Being a Psychiatrist Online Dr Christopher Pell Consultant ...

DIGITAL PROFESSIONALISM
Being a Psychiatrist Online
Rock1997 CC-BY-SA
Dr Christopher Pell
@egosyntonically
Consultant Psychiatrist

OUTLINE
Background
Emerging legal trends
New GMC guidance
Debate
Further reading

GMC UP UNTIL NOW...
No specific guidance on social media
Comes down to probity, professionalism and confidentiality standards in Good Medical Practice
“We would see the principles that apply to this as no different from those that apply in sharing
information in other areas, for example what information about their work doctors might share with
friends at the pub or in other social settings, although obviously the range of people who might have
access to their comments is likely to be wider.”
“In response to queries about this we have taken the view that doctors are allowed, like anyone else,
to have a private life and use of the internet and social networking sites are a part of this for many
people. It is clearly a matter of judgement, about what information doctors choose to share on such
sites and with whom, bearing in mind their professional obligations as a doctor and any contractual
requirements. It is not possible to state categorically what would and would not be acceptable in
relation to these matters as it is likely to depend on many factors, including the nature of the
comments, who could access them, and whether they were posted during or outside work hours.”

FACEBOOK
Total number of Facebook users: 1.06 billion
Daily active Facebook users: 618 million
Total number of Facebook pages: 50 million
Average no. of monthly posts per Facebook page: 36
Total number of Facebook mobile users: 680 million
Total no. of Facebook friend connections: 150 billion
Average number of friends per Facebook user: 141.5
Total no. of Facebook likes since launch: 1.13 trillion
Average daily Facebook likes: 2.7 billion
http://expandedramblings.com/index.php/resource-how-many-people-use-the-top-social-media/

TWITTER
Total Number of Twitter Users: 500 million
Total Number of Tweets Sent: 170 billion
Monthly Active Twitter Users: 200 million
Average Number of Followers per Twitter User: 208
Average Number of Tweets Sent Per Day: 400 million
Average Number of Tweets per Twitter User: 307
Average Time Per Month Spent by Users on Twitter:
170 minutes
Percentage of Twitter Users Accessing Via Mobile:
60%
Most Followed Celebrity on Twitter: Justin Bieber
http://expandedramblings.com/index.php/resource-how-many-people-use-the-top-social-media/

YOUTUBE
One billion unique views per
month
4 billion views per day
60 hours of video uploaded
per minute
Nearly 9 out of 10 (87%) of
UK internet users have used
YouTube
http://expandedramblings.com/index.php/resource-how-many-people-use-the-top-social-media/

YOUTUBE
One billion unique views per
month
4 billion views per day
60 hours of video uploaded
per minute
Nearly 9 out of 10 (87%) of
UK internet users have used
YouTube
http://expandedramblings.com/index.php/resource-how-many-people-use-the-top-social-media/

YOUTUBE
One billion unique views per
month
4 billion views per day
60 hours of video uploaded
per minute
Nearly 9 out of 10 (87%) of
UK internet users have used
YouTube
http://expandedramblings.com/index.php/resource-how-many-people-use-the-top-social-media/

POSITIVE MEDICAL USES OF
SOCIAL MEDIA
“Technology should be like oxygen:
ubiquitous, necessary, and invisible.”
-Chris Lehmann
“If you don’t learn something new
each day on Twitter, then you are
following the wrong people.”
-via @TweetSmarter

POSITIVE MEDICAL USES OF
SOCIAL MEDIA
Networking
Asking questions
Learning
Sharing
Informing
Reconnecting
Educating
Promoting
Entertaining
Employing
“Technology should be like oxygen:
ubiquitous, necessary, and invisible.”
-Chris Lehmann
Discovering
Conversing
Advertising
“If you don’t learn something new
each day on Twitter, then you are
following the wrong people.”
-via @TweetSmarter

POSITIVE MEDICAL USES OF
SOCIAL MEDIA
Twitter:
Keep up to date
Track jobs and other
opportunities
Inform others and share
interesting articles
Public health - track disease
outbreaks, emergencies
Networking particularly for
conferences - #RCPsychIC13
Crowd sourcing platform - ask
your followers
Journal clubs and specific
discussion groups - #meded
#TwitJC
Communicate with colleagues
(and patients?)

