Privacy, professionalism and Facebook: a dilemma for young doctors.

[Argirios Argiriou]

Med Educ. 2010 Aug;44( 8 ):805-13.

Privacy, professionalism and Facebook: a dilemma for young doctors.
MacDonald J, Sohn S, Ellis P.

Department of Psychological Medicine, University of Otago, Wellington School of Medicine and Health Sciences, Wellington 6242, New Zealand. Joanna.macdonald@otago.ac.nz


Abstract
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CONCLUSIONS: Young doctors are active members of Facebook. A quarter of the doctors in our survey sample did not use the privacy options, rendering the information they revealed readily available to a wider public. This information, although it included some healthy behaviours, also revealed personal information that might cause distress to patients or alter the professional boundary between patient and practitioner, as well as information that could bring the profession into disrepute (e.g. belonging to groups like 'Perverts united'). Educators and regulators need to consider how best to advise students and doctors on societal changes in the concepts of what is public and what is private.


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[Denominator]

Πολλά ερωτηματικά εγείρονται σχετικά με τη σχέση ιατρών και εργαλείων του διαδικτύου που έχουν σχέση με τα προσωπικά δεδομένα των ασθενών.
Εν τάχει σταχυολογώ ορισμένα από αυτά με την ελπίδα να συμπληρωθούν και να υπάρξει συζήτηση και προβληματισμός.

1) Έχουν δικαίωμα οι ιατροί να κάνουν "φίλους" στο Facebook ή στο Twitter; Ποια είναι δηλαδή τα όρια της σχέσης μεταξύ ιατρού και ασθενούς;
2) Έχει δικαίωμα ο ιατρός να κάνει διαδικτυακή έρευνα προκειμένου να συλλέξει στοιχεία για τον ασθενή του (σχετικά και άσχετα με την πάθησή του);
3) Μήπως η έκθεση των ιατρών σε ιστοσελίδες κοινωνικής δικτύωσης καθιστά επισφαλή ορισμένα στοιχεία που άπτονται του ιατρικού απορρήτου (δεδομένου ότι όλο και κάποιος θα έχει ξεχάσει να επαναφέρει τις ρυθμίσεις ασφαλείας του στο επιθυμητό επίπεδο);

Τα πιο πάνω είναι ενδεικτικά.

Σχετικά με το θέμα εντόπισα ένα πολύ ενδιαφέρον άρθρο:


The Lancet, Volume 377, Issue 9772, Pages 1141 - 1142, 2 April 2011

Facebook friend request from a patient?

Sharmila Devi


Widespread use of new technologies such as social networking sites are creating ethical problems for physicians that some doctors' organisations are beginning to address. Sharmila Devi reports.

Social networking sites such as Facebook and the ubiquity of search engines such as Google are creating new medical ethical dilemmas as physicians around the world grapple with how to responsibly include new technologies in their professional lives.

In the USA, birthplace of most of these technological advances, various associations of health-care professionals are starting to issue codes of conduct when dealing with new digital media. Other countries, such as the UK, Canada, and Australia, are also debating what rules should be set. But some doctors believe such codes will have to evolve and adapt as younger generations, used to living an online life from an early age, start to dominate health care and to teach subsequent waves of professionals.

Websites such as Facebook allow individuals to post messages, photos, and videos and share them with an online group of friends. They can also be used to reach out professionally to a wider range of people than was possible with some traditional marketing methods. But used unwisely, such sites can blur the lines between the personal and professional and cause embarrassment.

“Older generations will moralise and say it's unethical and unprofessional [to be friends with clients on sites such as Facebook]”, says Ofer Zur, an Israeli psychologist based in California, USA, who offers online courses in digital medical ethics. “Younger generations have less of a sense of hierarchy and see the internet as an equaliser that opens doors. I am typical of the older generation because I sometimes cringe at the things my daughter posts online.”

Although it would seem obvious for many professionals to maintain as strict a boundary between them and clients in the online world as in the physical world, Zur said online interactions should be looked at on a case-by-case basis. For example, a physician in a small community might find that Facebook simply replicated the flow of information that already took place amid existing close relationships, he says.

