My talk about digital citizenship and social media for 4th year medical students at the University of Michigan.

1. DIGITAL CITIZENSHIP
FOR PHYSICIANS
Joyce Lee, MD, MPH
Twitter: @joyclee
www.doctorasdesigner.com

2. Current:
JAMA Pediatrics, Social
Media, Web Editor
Unitio
Previous:
Verily
Samuelsson Associates
@joyclee #hcsm

3. Q: Are there any other uses of social media in
clinical medicine or research that you want to learn
about?
A: “No. This is a complete waste of time. This is not
real research. The fad will die out soon.”

5. Twittersuperuser.com

6. YOU ARE A
DIGITAL CITIZEN
“A person utilizing information
technology (IT) in order to engage in
society, politics, and government
participation.”

7. “The Good Old Days”

8. @joyclee #hcsm
DOYOU HAVE A
CELLPHONE?
(1) Yes
(2) No

10. @joyclee #hcsm
PIECES OFYOU ARE
ALREADYALL OVER THE
INTERNET

11. “A world of indiscriminate
tracking where institutions
are stockpiling data about
individuals

12. Manoush Zomorodi
privacy-paradox.org

13. @joyclee #hcsm
WHAT DOES YOUR PHONE
KNOWABOUTYOU?
Metadata=Data about data

14. Time of a call or text
Incoming or outgoing
Duration of the call
Length of the text message
Phone # of senders & recipients
METADATA
@joyclee #hcsm

17. Metaphone=Android smartphone application
• The application automatically retrieved
– Historical call and text message [Short Message
Service (SMS)] metadata from device logs
– Information from a participant’s Facebook
account, to be used as ground truth for potential
inferences.
• 823 participants volunteered their metadata,
which included 251,788 calls and 1,234,231 text
messages

18. We randomly selected 30,000 numbers from our
dataset and queried free, public interfaces hosted by
Yelp, Google Places, and Facebook using these
numbers
31.9% of phone numbers can be
reidentified (automated)

19. Random selection of 250 phone numbers
• Manual query interface for an inexpensive
commercial database (Intelius; $19.95 a month ).
• Manual Google web searches to look for
identifying information (70 min)
82% of phone numbers can be
reidentified (automated & manual)

20. 80% Accuracy in Identifying a
Romantic Partner
Studied participants who according to their Facebook
profile were single N = 148 or in a relationship N =
309.

22. “Participant A held conversations with a
pharmacy specializing in chronic care, a
patient service that coordinates
management for serious conditions,
several local neurology practices, and a
pharmaceutical hotline for a prescription
drug used solely to manage the
symptoms and progression of relapsing-
remitting multiple sclerosis.”

23. “Participant B received a long phone
call from the cardiology group at a
regional medical center, talked briefly
with a medical laboratory, answered
several short calls from a local
drugstore, and made brief calls to a
self-reporting hotline for a cardiac
arrhythmia monitoring device.”

24. “Participant E made a lengthy phone call
to her sister early one morning. Then, 2
days later, she called a nearby Planned
Parenthood clinic several times. Two
weeks later, she placed brief additional
calls to Planned Parenthood, and she
placed another short call 1 month after.”

25. Metadata from an NSA request involving
a single suspect could uncover
information on approximately 25,000
individuals.
Extend the search by one degree of
separation — you, your friend and their
contacts — and an agent could recover
personal information on 20 million
people.

26. @joyclee #hcsm
Challenge #1:
TAKE BACKYOUR
METADATA

30. @joyclee #hcsm
DOYOU USE GOOGLE?
(1) Yes
(2) No

31. Incognito mode only deletes your local
search and browsing history - just the
content on your computer.
Websites, search engines, internet
service providers, and governments can
still easily track you across the web.
“BUT I SURF INCOGNITO!”

32. @joyclee #hcsm
DOYOU USE GMAIL,
DRIVE, DOCS, MAPS,
PHOTOS?
(1) Yes
(2) No

33. @joyclee #hcsm
WHAT DOESN’T
KNOWABOUTYOU?

34. http://www.pbs.org/wgbh/frontline/film/united-states-of-secrets/#video-2

35. http://www.pbs.org/wgbh/frontline/film/united-states-of-secrets/#video-2

36. @joyclee #hcsm
Challenge #2:
DUCK GOOGLE FOR
DUCK DUCK GO

37. “zero-data-retention policy”

39. https://myaccount.google.com/activitycontrols

40. @joyclee #hcsm
DOYOU USE
FACEBOOK?
(1) Yes
(2) No

41. @joyclee #hcsm
YOUR IDENTITYIS BEING
DEFINED & TRACKED BYAN
ALGORITHM
The Facebook algorithm