POSITIVE MEDICAL USES OF
SOCIAL MEDIA
Facebook
Present a professional image
Create a “fan page” for your
organisation - e.g. RCPsych
Use to disseminate
information
Generate discussion amongst
friends or fans

POSITIVE MEDICAL USES OF
SOCIAL MEDIA
Facebook
Present a professional image
Create a “fan page” for your
organisation - e.g. RCPsych
Use to disseminate
information
Generate discussion amongst
friends or fans

WHY DOCTORS SHOULD
CARE
✤ You are already on-line.

WHY DOCTORS SHOULD
CARE
✤ You are already on-line.
Try Googling yourself - find out what others would see
Your friends, family and patients are all on-line too (and may be
posting information about you)
Likely to continue to increase in next few years
Increasingly pervasive into other aspects of life
Doesn’t interfere with off-line relationships

DEVELOPING LEGAL TRENDS
#twitterjoketrial
Unnamed footballer saga
highlights courts’ ability to pursue
tweeters
Ongoing case in respect of Twitter
users who wrongly identified
Lord MacAlpine
Upshot in UK as of 2011 - all
tweets are considered public
domain material
Material posted is permanent and
searchable

SPECIFIC PROBLEM AREAS
FOR CLINICIANS
Personal views
Public Communication
Confidentiality
Professionalism
Defamation
CC: Takomabibelot

GMC CASES TO DATE
Dr Khalil
On 6 June 2011 at Thames Magistrates' Court, you
were convicted of sending electronic communications
that were grossly offensive or of an indecent, obscene
or menacing character Contrary to section 127(1)(a)
and (3) of the Communications Act 2003. Admitted
and found proved.
“In view of the seriousness of your conviction, the
Panel determined that the maximum period of 12
months’ suspension is necessary. The Panel also
determined that a review is necessary in order that a
subsequent Panel may be satisfied that you are fit to
resume practice following your period of suspension.”
CC: Takomabibelot

GMC CASES TO DATE
Dr Jasiak
In relation to your failure to treat your colleagues with dignity and
respect, you admitted that you regularly used nicknames for
colleagues. These included ‘sausage tits’, ‘nurse endowed’ and
‘jugs’.
You admitted that on the day you were dismissed from the Trust
you posted a comment on Facebook relating to your dismissal
knowing that it would be seen by the various Trust employees […]
You accepted that the language used was intemperate and
inappropriate.
This warning will be published on the List of Registered Medical
Practitioners (LRMP) for a period of five years and will be
disclosed to any person enquiring about your fitness to practice
history.
CC: Takomabibelot

GMC GUIDANCE
Part of process to update Good Medical Practice
Came into effect on 22nd April 2013
8 additional areas consulted on to provide explanatory guidance on the
GMCs views on what is expected of doctors in the following areas:
Acting as a witness in legal proceedings
Delegation and referral
Doctors' use of social media (new guidance)
Ending your professional relationship with a patient
Financial and commercial arrangements and conflicts of interest
Maintaining boundaries
Personal beliefs and medical practice
Reporting criminal and regulatory proceedings within and outside the UK

GMC GUIDANCE
Language used:
“Must” = an overriding duty or principle
“Should“ = the duty or principle will not apply in all situations or
circumstances, or where there are factors that are outside your control that
affect or control how you can follow the guidance
To maintain your license to practice, you must demonstrate, through the
revalidation process, that you work in line with […] this guidance.
Serious or persistent failure to follow this guidance will put your registration
at risk