Cases where health-care professionals have taken things too far are rare but well publicised. In February, a physician assistant working at a medical centre in New York state was found to have posted photos on Facebook showing him holding a syringe at a man's neck. He said: “When you can't start a line in a junkie's arm…go for the neck”, reported The Journal News, a local newspaper.

Such behaviour is unanimously condemned as inappropriate. More difficult to answer are questions such as whether health-care professionals should be allowed to research a client's background on the search engine Google? Does a blog's informative value outweigh any possible breach of confidentiality? Should medical students post online any personal information about themselves for fear of jeopardising relations with future clients and employers? “Questions about the internet are becoming a common inquiry among our members who want to take advantage of it, especially younger members and students, and the number one concern is confidentiality and how to preserve it”, says Erin Martz, manager of ethics and professional standards at the American Counselling Association. “We actually just received our first ethical complaint that's Facebook-connected and technically-driven. I do think Facebook can be quite dangerous.”

Edward Hill, a director at the North Mississippi Medical Centre and chair of the World Medical Association (WMA), which represents 95 national medical groupings, said he had “strong views” against health-care professionals socially interacting on the internet. “I work at a large medical entity with some 6000 employees and we don't allow anyone to use social networking and have firewalls against it”, he says. “In medicine, the number one important thing is trust in providers and trust can be lost in the social milieu.”

Hill says that the WMA will soon appoint a working group of six to eight physicians to assess social networking sites and new technology and a statement was likely to be issued next year. “We need to make sure physicians are aware of the potential loosening of professionalism”, he said.

The American Medical Association (AMA) adopted a new policy on physician use of social media just last November. Although it mentioned some positive examples, such as the Facebook group Doctors for Obama that mobilised thousands of doctors to communicate their views during the 2008 presidential campaign, it warned against physicians engaging in personal relationships online. “For example, Florida judges may not ‘friend’ lawyers who appear before them due to concerns of conflicts of interest or simply the appearance of impropriety”, said a report by the AMA's Council on Ethical and Judicial Affairs. “Physicians can similarly protect their professional relationship with patients, colleagues, and others by not engaging in social relationships or connections online and keeping personal social networking accounts, blogs, and other web content separate from professional content online.”

The report also discussed some of the risks of online searches of patients, such as uncovering content not intended for them that might have implications for patient care (eg, seeing a photo of a patient smoking a cigarette when the individual has denied being a smoker).

“Likewise, physicians who allow patients access to personal information online (by either accepting a patient's request to connect, extending a request to connect to a patient, or keeping privacy settings such that others may view personal content without making a formal connection) may risk a variety of repercussions if patients view this information, including loss of trust or respect.”

More controversially, the report said physicians should report colleagues if they posted content that seemed unprofessional because such reporting was a common standard in non-online professional interactions. “As members of a self-regulating profession, physicians who observe unprofessional content posted by colleagues have an ethical obligation to address the situation”, it said.

Health-care professionals certainly have to be aware their patients are increasingly tech-savvy. In 2010, 89 million US adults tapped social media resources for health-related purposes, compared with 63 million in 2008 and 38 million in 2007, according to a study by Manhattan Research, a US drug and health-care market research and services firm. The study said that consumers mostly used social media for medical purposes by creating or consuming content on blogs, chat rooms, message boards, online communities, and patient testimonials. Once online, certain medical condition groups that tended to skew older patients, such as those with cancer, were more likely to use social media for health reasons than their average age would predict, it said.

“New technology is empowering patients and enabling them to be much more assertive and health-care professionals have to spend more time helping them to sift through what might or might not be helpful online”, says Neil Coulson, a chartered psychologist at the University of Nottingham, UK. He said there was growing debate about such issues in the UK. “My perception is the UK is catching up with issues that North America started to face 3 or 4 years ago”, he says. “Across the Atlantic, things are more focused but there is growing recognition in the UK about the power of the internet although we haven't yet got to grips with it.”

