Digital update

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Digital update

  1. 1. DIGITAL PROFESSIONALISMBeing a Psychiatrist OnlineDr Christopher PellConsultant Psychiatrist@egosyntonicallyRock1997 CC-BY-SA
  2. 2. OUTLINEBackgroundEmerging legal trendsNew GMC guidanceDebateFurther reading
  3. 3. GMC UP UNTIL NOW ...No specific guidance on social mediaComes 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 sharinginformation in other areas, for example what information about their work doctors might share withfriends at the pub or in other social settings, although obviously the range of people who might haveaccess 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 manypeople. It is clearly a matter of judgement, about what information doctors choose to share on suchsites and with whom, bearing in mind their professional obligations as a doctor and any contractualrequirements. It is not possible to state categorically what would and would not be acceptable inrelation to these matters as it is likely to depend on many factors, including the nature of thecomments, who could access them, and whether they were posted during or outside work hours.”
  4. 4. FACEBOOKTotal number of Facebook users: 1.06 billion Daily active Facebook users: 618 million  Total number of Facebook pages: 50 million  Average no. of monthly posts per Facebook page: 36Total number of Facebook mobile users: 680 million  Total no. of Facebook friend connections: 150 billion Average number of friends per Facebook user: 141.5Total no. of Facebook likes since launch: 1.13 trillion  Average daily Facebook likes: 2.7 billion  http://expandedramblings.com/index.php/resource-how-many-people-use-the-top-social-media/
  5. 5. TWITTERTotal Number of Twitter Users: 500 million Total Number of Tweets Sent: 170 billion Monthly Active Twitter Users: 200 million  Average Number of Followers per Twitter User: 208Average Number of Tweets Sent Per Day: 400 millionAverage Number 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 Celebrity on Twitter: Justin Bieberhttp://expandedramblings.com/index.php/resource-how-many-people-use-the-top-social-media/
  6. 6. YOUTUBEOne billion unique views permonth4 billion views per day60 hours of video uploadedper minuteNearly 9 out of 10 (87%) ofUK internet users have usedYouTubehttp://expandedramblings.com/index.php/resource-how-many-people-use-the-top-social-media/
  7. 7. YOUTUBEOne billion unique views permonth4 billion views per day60 hours of video uploadedper minuteNearly 9 out of 10 (87%) ofUK internet users have usedYouTubehttp://expandedramblings.com/index.php/resource-how-many-people-use-the-top-social-media/
  8. 8. YOUTUBEOne billion unique views permonth4 billion views per day60 hours of video uploadedper minuteNearly 9 out of 10 (87%) ofUK internet users have usedYouTubehttp://expandedramblings.com/index.php/resource-how-many-people-use-the-top-social-media/
  9. 9. POSITIVE MEDICAL USES OFSOCIAL MEDIA“Technology should be like oxygen:ubiquitous, necessary, and invisible.”-Chris Lehmann“If you don’t learn something neweach day on Twitter, then you arefollowing the wrong people.”-via @TweetSmarter
  10. 10. POSITIVE MEDICAL USES OFSOCIAL MEDIA“Technology should be like oxygen:ubiquitous, necessary, and invisible.”-Chris Lehmann“If you don’t learn something neweach day on Twitter, then you arefollowing the wrong people.”-via @TweetSmarterNetworkingLearningInformingEducatingPromotingDiscoveringConversingAsking questionsSharingReconnectingEntertainingEmployingAdvertising
  11. 11. POSITIVE MEDICAL USES OFSOCIAL MEDIATwitter:Keep up to dateInform others and shareinteresting articlesNetworking particularly forconferences - #RCPsychIC13Journal clubs and specificdiscussion groups - #meded#TwitJCTrack jobs and otheropportunitiesPublic health - track diseaseoutbreaks, emergenciesCrowd sourcing platform - askyour followersCommunicate with colleagues(and patients?)
  12. 12. POSITIVE MEDICAL USES OFSOCIAL MEDIAFacebookPresent a professional imageCreate a “fan page” for yourorganisation - e.g. RCPsychUse to disseminateinformationGenerate discussion amongstfriends or fans
  13. 13. POSITIVE MEDICAL USES OFSOCIAL MEDIAFacebookPresent a professional imageCreate a “fan page” for yourorganisation - e.g. RCPsychUse to disseminateinformationGenerate discussion amongstfriends or fans
  14. 14. WHY DOCTORS SHOULDCARE✤ You are already on-line.
  15. 15. Try Googling yourself - find out what others would seeYour friends, family and patients are all on-line too (and may beposting information about you)Likely to continue to increase in next few yearsIncreasingly pervasive into other aspects of lifeDoesn’t interfere with off-line relationshipsWHY DOCTORS SHOULDCARE✤ You are already on-line.