DOCTORS’ USE OF SOCIAL
MEDIA
General Principles
Benefits and Risks
Social Media
Maintaining boundaries
Privacy
Maintaining confidentiality
Conflicts of interest
Respect for colleagues
Anonymity

GENERAL PRINCIPLES
In Good Medical Practice we say:
You must treat colleagues fairly and with respect.
You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the
profession.
When communicating publicly, including speaking to or writing in the media, you must maintain patient
confidentiality. You should remember when using social media that communications intended for friends
or family may become more widely available.
When advertising your services, you must make sure the information you publish is factual and can be
checked, and does not exploit patients’ vulnerability or lack of medical knowledge.
In Confidentiality we say:
Many improper disclosures are unintentional. You should not share identifiable information about patients
where you can be overheard, for example, in a public place or in an internet chat forum...

GENERAL PRINCIPLES
The standards expected of doctors do not change because they are
communicating through social media rather than face to face
or through other traditional media. However, using social media
creates new circumstances in which the established principles
apply.
You must also follow our guidance on prescribing, which gives
advice on using internet sites for the provision of medical services.
As well as this guidance, you should keep up to date with and
follow your organisation’s policy on social media.

PRIVACY
Using social media has blurred the boundaries between public and
private life, and online information can be easily accessed by others.
You should be aware of the limitations of privacy online and you
should regularly review the privacy settings for each of your social
media profiles. Because...
Social media sites cannot guarantee confidentiality
Others may be able to access your personal information
Location information may be shared
Information posted is permanent and distributable

DOCTORS’ USE OF SOCIAL
MEDIA

DOCTORS’ USE OF SOCIAL
MEDIA
Engaging people in public health and policy discussions
Establishing national and international professional networks
Facilitating patients’ access to information about health and services

DOCTORS’ USE OF SOCIAL
MEDIA
Engaging people in public health and policy discussions
Establishing national and international professional networks
Facilitating patients’ access to information about health and services

DOCTORS’ USE OF SOCIAL
MEDIA
Risks:
Maintaining boundaries
Follow separate guidance
If approached by a patient you should indicate you cannot mix social and
professional relationships and direct to your professional profile
Maintaining confidentiality
Caution even in private forums
Must not discuss individual patient or their care with those patients or anybody else
Caution that confidentiality may be breached by the sum of info on-line

CONFIDENTIALITY
Confidentiality is the sum of on-line information

CONFIDENTIALITY
Confidentiality is the sum of on-line information
Today
✤
Phew what a day! Ward understaffed, and annoying tribunal for that
difficult patient.

CONFIDENTIALITY
Confidentiality is the sum of on-line information
Today
✤
Phew what a day! Ward understaffed, and annoying tribunal for that
difficult patient.
Friday
✤
Wow, the nerve of some people - admitted a really difficult patient with
stroppy relatives today. People don’t appreciate doctors!

CONFIDENTIALITY
Confidentiality is the sum of on-line information
Today
✤
Phew what a day! Ward understaffed, and annoying tribunal for that
difficult patient.
Friday
✤
Wow, the nerve of some people - admitted a really difficult patient with
stroppy relatives today. People don’t appreciate doctors!
January
✤
Looking forward to starting on Ward 20 today!

CONFIDENTIALITY
Confidentiality is the sum of on-line information
Today
✤
Phew what a day! Ward understaffed, and annoying tribunal for that
difficult patient.
Friday
✤
Wow, the nerve of some people - admitted a really difficult patient with
stroppy relatives today. People don’t appreciate doctors!
January
✤
Looking forward to starting on Ward 20 today!
August
✤
Nice to see our local NHS Tayside newsletter today, interesting article on
Sunnyside hospital - I’ll be there for my next job!

