How much of a social media profile can doctors have?
BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e440 (Published 23 January 2012) Cite this as: BMJ 2012;344:e440
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I have given the thumbs up to every one of the discussions relating to the use of social media as this topic in its broadest sense is an ethical one grappling yet again with a technological advance we were not previoulsy able to anticipate. Clearly as a Medical Profession we need guidelines on the use of social media.
However there needs to be an embracing of the positve benefits these internet tools allow us. We can disseminate scientific information, post for international enquiry on difficult cases or problematic issues relating only to the medical profession. Doctors need support and female Doctors in particular need networking and support. The question is always HOW. I have noted in the UK that you have many password enabled members only on line forums that allow for such professional discussions particularly around patient care, that are widely participated in. This is not social media and like all patient communication is protected. It is commonsense to separate ones public and private lives, as well as in our case, our professional lives. There is no difference to the potentiality of risk with mailed letters, faxes or storage of written patient information. These can all be lost or interfered with by unscrupulous non medical persons, or scrutinised by a lawyer to determine if the Doctors have breached some law or other; whether by the content itself or by failing to protect that content from scrutiny by non medical persons. Doctors carry this risk every day.
Criticism of the systems of medicine or the politics of medicine seems a very slippery slope towards loss of individual freedom of expression and needs guarding against with rigorous valour if we are to persist with a democratic society. In this context again, common sense says we should not write what we would not say and personal or libellous discussion needs careful management.
As to whether Doctors have the right to socialise in non conservative ways again requires careful manaagement and guidelines for the profession. I dont care if my lawyer parties every night as long as s/he does their job however I probably wouldnt see him/her for an alcohol addiction or related legal issue. Nor would I see a conservative never married lawyer for counselling over juggling the multiple roles as a professional working mother. Again criminal activity in this domain is another matter and again is one which Doctors like Judges, lawyers professional football players have lived with for a long time.
Long live the discussion, and long live freedom but lets not ban the use of new technology which does nothing about the unlawful behaviour anyway.
Lets Educate.
Competing interests: No competing interests
How much of a social media profile can doctors have? The answer is - as much of a profile as they have in real life. There is no distinction between social media and reality. So many words are posted/blogged/published about how social media is somehow different. It is not.
Should you say 'yes' if a patient rang you and said she wanted to be your friend? No. Therefore non-commercial Facebook access is out.
Should you say 'leave the room please' if a patient attended one of your public lectures? No. Therefore Twitter for education is fine.
Should you identify a patient in conversation on a crowded lift/in a public canteen/on public transport? No. Therefore you don't identify them on social media.
In fact, should you talk to anyone about a patient apart from referring doctors/legal guardians/in court? No.
Should you discuss the operation/resuscitation/disease of an anonymous patient to a group at at party? No. Therefore you don't do this on social media.
We learnt about this in medical school, as I did 40 years ago. Doctors can and should involve themselves in social media because, as the Mayo Clinic says: 'Our patients are doing it, that's where we need to be' (1).
We cannot legislate or pontificate against stupidity. It requires the same undergraduate education about ethics that has been taught since Hippocrates.
The distinction between social media and real life is moot. Arguments about permanent storage and retrieval of your comments are irrelevant.
As I have said elsewhere, being Social on Professional Media - It's Not Rocket Science (2).
References
(1) http://casesblog.blogspot.com.au/2012/01/why-mayo-clinic-is-power-user-o... (accessed 11 Feb 2012)
(2) http://www.allergynet.com.au/category/allergynet/being-social-on-profess... (accessed 11 Feb 2012)
Competing interests: No competing interests
I find the idea that doctors should not be free to say things which some people may find uncomfortable or distasteful deeply troubling for two reasons.
Firstly, it is an infringement on our rights as human beings to free speech, irrespective of the fact that we are doctors. That must not be taken away so lightly. Ask the Bahraini medics who are currently in detention what they think.
Secondly, it stifles discussion and debate about vitally important issues for society. If doctors are cynical with, or disgusted by, some practices then why shouldn't the general public be allowed to know that? Who is the arbiter of what ordinary, non-medical people are allowed to know and in what manner or register they are allowed to know it? Who decides people are too 'sensitive' to hear certain things? Who decides when 'trust in the profession' is being undermined? Don't we all need to be a bit more grown up about who doctors are and how society has moved on? We're just people like everyone else and we don't have ominiscient, God-like status which can be punctured with the click of a Facebook post.
And why should online content be singled out? Why was Cardiac Arrest, the cynical medical drama by Jed Mercurio, allowed, but analogous FB postings may not be?
The terms of this debate and the apparently given position of the GMC and other bodies globally strikes me as very patrician and very sinister. This move by the medical regulatory bodies across the world to police online content from doctors for 'disreputableness' has overtones to me of censorship in Britain prior to the Lady Chatterley trial: "Would you be prepared for your wife or servants to read these postings?" Yes, actually, I damned well would, and it may even do them, and society, some good.
Let's be very careful for all our sakes before we start restricting doctors' freedom of speech. It won't stop here.
Competing interests: I'm a UK GP and a non-executive director of the BMJ Group Ltd.
McCartney draws on several expert opinions to explore some of the key issues raised for doctors in today’s digital environment. However, consideration too needs to be given to the underlying sociological concepts underpinning this ‘uneasy mix’ of professionalism and social media in order to inform any guidelines from a professional body that are developed.
It may be the same thing: discussion between a group of clinicians that may be overheard by anybody. But this discussion that occurs in a hospital canteen does not have any ‘privacy’: anyone may listen in. Indeed thanks to appropriate privacy settings a discussion on Facebook may be more ‘private’ than one in the canteen.