  16. 16. DEVELOPING LEGAL TRENDS#twitterjoketrialUnnamed footballer sagahighlights courts’ ability to pursuetweetersOngoing case in respect of Twitterusers who wrongly identifiedLord MacAlpineUpshot in UK as of 2011 - alltweets are considered publicdomain materialMaterial posted is permanent andsearchable
  17. 17. SPECIFIC PROBLEM AREASFOR CLINICIANSPersonal viewsPublic CommunicationConfidentialityProfessionalismDefamationCC: Takomabibelot
  18. 18. GMC CASES TO DATEDr KhalilOn 6 June 2011 at Thames Magistrates Court, youwere convicted of sending electronic communicationsthat were grossly offensive or of an indecent, obsceneor menacing character Contrary to section 127(1)(a)and (3) of the Communications Act 2003. Admittedand found proved.“In view of the seriousness of your conviction, thePanel determined that the maximum period of 12months’ suspension is necessary. The Panel alsodetermined that a review is necessary in order that asubsequent Panel may be satisfied that you are fit toresume practice following your period of suspension.” CC: Takomabibelot
  19. 19. GMC CASES TO DATEDr JasiakIn relation to your failure to treat your colleagues with dignity andrespect, you admitted that you regularly used nicknames forcolleagues. These included ‘sausage tits’, ‘nurse endowed’ and‘jugs’.You admitted that on the day you were dismissed from the Trustyou posted a comment on Facebook relating to your dismissalknowing that it would be seen by the various Trust employees […]You accepted that the language used was intemperate andinappropriate.This warning will be published on the List of Registered MedicalPractitioners (LRMP) for a period of five years and will bedisclosed to any person enquiring about your fitness to practicehistory. CC: Takomabibelot
  20. 20. GMC GUIDANCEPart of process to update Good Medical PracticeCame into effect on 22nd April 20138 additional areas consulted on to provide explanatory guidance on theGMCs 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 boundariesPersonal beliefs and medical practice Reporting criminal and regulatory proceedings within and outside the UK 
  21. 21. GMC GUIDANCELanguage used:“Must” = an overriding duty or principle“Should“ = the duty or principle will not apply in all situations orcircumstances, or where there are factors that are outside your control thataffect or control how you can follow the guidanceTo maintain your license to practice, you must demonstrate, through therevalidation process, that you work in line with […] this guidance.Serious or persistent failure to follow this guidance will put your registrationat risk
  22. 22. DOCTORS’ USE OF SOCIALMEDIAGeneral PrinciplesSocial MediaPrivacyConflicts of interestBenefits and RisksMaintaining boundariesMaintaining confidentialityRespect for colleaguesAnonymity
  23. 23. GENERAL PRINCIPLESIn 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 theprofession.When communicating publicly, including speaking to or writing in the media, you must maintain patientconfidentiality. You should remember when using social media that communications intended for friendsor family may become more widely available.When advertising your services, you must make sure the information you publish is factual and can bechecked, 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 patientswhere you can be overheard, for example, in a public place or in an internet chat forum...
  24. 24. GENERAL PRINCIPLESThe standards expected of doctors do not change because they arecommunicating through social media rather than face to faceor through other traditional media. However, using social mediacreates new circumstances in which the established principlesapply.You must also follow our guidance on prescribing, which givesadvice on using internet sites for the provision of medical services.As well as this guidance, you should keep up to date with andfollow your organisation’s policy on social media.
  25. 25. PRIVACYUsing social media has blurred the boundaries between public andprivate life, and online information can be easily accessed by others.You should be aware of the limitations of privacy online and youshould regularly review the privacy settings for each of your socialmedia profiles. Because...Social media sites cannot guarantee confidentialityOthers may be able to access your personal informationLocation information may be sharedInformation posted is permanent and distributable
  26. 26. DOCTORS’ USE OF SOCIALMEDIA
  27. 27. DOCTORS’ USE OF SOCIALMEDIAEngaging people in public health and policy discussionsEstablishing national and international professional networksFacilitating patients’ access to information about health and services
  28. 28. DOCTORS’ USE OF SOCIALMEDIAEngaging people in public health and policy discussionsEstablishing national and international professional networksFacilitating patients’ access to information about health and services
  29. 29. DOCTORS’ USE OF SOCIALMEDIARisks:Maintaining boundariesFollow separate guidanceIf approached by a patient you should indicate you cannot mix social andprofessional relationships and direct to your professional profileMaintaining confidentialityCaution even in private forumsMust not discuss individual patient or their care with those patients or anybody elseCaution that confidentiality may be breached by the sum of info on-line
  30. 30. CONFIDENTIALITYConfidentiality is the sum of on-line information
  31. 31. CONFIDENTIALITYConfidentiality is the sum of on-line informationToday✤ Phew what a day! Ward understaffed, and annoying tribunal for thatdifficult patient.