DOCTORS’ USE OF SOCIAL
MEDIA
Risks:
Respect for Colleagues
Covers all situations and all forms of interaction and communication
Must not bully, harrass or make gratuitous, unsubstantiated or unsustainable comments
about individuals online
Be aware that online content is subject to same laws of copyright, and defamation (or libel)
as other forms of communication
Conflicts of interest
You should be open about any conflict of interest and declare any financial or commercial
interests in healthcare organisations or pharmaceutical and biomedical companies

DOCTORS’ USE OF SOCIAL
MEDIA
Anonymity…
If you are writing in a professional capacity, you should
usually identify yourself.
Any material written by authors who represent themselves as
doctors are likely to be taken on trust and/or to represent the
views of the profession more widely.
You should also be aware that content uploaded anonymously
can, in many cases, be traced back to its point of origin.

DOCTORS’ USE OF SOCIAL
MEDIA
Anonymity…
If you identify yourself as a doctor in publicly accessible
social media, you should also identify yourself by name.
Any material written by authors who represent themselves as
doctors is likely to be taken on trust and may reasonably be
taken to represent the views of the profession more widely.
You should also be aware that content uploaded anonymously
can, in many cases, be traced back to its point of origin.

BACKLASH
Doctors will disappear off Twitter and interaction will be lost
Can doctors be trusted to exercise professionalism online?
Doctor anonymity will help protect identification of patient cases
being discussed
Suggestions have been made to run two accounts - If one account is
anonymous and the other under a real name, then the user is bound
to get them mixed up
Why, when patient safety is not an issue?
That doctors should have the right to be anonymous in their social
media activities just like any other profession
Doctors will feel unable to comment on medicine and medical politics
There are valid reasons to be anonymous
http://surgicalopinion.blogspot.com.au/2013/03/twitter-wars-on-anonymity-of-doctors-on.html

GMC RESPONSE
What does 'identifying yourself as a doctor' mean in practice?
There is a bit of judgement involved here. For example, if you want to blog about football and incidentally
mention that you're a doctor, there is no need to identify yourself if you don't want to.
If you're using social media to comment on health or healthcare issues, we think it's good practice to say
who you are.
In the guidance we say 'you should' rather than 'you must'. We use this language to support doctors
exercising their professional judgement. This means we think it is good practice but not that it is mandatory.
Does this restrict doctors' freedom of expression?
We are not restricting doctors' right to express their views and opinions except:
Where this would breach patient confidentiality
Where comments bully, harass or make malicious comments about colleagues on line. (A colleague is
anyone a doctor works with, whether or not they are also doctors).
One of the key messages in the guidance is that although social media changes the means of communication,
the standards expected of doctors do not change when communicating on social media rather than face to face or
through other traditional media (see paragraph 5 of the social media guidance).

GMC RESPONSE
Does this guidance apply to personal use?
The GMC has no interest in doctors' use of social media in their personal lives — Tweets, blogs, Facebook
pages etc. But doctors mustn’t undermine public trust in the profession. Usually this means breaking the
law, even where the conviction is unrelated to their professional life.
Why can't I raise concerns anonymously in social media?
We are not trying to restrict discussion about important issues relating to patient safety and certainly don't
want to discourage doctors from raising concerns. However, we wouldn't encourage doctors to do so via
social media because ultimately it's not private and it might well be missed by the people or organisations
who are able to take action to protect patients.
Why do publications like the BMJ allow anonymous blogs/letters articles? Does the guidance mean they can't
do that anymore?
BMJ is entirely independent of the GMC, and it is a matter for them to decide what is appropriate for their
website.
Many blogs are published without formal editorial or publisher control — although there may be
moderation on some sites. Using your name (or other identifying information) provides some transparency
and accountability.

PERSONAL VS PROFESSIONAL
PERSONAS
Article 8 of the Human Rights Act states:
A Helpful Venn Diagram
“Everyone has the right to respect for his private
and family life, his home and his correspondence.”
Care needed to ensure policy does not infringe our
rights to freedom of speech, and to a private life
Privacy
The
Internet
Would we accept policies that monitor and limit
what we say in public? Are tweets and posts any
different?
http://www.flickr.com/photos/buriednexttoyou/5095255302/
Is it possible to separate who we are?