Digital Professionalism 2013

DIGITAL PROFESSIONALISMBeing a Psychiatrist Online

Dr Christopher PellConsultant Psychiatrist

@egosyntonically

Rock1997 CC-BY-SA

OUTLINE

Background

Emerging legal trends

New GMC guidance

Debate

Further reading

GMC UP UNTIL NOW ...

No specific guidance on social media

Comes down to probity, professionalism and confidentiality standards in Good Medical Practice

“We would see the principles that apply to this as no different from those that apply in sharing information in other areas, for example what information about their work doctors might share with friends at the pub or in other social settings, although obviously the range of people who might have access to their comments is likely to be wider.”

“In response to queries about this we have taken the view that doctors are allowed, like anyone else, to have a private life and use of the internet and social networking sites are a part of this for many people. It is clearly a matter of judgement, about what information doctors choose to share on such sites and with whom, bearing in mind their professional obligations as a doctor and any contractual requirements. It is not possible to state categorically what would and would not be acceptable in relation to these matters as it is likely to depend on many factors, including the nature of the comments, who could access them, and whether they were posted during or outside work hours.”

FACEBOOK

Total no. of Facebook users: 1.06 billion

Daily active FB users: 618 million

Total no. of Facebook pages: 50 million

Average no. of monthly posts/page: 36

No. of friend connections: 150 billion

Average no. of friends per FB user: 141.5

Average daily FB likes: 2.7 billion

http://expandedramblings.com/index.php/resource-how-many-people-use-the-top-social-media/

http://investor.fb.com/releasedetail.cfm?ReleaseID=736911

http://investor.fb.com/releasedetail.cfm?ReleaseID=736911

http://files.shareholder.com/downloads/AMDA-NJ5DZ/2301311196x0xS1326801-13-3/1326801/1326801-13-3.pdf

http://www.socialbakers.com/blog/1561-cutting-through-the-crowds-on-facebook-news-feeds

http://files.shareholder.com/downloads/AMDA-NJ5DZ/2301311196x0xS1326801-13-3/1326801/1326801-13-3.pdf

http://www.jeffbullas.com/2012/04/23/48-significant-social-media-facts-figures-and-statistics-plus-7-infographics/


TWITTER

Total no. of Twitter Users: 500 million

Total no. of Tweets Sent: 170 billion

Average no. of Tweets Sent Per Day: 400 million

Average no. of Followers per Twitter User: 208

Average no. of Tweets per Twitter User: 307

Average Time Per Month Spent by Users on Twitter: 170 minutes

Percentage of Twitter Users Accessing Via Mobile: 60%

Most Followed Celeb on Twitter: Justin Bieber


http://techcrunch.com/2012/07/31/twitter-may-have-500m-users-but-only-170m-are-active-75-on-twitters-own-clients/

http://booksandpublishing.com/the-latest-news/inside-the-library-of-congresss-mission-to-organize-170-billion-tweets

http://mashable.com/2013/03/21/happy-7th-birthday-twitter/

http://www.telegraph.co.uk/technology/news/9601327/Average-Twitter-user-is-an-an-American-woman-with-an-iPhone-and-208-followers.html

http://www.mediabistro.com/alltwitter/50-twitter-fun-facts_b33589

http://allthingsd.com/20120927/instagram-beats-twitter-in-daily-mobile-users-for-the-first-time-data-says/

http://www.guardian.co.uk/technology/2012/dec/18/twitter-users-pass-200-million

https://twitter.com/justinbieber


YOUTUBE

One billion unique views per month

4 billion views per day

60 hours of video uploaded per minute

Nearly 9 out of 10 (87%) of UK internet users have used YouTube



POSITIVE MEDICAL USES OF SOCIAL MEDIA

“Technology should be like oxygen: ubiquitous, necessary, and invisible.”

-Chris Lehmann

“If you don’t learn something new each day on Twitter, then you are

following the wrong people.”-via @TweetSmarter


“Technology should be like oxygen: ubiquitous, necessary, and invisible.”

-Chris Lehmann

“If you don’t learn something new each day on Twitter, then you are

following the wrong people.”-via @TweetSmarter

Networking

Learning

Informing

Educating

Promoting

Discovering

Conversing

Asking questions

Sharing

Reconnecting

Entertaining

Employing

Advertising


Twitter:

Keep up to date

Inform others and share interesting articles

Networking particularly for conferences - #RCPsychIC13

Journal clubs and specific discussion groups - #meded #TwitJC

Track jobs and other opportunities

Public health - track disease outbreaks, emergencies

Crowd sourcing platform - ask your followers

Communicate with colleagues (and patients?)


