The Last Word: Social Media Forums

Aesthetic nurse Bethany Hall explores the use of social media forums for seeking professional guidance in the event of a clinical complication

Recent figures suggest that for Facebook alone, there are more than 2.32 billion active users per month.¹ In a world of smartphones and unwavering WiFi connections, would it be silly not to utilise this 24/7 support network for our own business? As someone who embraces the power of social media from a personal and business perspective, I have recently observed that the popular forums available to aesthetic practitioners like myself, have lately stopped being a place to share best practice and points for debate. Rather, I believe that for some, they have become somewhat of an emergency helpline.

This article aims to unpick whether social media platforms such as Facebook are an appropriate place to seek advice and guidance in the event of a live clinical emergency; or if the forums are better used as a reflective tool, post-event.

Why use forums?

I fully support the use of forums in a retrospective, reflective way. They are somewhere to share best practice, offer words of support and perhaps consider and debate different approaches for the future. These are all the things you may discuss in a ‘normal’ team environment. Much of the despair associated with the rise of the aesthetic industry does relate to lone working. As healthcare professionals, we often go from working in relatively large teams – with a variable skill mix – to working alone. It is reasonable to suggest that perhaps this is very detrimental to patient outcomes, especially in an instance where a complication occurs.

As aesthetic practitioners often work in isolation, situations where we do need to ‘bounce’ ideas offone another (as you would in any other role) are missed, which is disheartening, especially in a panic-ridden situation. Further to this, it is sometimes years before even an ‘advanced’ practitioner can experience a ‘true’ complication. For example, many posts on social media forums are regarding severe bruises/ haematomas but the practitioner has worried that they are a ‘true’ complication such as a vascular occlusion and upon further assessment/advice it is not. Although an advanced practitioner may have a wealth of clinical experience, anyone’s first experience of managing a complication will likely bring doubt, fear and panic. So, would a live, constantly updating forum not be the ideal place to seek immediate reassurance?

While the use of forums to ask urgent questions, such as, ‘Can anyone help? Potential vascular occlusion?’ may ultimately lead to a successful outcome for the patient, is it worth considering whether a practitioner frantically seeking advice from a Facebook forum can lead to a lack of faith and trust in a patient’s chosen practitioner and thus, any future treatment? Additionally, the advice provided on the forums may quite possibly be coming from those who are still relatively inexperienced, or their advice may not be entirely evidence based. Similarly, there is the risk of being given conflicting information from different professionals within the same thread. So, the injector who has originally posted for support and clinical advice may still indeed be left without the information they are seeking.

Is it worth considering whether a practitioner frantically seeking advice from a Facebook forum can lead to a lack of faith and trust in a patient’s chosen practitioner and thus, any future treatment? 

The argument

Independent accreditation body Save Face recently published its 2017/18 Consumer Complaints Report.² It found that 934 of 939 total patient complaints and concerns were related to practitioners who were not registered with the body, and 83% of treatments were carried out by non-medical professionals. I am someone who feels strongly regarding the progression of medical aesthetics to a specialism of its own. 

I also feel it is perhaps fair to say that any practitioner, regardless of whether or not they are held accountable by a regulating body, should absolutely not be undertaking any treatment where there has not been a sufficient demonstration of practical and theoretical competency in complications management as a part of their professional training. If done effectively – and these skills are maintained – this should enable all injectors to be wholly competent in managing complications, regardless of the outcome. There are also resources available, such as the British Association of Cosmetic Nurses’ (BACN) competency framework that supports practitioners to identify and develop their skills in relation to all aspects of aesthetic nursing.³ Able, knowledgeable, skillful and efficient are all adjectives that often accompany the term ‘competent’. 

So, the argument is, should someone who considers themselves a ‘competent practitioner’ be able to see all procedures through, despite the outcome, as we would in any other area of nursing or medicine? Is it safe, efficient, and fair to seek advice from (potential) strangers in the event of a problem via a social media forum? I say – no. As stated, I do not condemn the use of social media forums. I do believe that they fit very well into the modern, technology-driven world we have curated. However, there is a specific time and place for their use. Ultimately, this is not during a live clinical complication.

The solution

Preparation. Nobody necessarily wants to be faced with managing any complication, but by ensuring we are adequately prepared and trained in managing adverse events may help stop the requirement for panicked, rushed messages via a Facebook forum. The Aesthetic Complications Expert Group (ACE) has a range of evidenced-based protocols and algorithms for all members to view, and download from its website/forum if desired.^4-7 

ACE members have access to robust guidance relating to a multitude of events; such as acute infections, oedema and ptosis. These protocols and algorithms also state what to include in any emergency kit, of which every practitioner should have to hand in clinic if relevant to the treatments offered. In recent months, ACE has also developed an emergency helpline, further emphasising the fact that their Facebook forum is not the place for emergency guidance.⁸ The helpline is for practitioners who need assistance in the management of a complication in progress, who may not have experienced a complication before, or who perhaps usually work alone. This helpline is manned by aesthetic experts, with extensive knowledge and experience in managing a variety of complications. I believe this is a more appropriate avenue to pursue should you need help managing a complication, rather than a social media forum. 

Although the protocols and the helpline can be utilised as a great support in a complication situation; it is imperative that this guidance, and others like it, is not solely relied upon as a way of managing complications or as a means of replacing specialist training. They are simply an extra tool in the box, and should be used proactively. There are also other professional groups, such as the BACN⁹ and the British College of Aesthetic Medicine (BCAM),¹⁰ which have resources and services available to help and support their members. The BACN, for example, has local groups that can be utilised to find a local ‘buddy’ that practitioners can seek for assistance with complications. 

I believe a fellow practitioner who one could call upon to share expertise and knowledge at a time of potential panic is much more useful and appropriate than an unknown practitioner on a social media forum. 

There are also conferences that you can attend that specifically look at complications, such as the International Association for Prevention of Complications in Aesthetic Medicine (IAPCAM), which is where you can meet and learn from experts who are experienced in managing complications and seek their guidance. Notably, the importance of competent complications management is also being actively encouraged by many leading training companies, pharmacies and aesthetic practitioners – raising awareness and promoting best practice.

As stated, we can continue to utilise social media forums in a reflective manner; encouraging innovative and practical discussion around individual experiences. It is wonderful to see practitioners sharing complication management case studies within the group – in retrospect of the event. It is useful to see how this was managed, what support the practitioner may or may not have sought – and perhaps what they might do differently should a similar situation occur again. This information sharing not only allows the practitioner involved to reflect on their individual practice; it may also encourage other members of the group to identify certain areas within their own skills et that they need to develop further. This professional information sharing is something we can all participate in, and perhaps this proactive type of development is what will ultimately allow us to feel more competent in the eventuality of the live complication.

Summary

Anyone undertaking aesthetic procedures should be sufficiently prepared with evidence-based knowledge and a sufficient stock of the necessary emergency medications to deal with any adverse event. It is not fair on the patient to witness their practitioner seeking advice that is (potentially) not evidence based on a social media forum at a time when they are relying on their practitioner’s professionalism and medical training. We must not rely on these platforms as a safety net for any complication that may arise in our clinic. 

We must, as registered, accountable practitioners, ensure we are fully prepared with the right training, right support network, right protocols, right medication and right expectations (of our patient). We must do this not only to ensure that our patient is safe, and outcomes are as optimal as can be; but to maintain the credibility of our skill set, our duty of care and ultimately, our medical training.