking, sharing content such as opinions, information, photos, videos and audio’.⁵ These may include, but are not limited to, social networks (e.g. Facebook, LinkedIn), content-sharing platforms (e.g. WhatsApp, Instagram, YouTube, X, TikTok), personal and professional blogs, Internet discussion forums and the comment sections of websites.^5,6,7

As at October 2025, SA had 29.1 million social media user identities, representing 44.9% of the population and reflecting a year-on-year increase of 3.8 million (15.2%). Globally, 5.66 billion social media user identities were recorded.⁸

While individuals typically make medical decisions in accordance with their own views and values, these are often shaped or influenced by their experiences, the environment and their social circle, whether in-person or online.⁹ In the healthcare context, patients do not necessarily use social media to circumvent HCPs, but rather as a complement to HCP services to fulfil the patients’ needs that the HCP cannot meet.¹⁰

This CPD article aims to synthesise the HPCSA guidelines and complementary resources on social media use into practical recommendations for HCPs.

Booklet 16 speaks to HCPs’ obligations on the Ethical Rules of Conduct for Health Practitioners Registered under the Health Professions Act 1974, as amended¹¹ and other pieces of relevant legislation, such as the Promotion of Access to Information Act (PAIA),¹² and the Protection of Personal Information Act (POPIA).¹³ Table 1 summarises these frameworks.

According to the Bill of Rights of the Constitution of the Republic of SA, every person has the right to approach the court to enforce their rights when they are threatened or violated.¹⁴ These include, but are not limited to: (1) have dignity protected and respected, (2) physical and psychological integrity, (3) equality, (4) privacy and (5) freedom of expression. Many of the rights are not absolute, but their infringement ought to be justifiable and reasonable in an open and democratic society.^7,14

As it relates to social media, the first case in SA where damages were awarded to the plaintiff for a defamatory statement made on Facebook transpired in 2013.^7,15 Further cases have been taken to court after this ruling. In the healthcare context, the HPCSA recently found a HCP guilty of unprofessional conduct and imposed a fine of R10 000.00 for social media posts deemed abusive and damaging to the profession’s reputation. The ruling, based on X posts made in 2025 (which have since been deleted), sparked global debate regarding free speech versus ethical standards.^16,17 These cases may demonstrate the ‘disinhibition effect’, defined as the lowering in the online social environment of the psychological restraints that normally serve to regulate behaviour.^7,18,19 In both cases, individuals may have expressed themselves more freely and impulsively online than they would in face-to-face interactions. The relative anonymity, perceived distance and informal nature of social media platforms reduce self-restraint, leading to statements that may breach legal, ethical or professional boundaries.^7,18,19 These cases highlight how lowered inhibitions while on social media can result in possible reputational harm, legal liability and professional sanctions, underscoring the tension between freedom of expression and the ethical obligations of HCPs.

There are ethical obligations and responsibilities imposed on HCPs regarding their relationships with their patients and each other, such as those set out in the General Ethical Guidelines for Health Care Professionals (Booklet 1)²⁰ and Confidentiality: Protecting and Providing Information (Booklet 5).²¹ Obligations relating to the electronic storage and transmission of health records for professional purposes are found in General Ethical Guidelines for Management of Health Records (Booklet 9)²² and Ethical Guidelines for Good Practice in Telehealth practice (Booklet 10).²³

Pontarelli et al.⁹ explored the frequency of ethical transgressions sanctioned by the HPCSA in the context of increased patient empowerment, as a result of the accelerated use of social media by patients between 2014 and 2023. Of the 1012 ethical transgressions among 452 registered HCPs, fraudulent conduct, including falsifying status or qualifications, false advertising material, fraudulent medical records and financial reports and fraudulent billing constituted the predominant complaints. Between 2006 and 2016, there was a reported 100% increase in the number of complaints submitted to the HPCSA.⁹ This increase in lodged complaints has been attributed to the HPCSA distributing pamphlets directing patients on how to place complaints, as well as an increase in patients’ awareness of their rights. This increase may also be likely because of the increasing use of social media in the modern age and will continue to grow as more people flock to various platforms to gather information and communicate.⁹ The study identified the need for an HCP ethics education plan that offers more than a mere check-a-box exercise and recommended an education programme like that of the Minnesota Board of Dentistry and Dr. Bebeau^24,25 that would foster individualised reflection on ethical shortcomings, strengthen SA’s healthcare sector and build public trust by cultivating strong patient-professional relationships.⁹

The World Medical Association’s Statement on Social Media²⁶ and Guidelines on Promotional Mass Media Appearances²⁷ underscore that HCPs’ presence in social and mass media must uphold the same ethical standards as clinical practice. Online communication should protect patient confidentiality, respect professional boundaries and provide accurate, evidence-based information. Physicians are cautioned against using social media or promotional appearances to advertise products, endorse unproven treatments or exaggerate qualifications. Instead, their digital and media engagement should serve public health education, transparency and trust, ensuring that professionalism and integrity remain paramount over visibility or commercial gain.

Based on the previous sections, the framework of ‘Protect Patients, Protect Yourself, and Protect the Profession’ is presented as a guide for HCPs, with Table 1 illustrating practical examples of recommended do’s and don’ts.^{2,5,6,7,9,11,12,13,14,21,28}

Social media offers powerful tools for communication and advocacy in family practice. However, its responsible use requires adherence to ethical and legal frameworks and ongoing professional reflection. By following HPCSA and other guidelines and applying practical do’s and don’ts, HCPs can harness social media to strengthen patient trust, advance public health and uphold the integrity of the profession.