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Bhide e professionalism.ppt resident talk revised 12 13


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Social Media guidelines for Mayo Clinic Internal Medicine residents

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Bhide e professionalism.ppt resident talk revised 12 13

  1. 1. Social Media and e-Professionalism for Residents Vandana Y. Bhide, MD @VeeMD VeeMD #MayoClinicFL #HCSM #MedEd ©2010 MFMER | slide-1
  2. 2. Mayo Clinic Social Media Policy • Strongly discourages ―friending‖ of patients on social media websites • Does not endorse people, products, services and organizations. • On social media websites such as LinkedIn, where affiliation to Mayo Clinic is known, personal recommendations should not be given or requested • Write in the first person…make it clear that you are speaking for yourself and not on behalf of Mayo Clinic
  3. 3. What would you think if you saw this picture on Facebook and realized he was your doctor? Collier, Roger Professionalism: Social Media Mishaps CMAJ, September 4, 2012, 184(12)
  4. 4. Should physicians be held to a higher standard than the general public? What do you think?
  5. 5. Physicians are held to a higher standard, because of the trust placed on them by patients and society
  6. 6. Medical Professionalism in the New Millennium: A Physician Charter • Professionalism is the basis of medicine‘s contract with society • Principle of primacy of patient welfare • Commitment to patient confidentiality • Commitment to maintaining appropriate relations with patients • Commitment to professional responsibilities American Board of Internal Medicine, American College of Physicians, European Federation of Internal Medicine Ann Intern Med. 5 February 2002;136(3):243-246
  7. 7. ―Physicians certainly have the right to have private lives and relationships…but they must also be mindful that their patients and the public see them first and foremost as professionals rather than private individuals and view physician conduct through the lens of their expectations about how an esteemed member of the community should behave.‖ McMahon Sr, John W., Chair AMA Professionalism in the Use of Social Media
  8. 8. AMA Professionalism in the Use of Social Media ―Participating in social networking and other similar Internet opportunities can support physicians‘ personal expression, enable individual physicians to have a professional presence online, foster collegiality and camaraderie within the profession, provide opportunity to widely disseminate public health messages...‖ McMahan, John W. , Chair. Professionalism in the Use of Social Media, June 2011
  9. 9. Intern writes about patient‘s Facebook ―Friend Request‖ In an e-mail to students and faculty of Harvard Medical School, Dean for Medical Education Jules Dienstag wrote: ―Caution is recommended. . . in using social networking sites such as Facebook… Items that represent unprofessional behavior that are posted by you on such networking sites reflect poorly on you and the medical profession. Such items may become public and could subject you to unintended exposure and consequences.‖ Becoming a Physician: Practicing Medicine in the Age of Facebook Sachin H. Jain, M.D., M.B.A. N Engl J Med 2009; 361:649-651August 13, 2009DOI: 10.1056/NEJMp0901277 ©2010 MFMER | slide-9
  10. 10. Federation of State Medical Boards • Protect the Privacy and Confidentiality of their patients • Avoid requests for online medical advice • Act with professionalism • Be forthcoming about employment, credentials and conflicts of interest • Be aware that information posted online may be available to anyone, and could be misconstrued Rhyne JA et al Federation of State Medical Boards Model Policy Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice
  11. 11. Federation of State Medical Boards • Protect the Privacy and Confidentiality of their patients Rhyne JA et al Federation of State Medical Boards Model Policy Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice
  12. 12. ―Blatant violations of patient privacy and confidentiality have occurred when physicians have posted photos of patients or described situations with enough identifying information that others may decipher the patient‘s identify.