Facebook

Present a professional image

Create a “fan page” for your organisation - e.g. RCPsych

Use to disseminate information

Generate discussion amongst friends or fans

WHY DOCTORS SHOULD CARE

✤ You are already on-line.

Try Googling yourself - find out what others would see

Your friends, family and patients are all on-line too (and may be posting information about you)

Likely to continue to increase in next few years

Increasingly pervasive into other aspects of life

Doesn’t interfere with off-line relationships

WHY DOCTORS SHOULD CARE

✤ You are already on-line.

DEVELOPING LEGAL TRENDS#twitterjoketrial

Unnamed footballer saga highlights courts’ ability to pursue tweeters

Ongoing case in respect of Twitter users who wrongly identified Lord MacAlpine

Upshot in UK as of 2011 - all tweets are considered public domain material

Material posted is permanent and searchable

SPECIFIC PROBLEM AREAS FOR CLINICIANS

Personal views

Public Communication

Confidentiality

Professionalism

DefamationCC: Takomabibelot

GMC CASES TO DATE

Dr Khalil

On 6 June 2011 at Thames Magistrates' Court, you were convicted of sending electronic communications that were grossly offensive or of an indecent, obscene or menacing character Contrary to section 127(1)(a) and (3) of the Communications Act 2003. Admitted and found proved.

“In view of the seriousness of your conviction, the Panel determined that the maximum period of 12 months’ suspension is necessary. The Panel also determined that a review is necessary in order that a subsequent Panel may be satisfied that you are fit to resume practice following your period of suspension.” CC: Takomabibelot

GMC CASES TO DATE

Dr Jasiak

In relation to your failure to treat your colleagues with dignity and respect, you admitted that you regularly used nicknames for colleagues. These included ‘sausage tits’, ‘nurse endowed’ and ‘jugs’.

You admitted that on the day you were dismissed from the Trust you posted a comment on Facebook relating to your dismissal knowing that it would be seen by the various Trust employees […] You accepted that the language used was intemperate and inappropriate.

This warning will be published on the List of Registered Medical Practitioners (LRMP) for a period of five years and will be disclosed to any person enquiring about your fitness to practice history. CC: Takomabibelot

GMC GUIDANCE

Part of process to update Good Medical Practice

Came into effect on 22nd April 2013

8 additional areas consulted on to provide explanatory guidance on the GMCs views on what is expected of doctors in the following areas:

Acting as a witness in legal proceedings Delegation and referral Doctors' use of social media (new guidance) Ending your professional relationship with a patient Financial and commercial arrangements and conflicts of interest Maintaining boundaries Personal beliefs and medical practice Reporting criminal and regulatory proceedings within and outside the UK

GMC GUIDANCE

Language used:

“Must” = an overriding duty or principle

“Should“ = the duty or principle will not apply in all situations or circumstances, or where there are factors that are outside your control that affect or control how you can follow the guidance

To maintain your license to practice, you must demonstrate, through the revalidation process, that you work in line with […] this guidance.

Serious or persistent failure to follow this guidance will put your registration at risk

DOCTORS’ USE OF SOCIAL MEDIA

General Principles

Social Media

Privacy

Conflicts of interest

Benefits and Risks

Maintaining boundaries

Maintaining confidentiality

Respect for colleagues

Anonymity

GENERAL PRINCIPLES

In Good Medical Practice we say:

You must treat colleagues fairly and with respect.

You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession.

When communicating publicly, including speaking to or writing in the media, you must maintain patient confidentiality. You should remember when using social media that communications intended for friends or family may become more widely available.

When advertising your services, you must make sure the information you publish is factual and can be checked, and does not exploit patients’ vulnerability or lack of medical knowledge.

In Confidentiality we say:

Many improper disclosures are unintentional. You should not share identifiable information about patients where you can be overheard, for example, in a public place or in an internet chat forum...

GENERAL PRINCIPLES

The standards expected of doctors do not change because they are communicating through social media rather than face to face or through other traditional media. However, using social media creates new circumstances in which the established principles apply.

You must also follow our guidance on prescribing, which gives advice on using internet sites for the provision of medical services.

As well as this guidance, you should keep up to date with and follow your organisation’s policy on social media.

PRIVACY

Using social media has blurred the boundaries between public and private life, and online information can be easily accessed by others. You should be aware of the limitations of privacy online and you should regularly review the privacy settings for each of your social media profiles. Because...