Emma Short, a chartered psychologist at the University of Bedfordshire, UK, said there was no consensus in the UK on, for example, whether online therapy might be useful and suitable for less vulnerable patients. Online video telephone services, such as Skype, might not improve the environment for therapy because of their often poor visual quality, she said. “Technology doesn't necessarily help if the therapist needs non-verbal clues to be effective”, she says. “On something like Skype, it would be hard to know if the patient was suffering from a social phobia or whether there was just poor quality.”

The Canadian Counselling and Psychotherapy Association has updated its ethics notes to cover issues such as use of email and concerns about confidentiality in the increasing use of electronic records, says Lynda Younghusband, chair of the association's ethics committee.

She says that although it was within a patient's rights to Google and to research a health-care provider, it was not acceptable the other way round. “We can assume others are doing it but clients should feel a counsellor wouldn't do it and they would see it as snooping”, she says. “Clients have the right to tell me as much or as little as they choose to.”

But the Australian Psychological Society left open the possibility of client internet searches. “The appropriate use of online searching should be guided by the best interests of the client, not to satisfy the curiosity of the psychologist”, said an article in the society's journal InPsych published in August, 2010. “Examples of this may be to corroborate important facts provided by a client, or where client safety is at risk and his or her Facebook site is accessed for signs of suicidality.”

The article also warned professionals to be aware of the amount and scope of information about themselves that can be made available to clients via Google. “Frequently information is available online from sources for which consent may not have been given. It may be helpful for psychologists to do a Google search of themselves to ensure they would feel comfortable with clients potentially accessing such information”, it said. “Requests can be made for information to be removed from online sources that psychologists do not wish to be accessed by clients.”


Υ.Γ. Η Ελληνική Νομοθεσία στο μοναδικό σημείο που αναφέρεται στη σχέση ιατρών και διαδικτύου είναι στο άρθρο 18 του Νόμου 3418/2005 (Κώδικας Ιατρικής Δεοντολογίας), το οποίο αναφέρει τα εξής:

Παρουσία των ιατρών στο διαδίκτυο

1. Οι ιατροί μπορούν να διατηρούν ιστοσελίδα στο διαδίκτυο στην οποία αναφέρονται ιδίως τα οριζόμενα στην παράγραφο 3 του άρθρου 17.
2. Το όνομα, η επωνυμία ή ο τίτλος που επιλέγει ο ιατρός για την ιστοσελίδα του ή την ηλεκτρονική του διεύθυνση πρέπει να συνάδουν με την επαγγελματική του ευπρέπεια και αξιοπρέπεια και να ανταποκρίνονται στις πραγματικά παρεχόμενες υπηρεσίες. Η ιστοσελίδα πρέπει να αναφέρει το χρόνο της τελευταίας της ενημέρωσης. Πρέπει, επίσης, να αναφέρει οποιαδήποτε πιθανή σύγκρουση συμφερόντων.
3. Η ιστοσελίδα μπορεί να περιλαμβάνει πληροφορίες σχετικά με τις συμβάσεις ή τη με οποιονδήποτε τρόπο συνεργασία του ιατρού με το Δημόσιο, τα ταμεία ασθενείας και τους ασφαλιστικούς φορείς.
4. Οι πληροφορίες που παρέχονται στην ιστοσελίδα πρέπει να είναι ακριβείς, αντικειμενικές, κατανοητές και σύμφωνες με τον παρόντα Κώδικα. Σε καμία περίπτωση δεν πρέπει να οδηγούν σε παραπλάνηση του κοινού ή σε έμμεση συγκριτική εκτίμηση προσόντων ή πτυχίων.

[Argirios Argiriou]

Attract Patients & Keep Them (Healthy) with Social Media.

by Katie Matlack
Medical Market Analyst, Software Advice
December 20, 2011

Two-thirds of physicians use social media in their practice of medicine, a September study by QuantiaMD and the Care Continuum Alliance reported. Why? Marketing, brand awareness and business development.