  13. 13. ―It seems that many of these violations take place because the Internet is widely perceived to be different from other public environments, like hospital corridors.‖
  14. 14. ―Whereas in the past a physician may have been concerned about a conversation being overheard in an elevator by a handful of people, now a post on a social networking site may reach millions of people within a matter of minutes. Internet users often experience a lack of inhibition and feeling of anonymity.‖ McMahon Sr, John W., Chair, ©2010 MFMER | slide-14
  15. 15. Physician Obligations—Same in person & online • Privacy—to prevent unauthorized access to patient data and to ensure that ―de-identified‖ data cannot be linked to the healthcare professional or patient Rhyne JA et al Federation of State Medical Boards Model Policy Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice • The Online Conversation is the same as the conversation in the Elevator or Hallway
  16. 16. "Physicians should be cognizant of standards of patient privacy and confidentiality that must be maintained in all environments, including online, and must refrain from posting identifiable patient information online.‖ AMA Policy: Professionalism in the Use of Social Media (June 2011)
  17. 17. ER Doc Violated Patient Privacy • Westerly, Rhode Island Dr. A.T., who worked at Westerly Hospital, ―did not include the patient‘s name [in Facebook], but she wrote enough that others in the community could identify the patient‖ (Boston Globe). • An ―unauthorized third party‖ determined the identity of the patient • Dr. A.T. deleted post and her Facebook account, apologized • Fired from position as ER physician, fined $500
  18. 18. ―An incident occurred where I unintentionally, but very foolishly breached patient confidentiality and hospital policy. I published a de-identified image of an ‗interesting‘ skull x-ray on my Facebook page, (in fact there was absolutely no information attached to this image, and even I had no idea who it belonged to, or what the clinical story behind it was). Incredibly…this x-ray was in fact correctly identified by a reader, who made an official complaint. The resulting disciplinary action brought my whole website/ Facebook presence to an uncomfortable, and personally distressing head‖
  19. 19. Avoid 18 HIPPA (Health Insurance Portability and Accountability Act of 1996) Identifiers 1. Names 2. All geographical subdivisions smaller than a State 3. All elements of dates (except year) directly related to an individual, including birth date 4. Phone numbers 5. Fax numbers 6. Electronic mail addresses 7. Social Security numbers 8. Medical record number 9. Health plan beneficiary numbers 10. Account numbers 11. Certificate/license numbers 12. Vehicle identifiers and serial numbers, including license plate numbers 13. Device identifiers and serial numbers 14. Web Universal Resource Locators (URLs) 15. Internet Protocol (IP) address numbers 16. Biometric identifiers, including fingerprints 17. Full face photographic images and any comparable images 18. Any other unique identifying number, characteristic, or code ©2010 MFMER | slide-19
  20. 20. Online discussions of specific patients should be avoided, even if all identifying information is excluded. It is possible that someone could recognize the patient to which you are referring based upon the context University of Utah Health Sciences Center: Office of Graduate Medical Education Social Media Policy December 3, 2012
  21. 21. • Need to get consent for Photography • Ask Mayo Photographer to take photo • No Cell phone pictures • Don‘t let patients email you their photographs • Wounds • Cellulitis borders
  22. 22. My Recommendation: • Don‘t discuss patients (even if de-identified) on social media platforms • Don‘t discuss aspects of your professional life (how many central lines you placed, how many admissions you had, how hard you had to work, how many times you were paged, how grateful a patient was for your care, etc.) • OK to discuss what you ate for dinner!
  23. 23. Federation of State Medical Boards • Protect the Privacy and Confidentiality of their patients • Avoid requests for online medical advice Rhyne JA et al Federation of State Medical Boards Model Policy Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice
  24. 24. Avoid Giving Advice Online • Disclaimers that what you are writing online does not constitute medical advice may not be judicially sound • It‘s easy to develop a physician-patient relationship but hard to break it --Arthur R. Derse, MD, JD, Director of the Center for Bioethics and Medical Humanities, Medical College of Wisconsin • Ok to discuss health topic in a general way that would be applicable to a wide number of patients
  25. 25. Make sure that you differentiate medical opinions from medical facts. The world of medicine is foreign to many, so readers may take your words at face value. Try to make clear what statements reflect your personal beliefs University of Utah Health Sciences Center: Office of Graduate Medical Education Social Media Policy December 3, 2012