Social media sites cannot guarantee confidentiality

Others may be able to access your personal information

Location information may be shared

Information posted is permanent and distributable


Engaging people in public health and policy discussions

Establishing national and international professional networks

Facilitating patients’ access to information about health and services


Risks:

Maintaining boundaries

Follow separate guidance

If approached by a patient you should indicate you cannot mix social and professional relationships and direct to your professional profile

Maintaining confidentiality

Caution even in private forums

Must not discuss individual patient or their care with those patients or anybody else

Caution that confidentiality may be breached by the sum of info on-line

CONFIDENTIALITY

Confidentiality is the sum of on-line information

CONFIDENTIALITY


Today✤ Phew what a day! Ward understaffed, and annoying tribunal for that

difficult patient.

CONFIDENTIALITY



difficult patient.

✤ Wow, the nerve of some people - admitted a really difficult patient with stroppy relatives today. People don’t appreciate doctors!Friday

CONFIDENTIALITY



difficult patient.


✤ Looking forward to starting on Ward 20 today!January

CONFIDENTIALITY



difficult patient.


✤ Looking forward to starting on Ward 20 today!January

✤ Nice to see our local NHS Tayside newsletter today, interesting article on Sunnyside hospital - I’ll be there for my next job!August


Risks:

Respect for Colleagues

Covers all situations and all forms of interaction and communication

Must not bully, harass or make gratuitous, unsubstantiated or unsustainable comments about individuals online

Be aware that online content is subject to same laws of copyright, and defamation (or libel) as other forms of communication

Conflicts of interest

You should be open about any conflict of interest and declare any financial or commercial interests in healthcare organisations or pharmaceutical and biomedical companies


Anonymity…

If you are writing in a professional capacity, you should usually identify yourself.

Any material written by authors who represent themselves as doctors are likely to be taken on trust and/or to represent the views of the profession more widely.

You should also be aware that content uploaded anonymously can, in many cases, be traced back to its point of origin.


Anonymity…

If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name.

Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely.

You should also be aware that content uploaded anonymously can, in many cases, be traced back to its point of origin.

BACKLASH

Doctors will disappear off Twitter and interaction will be lost

Can doctors be trusted to exercise professionalism online?

Doctor anonymity will help protect identification of patient cases being discussed

Suggestions have been made to run two accounts - If one account is anonymous and the other under a real name, then the user is bound to get them mixed up

Why, when patient safety is not an issue?

That doctors should have the right to be anonymous in their social media activities just like any other profession

Doctors will feel unable to comment on medicine and medical politics

There are valid reasons to be anonymous

http://surgicalopinion.blogspot.com.au/2013/03/twitter-wars-on-anonymity-of-doctors-on.html

http://surgicalopinion.blogspot.com.au/2013/03/twitter-wars-on-anonymity-of-doctors-on.html

GMC RESPONSE

What does 'identifying yourself as a doctor' mean in practice?

There is a bit of judgement involved here. For example, if you want to blog about football and incidentally mention that you're a doctor, there is no need to identify yourself if you don't want to.

If you're using social media to comment on health or healthcare issues, we think it's good practice to say who you are.

In the guidance we say 'you should' rather than 'you must'. We use this language to support doctors exercising their professional judgement. This means we think it is good practice but not that it is mandatory.

Does this restrict doctors' freedom of expression?

We are not restricting doctors' right to express their views and opinions except:

Where this would breach patient confidentiality

Where comments bully, harass or make malicious comments about colleagues on line. (A colleague is anyone a doctor works with, whether or not they are also doctors).

GMC RESPONSE

Does this guidance apply to personal use?

The GMC has no interest in doctors' use of social media in their personal lives — Tweets, blogs, Facebook pages etc. But doctors mustn’t undermine public trust in the profession. Usually this means breaking the law, even where the conviction is unrelated to their professional life.

Why can't I raise concerns anonymously in social media?

We are not trying to restrict discussion about important issues relating to patient safety and certainly don't want to discourage doctors from raising concerns. However, we wouldn't encourage doctors to do so via social media because ultimately it's not private and it might well be missed by the people or organisations who are able to take action to protect patients.

Why do publications like the BMJ allow anonymous blogs/letters articles? Does the guidance mean they can't do that anymore?

BMJ is entirely independent of the GMC, and it is a matter for them to decide what is appropriate for their website.

PERSONAL VS PROFESSIONAL PERSONAS

Article 8 of the Human Rights Act states: “Everyone has the right to respect for his private and family life, his home and his correspondence.”

Care needed to ensure policy does not infringe our rights to freedom of speech, and to a private life

Would we accept policies that monitor and limit what we say in public? Are tweets and posts any different?

Is it possible to separate who we are?

The InternetPrivacy

http://www.flickr.com/photos/buriednexttoyou/5095255302/

A Helpful Venn Diagram

http://www.flickr.com/photos/buriednexttoyou/5095255302/

Digital Professionalism 2013

Health & Medicine

Transcript of Digital Professionalism 2013