Professional use of social media by residents Lecture to University of Toronto obstetrics/gynecology residents - April 21, 2015

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Professional use of social media
for residents
Where were you when the tide came in?
April 21, 2015
Pat Rich @cmaer

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Who I am
Pat Rich – Strategic Advisor, CMA
Enterprise Marketing
Experienced health care
communicator with a keen interest and
involvement in the use of social media
tools in medicine and health care and
believers in the value of these tools
WHO I AM NOT
Physician
Academic

3. WhatisSocialMedia?
 Extension of every day interaction
 Conversations & exchange
 Communities of shared interest
 Tools for innovation
 Integrates technology

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Why care?
“Whether physicians are active on social media or not, an
understanding of social media and its potential implications on their
professional lives is essential.”
Dr. Hartley Stern, CEO, Canadian Medical Protective Association
While individual physicians are at different stages in their use of
social media, it is a journey all physicians will eventually take. Social
media is becoming so pervasive its importance as a channel to keep
current on medical findings and to confer with colleagues is
undeniable.”
CMPA Supplement

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A changing environment: Are you digitally literate
enough to be a physician?
“Today’s medical professionals must be masters of different skills that are
related to using digital devices or online solutions” and mastering those
skills “is now a crucial skill set that all medical professionals require.”
Dr. Bertalan Mesko
The democratization of media has made every physician an independent
publisher …physicians now have to learn to manage and maintain their
identity in the public space,”
Dr. Bryan Vartabedian,
From an article by Stephen Pelletier, in the AAMC Reporter,
Aug, 2014

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A changing environment
 Reality of the networked world: social communication will define the way
MDs engage, learn and communicate
 The most important decision a physician will make is who and what to
listen to
 The internet has changed the way patients see doctors, their diseases
and themselves
 A great digital footprint will never cover for a doctor’s poor care
Dr. Bryan Vartabedian, adapted tweets from lecture to first
year Baylor College of Medicine Students

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Social media “policies” by
academic medical centers or
medical schools point out the
“don’t do this, don’t do that”, but
let’s also focus on what the
trainees CAN do. Let’s
consider how we can IMPROVE
our current health care system
and ultimately the care of
patients with innovative uses of
social media and social
networking …
Dr. Alex Djuricich, Association
Dean for CME, University of
Indiana School of Medicine

8. Why consider social media?
 To stay informed
 Communicate (engage) with peers and patients
 Disseminate information
 To learn
 Advocate for/against something
 Because if you decide not to use social media, your
decision should be based on sound knowledge
about what you are choosing not to use

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Peer Leader – Dr. Jen
Gunter
OB/GYN, writer, sexpert, defender
of evidence-based medicine,
Canadian Spice. I wield the lasso
of truth. Tweets not medical
advice. I speak for no one but me.
21,000 followers on Twitter
Regular blogger

10. The HPV article

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Peer leader II
Dr. Helen Madamba
Obstetrician Gynecologist -
Infectious Disease specialist.
Public Health advocate. Research
enthusiast. Executive Director of
The Share A Child Movement, Inc.
147 followers on Twitter
Just learning to blog

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14. Social networking and ob/gyn
 GYNCSM chat is for survivors,
caregivers, advocates and– this is the unique
part—healthcare providers. In addition to a
survivor, Dee @womenofteal, and patient
advocated, Christina @btrfly12, the chat has three
medical oncologist moderators: Dr. Don Dizon
(GYN/ONC), Dr. Merry J. Markham, Dr. Rick
Boulay (GYN/ONC) and Dr. Anne Becker-Schutte,
a mental health moderator.

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The rules
 College of Physicians and Surgeons of Ontario Guidelines
 CMPA overview of the impact of social media on your practice
 Canadian Medical Association – Issues and Rules of Engagement

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“We have current roles
and guidelines but times
are changing quickly. By
2017 patients and their
health care providers
are going to be
communicating very
differently.”
Dr. Darren Beiko, Queens
University urologist, July,
2013

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The rules - translated
“Don’t be banal, self-promote excessively, share confidential material
(especially about patients), be a troll, break the law, commit a libel, or
overdo it.”
Dr. Richard Smith, BMJ, March 1, 2012

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“Don’t Lie, Don’t Pry
Don’t Cheat, Can’t Delete
Don’t Steal. Don’t Reveal”
Dr. Farris Timimi, medical
director, Mayo Clinic Center for
Social Media, April 5, 2012

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Key elements of the rules
* Apply same principles of professionalism that apply in person
* Respect patient confidentiality
“Social media should be treated as a public forum akin to an op-ed in a
newspaper or a lecture. Anything that would be inappropriate to share in
these more traditional outlets should be considered inappropriate to share
online.”
CFMS Guide to Medical Professionalism:
Recommendations for Social Media

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CMA guidance
 Rules of Engagement
 Understand technology and audience
 Be transparent
 Respect others
 Focus on areas of expertise

21.  Impact on patients
 Liability
 Privacy
 Ethics
 Boundaries
 Time theft
 Reputation
 Compensation
Thechallenges

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What not to do
Chicago Doctor Accused of Posting Photos of Intoxicated Patient
Aug. 20, 2013 (AP)
By ALANA ABRAMSON A former Northwestern University student claims
that after she was admitted to an Illinois hospital for extreme intoxication, a
doctor there took photos of her and posted them to social media sites with
commentary about her condition.
Elena Chernyakova filed suit in the Cook County Circuit Court against Dr.
Vinaya Puppala, the Feinberg School of Medicine and the Northwestern
Memorial Hospital on Aug. 15, claiming invasion of privacy and infliction of
emotional distress. Puppala is a fellow in the Multidisciplinary Pain Medicine
Fellowship at Feinberg, which works in conjunction with Northwestern
Memorial Hospital, according to court documents.