  26. 26. Physician Blogs • Study of 271 medical blogs: three blogs showed recognizable photographic images of patients • 45 blogs included sufficient information for patients to identify their doctors or themselves • Healthcare products were promoted, either by images or description in 31 blogs Lagu Tara et al Content of weblogs written by health professionals. J Gen Intern Med 23(10):1642-6 ©2010 MFMER | slide-26
  27. 27. No Such Thing as an Anonymous Blog • Defendant in a malpractice suit involving the death of a 12-year-old patient was Ivy League-educated pediatric pulmonologist RPL • Opposing attorney discovered that RPL had blogged about the case under the pseudonym ―Flea.‖ Attorney asked RPL in court if he was ―Flea‖ • ―In his blog, Flea had ridiculed the plaintiff's case and the plaintiff's lawyer. He had revealed the defense strategy. He had accused members of the jury of dozing.‖ Jonathan Saltzman, Boston Globe 2007 =full • Next day, Flea agreed to pay a ―substantial‖ settlement
  28. 28. How NOT to Blog About Your Job. Especially If You Are a Doctor ―When you blog, think as if your boss is reading it. If you feel uncomfortable about it, just don't post it. Blogging is a public activity, every single word can be potentially scrutinized and inspected for adverse meaning.‖ Ves Dimov, M.D., Assistant Professor at University of Chicago, Board-certified in Allergy/Immunology (Med/Peds) and Medicine
  29. 29. Why do intelligent people do this? • ? Free Speech or Patient Privacy? • Online Disinhibition effect: • You don‘t know me • You can‘t see me Suler, J. (2004). CyberPsychology and Behavior, 7, 321-326 • Talking on the Internet, people regress. It's that simple…People regress, expressing sex and aggression as they never would face to face Norman N. Holland, The Internet Regression John Suler‘s The Psychology of Cyberspace Jan 1996 ©2010 MFMER | slide-29
  30. 30. • Protect the Privacy and Confidentiality of their patients • Avoid requests for online medical advice • Act with professionalism Rhyne JA et al Federation of State Medical Boards Model Policy Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice
  31. 31. ―The-Not-So-Private-Parts‖ (Kashmir Hill, Forbes) • 4 nursing students, including DB, were expelled from school for posting photograph of human placenta • School claimed DB displayed poor judgment and failed to live up to the nursing profession‘s ethical standards
  32. 32. ―Placenta Lawsuit Gives Birth to Outrage‖ (Kashmir Hill, Forbes) • ―Does this bit of over sharing warrant expulsion? The placenta isn‘t identifiable in any way…(it) disturbingly looks a bit like a small roasted turkey. (I couldn‘t even tell it was a placenta.)‖ • Kansas Judge Eric Melgren ruled that expulsion was not warranted since her teacher allowed photographs taken and should have expected that the photographs would be viewed. • (Including by the whole world on the internet I guess!)
  33. 33. The Placenta Precedent Federal District Judge Eric Melgren wrote: Photos are taken to be viewed. When [nursing student supervisor] D. granted permission to take the photos, it was unreasonable to assume that they would not be viewed. If the photos were objectionable…then it would not have mattered whether the photos were viewed on Facebook or elsewhere.
  34. 34. HIPPA Violation? ―No word on whether the placenta plans to sue for invasion of its privacy.‖ --Kashmir Hill, Forbes ©2010 MFMER | slide-34
  35. 35. Online Posting of Unprofessional Conduct by Medical Students Chretien KC et al JAMA. 2009;302(12):1309-1315. doi:10.1001/jama.2009.1387 • 78/130 US medical schools responded to survey • 60% of schools reported students posting inappropriate content on internet • 13% reported patient confidentiality violations • 48% reported racist remarks made by students • 52% reported profanity online by students • 39% reported photographs of intoxication • 38% reported sexually suggestive content • Only 38% of schools had online content policy • 3 schools reported expulsion of a student ©2010 MFMER | slide-35
  36. 36. University of Florida Facebook Profiles Thompson LA et al J Gen Intern Med. 2008 July; 23(7): 954–957 • Study evaluated 501 medical students (44.5% of students) and 312 resident Facebook profiles • Only 1/3 of accounts were private • Qualitative review of 10 random profiles: • Included profanity (―PIMP—Party of important male physicians‖), ―Keep your ____ hand down in lecture‖ • Sexist comments (―Physicians looking for trophy wives in training‖) • Racial comments (―I should have gone to a Blacker college‖) ©2010 MFMER | slide-36
  37. 37. “When you’re young, you know, you make mistakes and you do some stupid stuff. I want everybody here to be careful about what you post on Facebook, because in the YouTube age, whatever you do will be pulled up again later somewhere in your life.” President Barack Obama to 9th grade class, Wakefield High School, Virginia ©2010 MFMER | slide-37
  38. 38. Dr. Ryan Greysen, Assistant Professor Hospital Internal Medicine UCSF (R), staged a hypothetical picture depicting alcohol without intoxication. According to a survey of State Medical Boards, SMB, this type of online physician behavior could potentially prompt investigation of physician professionalism A Word of Caution about photographs depicting alcohol: •It is better to avoid all pictures and mentions of drinking •Even when done on personal time away from Mayo Clinic •Even when ―drinking responsibly‖ ©2010 MFMER | slide-38