Patients looking for a new doctor often look to the web to find practitioners in the city and specialty they need. So, participating in networks like LinkedIn and Facebook enhances a doctor’s visibility with potential patients.

Moreover, social media can help doctors provide better care, suggests one study discussed in peer-reviewed Chest Journal. It found that patients who hear from their doctor after their consultation are more likely to take their meds properly and follow the doctor’s advice. It also found that patient-doctor communication after the appointment improved patient satisfaction and retention.

Another use for social media? Education. As the New England Journal of Medicine reported, doctors often find themselves correcting patients who believe anything they read on the Internet. Physicians can use social media channels to combat quack claims.

One specialist with a strong Twitter and Facebook presence is Dr. Howard Luks. In a 2010 interview with ABC, he said the physician’s role is becoming that of a leader “helping the engaged and interested patient navigate the Internet.”

Ready to be social, then? Here’s the key: If you know your target audience and its habits, then you’ll be in a better position to reach them successfully.

Step 1: Make Sure Your Patients Actually Use Social Media
I spoke with a few doctor friends for this article. Those who treated older or impoverished populations who didn’t regularly access the Internet said social media was less relevant to them. But, they all hastened to add they were sure it could be useful for colleagues whose patients were active on social networks. For example, one suggested young mothers could benefit from a physician’s Twitter feed reminding them about health issues for their children in their first days.

Step 2: Figure Out What Your Patients Want to Learn
Many medical practices use social media to answer common patient questions on topics like flu shot availability or changes to insurance plan acceptance. You can also use Twitter and Facebook to share links to relevant news articles (e.g. “Great article in the Times on recovery from knee surgery”). Or, you can share a blog post you’ve written yourself. One simple way to know your audience’s interests and habits? A quick waiting room paper survey on what patients would like to hear from you, and where they get their health news from now.

Step 3: Choose Content That Appeals to Your Patients
When it comes to pointing your patients to outside information, think about your audience. For example, if you’re a pediatrician, preteen patients will probably appreciate links to YouTube videos where Justin Bieber talks about the importance of an active lifestyle. If you’re a physician serving largely college-aged patients, sharing the Bieber video would paint you as out-of-touch, though. To get your point across here, a better bet might be to link to an article in Marie Claire where Scarlett Johansson advocates regular STD testing.

Step 4: Create a Schedule and Publish Regularly
Start out that schedule with a date to set up a Facebook business page linking to your practice’s website. Then share one news story and one educational resource each week. To make your task easier, identify five news sources and three educational resources you trust. Once Facebook is under control, create a great LinkedIn profile. Surf around and find peers whose profiles you envy, then use their style and format for inspiration. Next, reach out to current and former colleagues to “connect” and get recommendations. Recommendations enhance your credibility, and will help you appear near the top in LinkedIn search results. To round out your social media presence, add a Twitter account. Find colleagues and news sources to “follow,” and start small, with the intention of creating a two-sided conversation.

Step 5: Monitor Your Online Rep and Manage It With Care
Unsubstantiated reviews on sites like Yelp can be confusing and misleading–so presenting your own online bio is critical. Another benefit of an online presence? Prospective patients looking at your practice’s Facebook page will be notified if any of their friends are already fans of your practice. After all, the whole reason advertisers drool over Facebook ads is that it’s proven that recommendations from peers carry significant weight when people are making decisions. Let your patients know when you go on Facebook and ask them to become fans of your practice. Avoid adding them as personal friends from your personal account, though, since that can violate patient-doctor ethical boundaries.

To take control of your social media presence, you needn’t be witty or a social butterfly. You just need to plan and research well, which most doctors can do naturally. The first three steps I lay out don’t involve the social networks yet–they involve understanding your target audience: current and future patients. Once you’ve verified your patients use social media, figure out what they’re interested in learning from you, and what kind of content you’ll use to provide appropriate information. Then, setting up your Facebook, LinkedIn, and Twitter profiles is straightforward.


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