  32. 32. CONFIDENTIALITYConfidentiality is the sum of on-line informationToday✤ Phew what a day! Ward understaffed, and annoying tribunal for thatdifficult patient.✤ Wow, the nerve of some people - admitted a really difficult patient withstroppy relatives today. People don’t appreciate doctors!Friday
  33. 33. CONFIDENTIALITYConfidentiality is the sum of on-line informationToday✤ Phew what a day! Ward understaffed, and annoying tribunal for thatdifficult patient.✤ Wow, the nerve of some people - admitted a really difficult patient withstroppy relatives today. People don’t appreciate doctors!Friday✤ Looking forward to starting on Ward 20 today!January
  34. 34. CONFIDENTIALITYConfidentiality is the sum of on-line informationToday✤ Phew what a day! Ward understaffed, and annoying tribunal for thatdifficult patient.✤ Wow, the nerve of some people - admitted a really difficult patient withstroppy relatives today. People don’t appreciate doctors!Friday✤ Looking forward to starting on Ward 20 today!January✤ Nice to see our local NHS Tayside newsletter today, interesting article onSunnyside hospital - I’ll be there for my next job!August
  35. 35. DOCTORS’ USE OF SOCIALMEDIARisks:Respect for ColleaguesCovers all situations and all forms of interaction and communicationMust not bully, harrass or make gratuitous, unsubstantiated or unsustainable commentsabout individuals onlineBe aware that online content is subject to same laws of copyright, and defamation (or libel)as other forms of communicationConflicts of interestYou should be open about any conflict of interest and declare any financial or commercialinterests in healthcare organisations or pharmaceutical and biomedical companies
  36. 36. DOCTORS’ USE OF SOCIALMEDIAAnonymity…If you are writing in a professional capacity, you shouldusually identify yourself.Any material written by authors who represent themselves asdoctors are likely to be taken on trust and/or to represent theviews of the profession more widely.You should also be aware that content uploaded anonymouslycan, in many cases, be traced back to its point of origin.
  37. 37. DOCTORS’ USE OF SOCIALMEDIAAnonymity…If you identify yourself as a doctor in publicly accessiblesocial media, you should also identify yourself by name.Any material written by authors who represent themselves asdoctors is likely to be taken on trust and may reasonably betaken to represent the views of the profession more widely.You should also be aware that content uploaded anonymouslycan, in many cases, be traced back to its point of origin.
  38. 38. BACKLASHDoctors will disappear off Twitter and interaction will be lostCan doctors be trusted to exercise professionalism online?Doctor anonymity will help protect identification of patient casesbeing discussedSuggestions have been made to run two accounts - If one account isanonymous and the other under a real name, then the user is boundto get them mixed upWhy, when patient safety is not an issue?That doctors should have the right to be anonymous in their socialmedia activities just like any other professionDoctors will feel unable to comment on medicine and medical politicsThere are valid reasons to be anonymoushttp://surgicalopinion.blogspot.com.au/2013/03/twitter-wars-on-anonymity-of-doctors-on.html
  39. 39. GMC RESPONSEWhat 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 incidentallymention that  youre a doctor, there is no need to identify yourself if you dont want to.If  youre using social media to comment on health or healthcare issues, we think its  good practice to saywho you are.In the guidance we say you should rather than you must. We use this language to  support doctorsexercising 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 isanyone a doctor works with, whether or not they are also doctors).One of the  key messages in the guidance is that although social media changes the means of  communication,the standards expected of doctors do not change when  communicating on social media rather than face to face orthrough other  traditional media (see paragraph 5 of the social media guidance). 
  40. 40. GMC RESPONSEDoes this guidance apply to personal use?The GMC has no interest in doctors use of social media in their personal lives —  Tweets, blogs, Facebookpages etc. But doctors mustn’t undermine public trust  in the profession. Usually this means breaking thelaw, even where the  conviction is unrelated to their professional life. Why cant  I raise concerns anonymously in social media?We are not trying to restrict discussion about important issues relating  to patient safety and certainly dontwant to discourage doctors from raising  concerns. However, we wouldnt encourage doctors to do so viasocial media because  ultimately its not private and it might well be missed by the people or organisationswho are able to take action to protect patients.Why do publications like the BMJ  allow anonymous blogs/letters articles? Does the guidance mean they cantdo  that anymore?BMJ is entirely  independent of the GMC, and it is a matter for them to decide what is  appropriate for theirwebsite.Many blogs  are published without formal editorial or publisher control — although there  may bemoderation on some sites. Using your name (or other identifying  information) provides some transparencyand accountability.
  41. 41. PERSONAL VS PROFESSIONALPERSONASArticle 8 of the Human Rights Act states:“Everyone has the right to respect for his privateand family life, his home and his correspondence.”Care needed to ensure policy does not infringe ourrights to freedom of speech, and to a private lifeWould we accept policies that monitor and limitwhat we say in public? Are tweets and posts anydifferent?Is it possible to separate who we are?TheInternetPrivacyhttp://www.flickr.com/photos/buriednexttoyou/5095255302/A Helpful Venn Diagram

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