42. https://chrome.google.com/webstore/detail/what-facebook-thinks-
you/eoknmaajkanapojcdeccofmeimpddoim

43. 1. What you do on FB
2. What you do on other websites
3. Personal data purchased from
offline data brokers (mortgages, car
ownership and shopping habits)
@joyclee #hcsm

44. Facebook offers advertisers >1,300
categories for ad targeting:
Email, location, sexual preference,
community information, likes “grass”, likes
“wax”; property size less than .26 acres;
households with 7 credit cards
@joyclee #hcsm

45. Orbitz = higher prices for hotels for Mac
computer users
Staples = higher prices in certain ZIP codes.
The Princeton Review = Higher charges for
online SAT tutoring course in certain ZIP
codes: $6,600 vs. $8,400.
@joyclee #hcsm

47. @joyclee #hcsm
Challenge #3:
USE THE WHAT FACEBOOK
THINKS YOU LIKE TOOL
What does this mean for your online
identity as an individual/MD?

48. @joyclee #hcsm
DOYOU USE SIRI,
ALEXA, ECHO, OR
GOOGLE HOME?
(1) Yes
(2) No

50. There’s no user-accessible record of your
previous queries because Apple associates
them with a random ID number, rather than
your email address or iCloud account. After six
months, both are deleted.

51. ”Amazon maintains a database of your
conversations with the Echo, which you can
see and manage online. In addition, audio data
is encrypted when it enters and leaves your
home, to minimize the risk of interception by
hackers”

53. @joyclee #hcsm
PIECES OFYOU ARE
ALREADYALL OVER THE
INTERNET

54. @joyclee #hcsm
ARE THOSE
PRIVATE PIECES OR
PUBLIC PIECES?

55. @joyclee #hcsm
CAN YOU SEPARATEYOUR
PRIVATE AND PUBLIC
IDENTITYAS A PHYSICIAN?
(1) YES
(2) NO

57. When a physician asks, “Should I post this
on social media?” the answer does not
depend on whether the content is
professional or personal but instead depends
on whether it is appropriate for a physician in
a public space

58. @joyclee #hcsm
YOU HAVE NO CONTROL
OVER WHAT HAPPENS
TOYOU ON THE
INTERNET

61. @joyclee #hcsm
YOU ARE A
PUBLIC PHYSICIAN

66. @joyclee #hcsm
YOU NEED TO MANAGE
THE MECHANICS AND
CONTENT OF SHARING
ONLINE

74. Iceberg Tweeting
@craigmod Link

75. Text
Date, Time
Retweet
Favorite
Individuals
Photo/Video
Replies

77. No risks outlined on the
Youtube Twitter Card metatags!

79. @joyclee #hcsm
Challenge #4:
RULES AND ETIQUETTE

82. “Due to your clenching and grinding habit, this
is not the first molar tooth you have lost due to
a fractured root…This tooth is no different.”
I looked very closely at your radiographs and
it was obvious that you have cavities and gum
disease that your other dentist has
overlooked. … You can live in a world of denial
and simply believe what you want to hear
from your other dentist or make an educated
and informed decision
-Dentist
1

83. “You brought your daughter in for the
exam in early March 2014,” he wrote.
“The exam identified one or more of the
signs I mentioned above for scoliosis. I
absolutely recommended an x-ray to
determine if this condition existed; this x-
ray was at no additional cost to you”
-Chiropractor
2

84. 3

85. 4

86. 4

87. 5

88. “5 nurses who worked at Tri-City Medical
Center in Oceanside, CA used social
media to post their personal discussions
concerning hospital patients. No photos,
patients names, or other identity-
compromising information were posted.”
6

89. 7

90. 8

91. 9

92. 10

93. 11

94. Director, Chief Operating Officer of the Cleveland
Clinic Wellness Institute12

95. 12

96. ”Hey I will send you an email
with the patient’s info”
13

97. “I will add it to google drive”
14

98. “He wrote this opinion piece on his own
and it does not reflect the position of the
Cleveland Clinic whatsoever, and we
strongly support vaccinations and the
protection of patients and employees,”
said Eileen Sheil, executive director of
corporate communications for the
medical center.

100. EVERYHEALTHCARE PROFESSIONAL IS
THE VOICE OF HIS/HER INSTITUTION
”Disclaimer or not, logo or no logo, the world knew that
this doctor was leadership at The Cleveland Clinic.”
“Our public engagement is inextricably linked to our
work and other aspects of our lives.”
“Welcome to the age of transparency.”
@Doctor_V

101. DOYOU EXIST IFYOU
ARE NOT ONLINE?

108. GO FORTH AND BE A
GOOD DIGITAL CITIZEN!
joyclee@med.umich.edu
http://www.doctorasdesigner.com/
Twitter: @joyclee
https://medium.com/@joyclee