  39. 39. • If they interact with patients on the Internet, physicians must maintain appropriate boundaries of the patient-physician relationship • Physicians should consider separating personal and professional content online AMA Policy: Professionalism in the Use of Social Media ©2010 MFER | slide-39
  40. 40. Depiction of alcohol Real Life MASH? ©2010 MFMER | slide-40
  41. 41. 99 bottles of rum on the wall, 99 bottles of rum… ©2010 MFMER | slide-41
  42. 42. • More drinking… • Facebook Groups: Community • Tags: Partying doctors Haiti ©2010 MFMER | slide-42
  43. 43. Haiti earthquake relief physician volunteers ©2010 MFMER | slide-43
  44. 44. Facebook pictures denounced by readers for being in poor taste ©2010 MFMER | slide-44
  45. 45. Smiling before an amputation ©2010 MFMER | slide-45
  46. 46. At least the face is obscured….. would you want this picture of you or a family member shown on Facebook? Does HIPPA count in Haiti? ©2010 MFMER | slide-46
  47. 47. YouTube Video of Physicians/Nurses Laughing • Unauthorized 3 minute YouTube video of foreign object being removed from patient‘s rectum • Doctors and nurses laughing and cheering YouTube surgery video spells trouble for docs: Philippine surgeons cheer after removing object from patient's rectum Associated Press 4/16/2008 • Many other examples of YouTube videos, too numerous to recount ©2010 MFMER | slide-47
  48. 48. This goes under the heading of Yes, You can buy anything on eBay • Dr. CEA, a surgeon in St. Augustine, FL, failed American Board of Surgery exam in 2002 • Was allowed to review test results at the Board‘s Philadelphia office • Memorized test questions and answers • Passed Surgery board exam in 2003 • August 2004 sold 86 questions (out of 290) on eBay, registered through a friend Doctor sold exam questions on eBay The Florida surgeon has agreed to pay $36,000 in restitution. By Damon Adams, amednews staff. June 20, 2005.
  49. 49. For Sale on eBay: General Surgery Board Exam Review Questions ―These are the actual certifying general surgery board questions with correct answers, guaranteed to improve your test score. A friend of mine failed this written exam, paid the $100 sitting fee and flew to Philadelphia to review his test. ... Why take the chance at failing, getting a year behind your peers...? Get an advantage now!" Photograph by Ken Cole
  50. 50. Oh Boy, ebay error • American Board of Surgery sued for copyright infringement • CEA relinquished his notes, was fined $36,000, lost his board certification, lost his job in St. Augustine Photograph of St. Augustine from The Palm Beach Post http://www.palmbeach st-augustine-floridaspend-your-holidaysup-north/nLx6g/
  51. 51. • The internet is like Vegas: What happens there stays there… • Forever • You can take it down but you can‘t take it back
  52. 52. ―When you post something publicly online, it‘s something that could be online in perpetuity‖ Humayan Chaudry, DO, President and CEO of the Federation of State Medical Boards
  53. 53. Physicians must recognize that actions online and content posted may negatively affect their reputations among patients and colleagues, may have consequences for their medical careers (particularly for physicians-intraining and medical students), and can undermine public trust in the medical profession AMA Policy: Professionalism in the Use of Social Media
  54. 54. ―something as seemingly innocuous as humor, when taken out of context, could reach and be misinterpreted by an unintended audience (patients, superiors, future employers) and lead to a tarnished reputation.‖ ©2010 MFMER | slide-54
  55. 55. Residents should consider that everything they post online contributes to a lifetime record that is readily accessible to others. Potential employers may use social media to access this record to evaluate applicants. Posting distasteful, immature, or offensive content may eliminate job or other professional opportunities. Residents must convey a professional and ethical presence to all who might view their online University of Utah Health Sciences Center: Office of Graduate Medical Education Social Media Policy December 3, 2012
  56. 56. Use privacy settings to safeguard personal information and content to the fullest extent possible on social networking sites AMA Policy: Professionalism in the Use of Social Media ©2010 MFMER | slide-56
  57. 57. Know Your Online Privacy Settings ―You can manage the privacy of your status updates, photos and information using the inline audience selector — when you share or afterwards. Remember: the people you share with can always share your information with others, including apps.‖ ©2010 MFMER | slide-57
  58. 58. Facebook Privacy Settings • Public (anyone in the world can see your post) • Remember you may be tagged in photographs without knowing it • Photographs/updates can be downloaded or forwarded • Make this visible to: • Hide this from: • (Your mother) • (Your Attending) ©2010 MFMER | slide-58
  59. 59. Custom Privacy Settings on Facebook
  60. 60. Why I Can‘t Spend Time on Facebook
  61. 61. Questions?
  62. 62. Thank You
  63. 63. Social Media and e-Professionalism for Residents Vandana Y. Bhide, MD Vitamin Vee Blog @VeeMD VeeMD Channel Vandana Bhide