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Twitter post by Tennessee cardiologist, Nov. 15,
2012
What not to do - II

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What not to do III - Cell phones in hospitals
“… one would be hard-pressed to find a health care team in which at least
one member is not engaged on their smartphone during rounds. While you
attend to the flashing light or fancy ring tone, others are usually wondering if
you are looking up a life-saving dose of an inotrope, answering a text
regarding dinner plans or simply being rude. Although technologies
themselves may be neutral, their use or misuse may not be.”
“Physicians also routinely answer their phonesand discuss confidential
patient information in environments that they previously would have avoided
for such discussions — cafeterias, elevators and other public places inside
the hospital or out.”
From “Be smarter with cell phones” editorial, CMAJ 2011

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Mobile device use in
hospital
• Does the hospital have a
policy
• Will it harm interaction with
patient?
• Is it a secure network for
sharing data?
• Can others overhear
confidential information?

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The Boundary Fallacy
Keeping a boundary between
professional and personal life on social
media is “operationally impossible,
lacking in-agreement among active
physician social media users,
inconsistent with the concept of
professional identity, and potentially
harmful to physician and patients.”
Rather than eliminating boundaries and
“suggesting anything goes,” physicians
should just ask themselves whether
what they are posting on social media
is appropriate for a physician in a
public space – with the issue of the
content being professional or personal
being irrelevant.
“Social Media and Physicians’ Online Identity Crisis”
published in JAMA, Aug. 14 (v.310, no: 6, 581-582).

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Social media and medical education
“Medical educators must begin modelling
professionalism online the way they currently do in
person. They will likely do so only when medical
curricula explicitly require use of social media as a
component of teaching.”
Drs. Moneeza Walji and Matthew B. Stanbrook CMAJ Online release April
7, 2015

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-“For those of us
who have the
philosophy that we
want to graduate
docs who are
better than we are,
Twitter is a great
thing.”
Dr. Chris Simpson, cardiologist
and CMA President-Elect

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I think there are too many people on the
Web offering advice to you on how to use
social media. Most of this advice is just
regurgitated advice from people you may
never have heard of before,
…You really don’t need “How To” tips
on blogging or Twitter. Oh, I’m
confident that you’ll be told otherwise
– but those folks, well-intentioned as
they may be, don’t understand that
you’re smarter than that.
Rather than learn bad habits from the
get-go, take advantage of your lack of
experience. It’s okay to make mistakes
that don’t cause harm and violate the
privacy and dignity of others.
From: Physician Social Media: Has
Advice About It Become a Crock? Yes
@philbaumann, Jan. 1, 2013

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Using social media in residency: Suggestions
 Facebook presence for colleagues etc
 LinkedIn account to:
 Build network for future career
 Follow discussion forums on medical education
 Twitter account to:
 Develop your list of people, journals and other accounts to follow
 Watch (and engage) medical Twitter community (e.g. #hcsmca,
#hcsm)
 Follow and engage your professors

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Why Twitter:
• Easy to set up
• Unthreatening
• Non-Intrusive
• Low maintenance
• Useful

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An expert Canadian physician voice
 Dr. Ali Jalali, teaching chair, faculty of medicine, University of Ottawa

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CMA Leadership
• CMA Rules of Engagement
• CMA Online Course on
Social Media Use
• CMA guidance on use of
medical apps by patients
• Current president leading
advocate of social media
use by physicians

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▸Questions?

36. Case study: The Political Resident
Brandon is a resident who, since starting medical
school, has kept a blog about his views on medicine,
medical education, and health care politics. Recently,
Brandon has blogged extensively about his extreme
political views regarding the upcoming election. His
residency director reads his blog and tells him that he
must delete his posts and can no longer write new
ones, as he is not only a hospital employee and a
representative of the residency program, but also a
professional who must represent himself accordingly
American College of Medical Schools Digital Literacy Toolkit

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Discussion
Is it reasonable for the residency program director to tell this resident that
this non-medical blog should be removed? The residency director tells this
resident to remove his blog. What would an appropriate response be?
 A. What a resident does on his own time is his business.
 B. He should have asked him to remove the offending posts and be
careful in the future.
 C. When you are a student and resident, you are ultimately under the
guidance of your dean and residency director.

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Case study: The Case of the Facebook Faceplant
The Case of the Facebook Faceplant
From: Academic Life in Emergency Medicine – MEdIC
Series