Social technologies have unequivocally altered the underlying architecture of social interaction and information distribution(1). A face-to-face conversation between two doctors in a canteen is afforded the privilege of anthropomorphic forgetfulness, and is obviously not archived, indexed, and accessible to others in the way in which a Facebook Wall posting may be. Conversely however, social media technologies, to the experienced user, afford a granularity to privacy and access controls far beyond that afforded to clinicians conversing in a busy canteen filled with other staff, patients, and family members.
It is hence relevant to point out that the ‘threat to professionalism’ posed by many of the scenarios described in the article seems to pertain not to the medical professional’s behaviour itself, but to the fact that it was recorded or made public.
As McCartney states, there are ‘clear things a doctor should not do, online or not’. Patient confidentiality must be maintained; and the public confidence in the medical profession must be upheld.
It is hence critical to demarcate actual lapses in professionalism, which have occurred as long as the medical profession has existed, from those issues raised by this paradigm shift in communication, with which perhaps classical concepts of medical professionalism are not equipped to deal.
Educational initiatives pertaining to professionalism in medical school curricula are highly supported(2), and there are now calls for the dedicated teaching of ‘digital professionalism’(3). The concept of medical professionalism carries ‘connotations, complexities, and nuances’(4), making the ensuing conversation somewhat ambiguous, even before one begins to test it against situations evolving as a result of social media.
Education and guidelines from professional bodies are required, but attempts to reaffirm classical concepts of professionalism or even draw on classical definitions of terms such as public and private, risks alienating those clinicians most in need of guidance. We would implore bodies involved in the development of such guidelines to not only reevaluate their own definition of medical professionalism, but also have a very clear understanding of the paradigm shifts in communication and socialisation that are occurring.
1. Boyd D. Social Network Sites: Public, Private, or What? The Knowledge Tree. 2007 May;13.
2. Roberts LW, Green Hammond KA, Geppert CM, Warner TD. The positive role of professionalism and ethics training in medical education: a comparison of medical student and resident perspectives. Acad Psychiatry. 2004 Fall;28(3):170-82.
3. Mostaghimi A, Crotty BH, Landon BE. The availability and nature of physician information on the internet. J Gen Intern Med. 2010 Nov;25(11):1152-6.
4. Swick HM. Toward a normative definition of medical professionalism. Acad Med. 2000 Jun;75(6):612-6.
Competing interests: Stewart Morrison: Australian Medical Association Doctors-in-Training Social Media Working Group Hugh Stephens: Australian Medical Association Doctors-in-Training Social Media Working Group Social Media Consultant, Dialogue Consulting
The recent surge in use of social media has not really changed the private behaviour of doctors - it has just made it more visible (1). There should be little difficulty in judging whether much questionable online behaviour is inappropriate. It always has been - the only difference is that now everyone can see it. It is fair to say that nobody should post anything online that they would not mind having up in lights with their name attached, especially potentially identifiable patient information. The core question for doctors is how we see professionalism in our lives.
There is evidence that much of doctors’ perception of what is professional behaviour comes from the hidden curriculum, i.e. by emulating colleagues (2). But professionalism should be actively nurtured by trainers and educators, rather than being addressed only when problems arise. Unfortunately many students dislike learning about professionalism, but like spending time on Facebook. We used this apparent obstacle as a novel educational tool, by advancing social media as a lens through which students examine their concepts of professionalism. Our one-hour e-learning module (freely available at http://www.healthinfomatters.com/elearning/onlineprofessionalism/4c1.html) has been enthusiastically welcomed.
References:
1. MacDonald J, Sohn S, Ellis P. Privacy, professionalism and Facebook: a dilemma for young doctors. Med Educ 2010;44 (8):805–13.
2. Gaiser RR. The teaching of professionalism during residency: why it is failing and a suggestion to improve its success. Anesth Analg 2009;108(3):948–54.
Competing interests: No competing interests
Junior doctors have grown up in a world immersed in an ever-changing technological age. They have experimented with and inquisitively used every new device, every new piece of software and recently every new app as they become available.
As such there is a huge amount of web-based "fallout" from their use of the internet as they have grown up: pictures of them as teenagers online, articles they may have posted on blogs at the age of 13, details of them on clubs and group webpages.
I know a number of colleagues who have taken steps to remove some of these items, which they may not originally have been aware existed, from the public domain to ensure they can't incriminate them.
Such details are so easily accessible to patients but often still exist online unbeknown to the doctor in question. I wonder how many doctors, who perhaps are not aware of their more questionable "fallout" leave their professional integrity in the balance.
Competing interests: No competing interests
Social media are a mixed blessing. They facilitate private and public communication, but they can also blur the boundary between the two, and in doing so, violate confidentiality, privilege, and proper judgment. It’s important to remember that all communication includes trusting disclosures that deserve to be honored.
Competing interests: No competing interests
Re: How much of a social media profile can doctors have?
Whilst maintaining patient confidentiality is of course paramount, the issue here is maintaining patients' trust. I wonder if it is hypocritical of a doctor with a facebook profile full of drunken photographs to advise a patient to drink less alcohol, or indeed a doctor with photographs of themselves smoking to give cessation advice. Whilst it is at the doctors' own discretion to smoke or drink in their own free time (provided it has no impact on the quality of their work) it is now much easier for patients to access this information via social media sites. Should we therefore be advising all doctors to hide such facets from their profiles in case patients lose trust?
Most patients accept that doctors are human beings who may well have vices, and therefore provided doctors are professional whilst at work and abstain from criminal practices, most patients are probably very happy to trust them in full. Placing regulations on what doctors can do with their social time is surely infringing upon their rights and is clearly unacceptable, so why should we expect them to hide these traits from their patients? Doctors can have as full a social media profile as they choose, provided it is used for social reasons and not to disseminate patient information - however anonymised it might seem.
Competing interests: No competing interests