Taking a Shot at Immunizations Online, Part 3

July 23, 2011

National Immunization Month is almost upon us (coming in August), and in anticipation, some of us Twitter health fans have decided to use this medium and other social media tricks to support this effort.  For those who have not been keeping pace with the progress of this project, part 1 and part 2 are in the archive of this blog. To wrap up what has been happening this month, allow this post to bring everyone p to speed.

Our steadfast volunteer, April Foreman (@DocForeman), has been shaking the trees for leads in the ministry community in Kansas City for contacts who would be willing to spread greater awareness regarding immunization health and vaccine locales among their faithful.  Meanwhile, Mike Boivin (@CommPharm), posted his own poignant account of why he knows vaccines don’t cause autism, writing as a parent of a child with autism. Read this very powerful essay here. During the course of several chats, the topic of using temporary tattoos to spread the word on vaccine clinic locations became a popular topic. Mike Smith (@rybolov) offered to create a pdf of our QR code-Google map that features the vaccine locations we researched for Kansas City, MO. He then provided a link to a place that sells temporary tattoo paper here. So, I have ordered the paper and await delivery. I will print out the pdf filled with our QR codes and try to get the tattoo sheets to Heather Paladine (@paladineh) who is attending the American Academy of Family Physicians (AAFP) National Conference this coming week in …wait for it: Kansas City! Nate Osit (@NateOsit) thinks we can track the number of times the URL in the QR code is read by using bit.ly. So, as part of our experiment, I will be tracking the QR URL on bit.ly just to see how many are clicked. This is such a whimsical idea that if this takes root, I can see all manner of applications for health awareness promotion.

Speaking of which, Heather Paladine  and Mike Boivin noted that what is most effective in targeting physicians is having ready-made information packets to give to parents and encouraging prenatal order sets with flu shots that physicians can use.  Plus, as Mike also noted providing OB/GYNs with the info on why pregnancy vaccines are a good idea is worthwhile. Here’s an article detailing the CDC’s recommendations on vaccines given during pregnancy, particularly H1N1 flu shot for expectant mothers.

Stay tuned as this project continues to gather steam and interest, inoculating the world from harm.

Who Defines Professionalism in Social Media?

July 19, 2011

Earlier today, Dr. Kelly Sennholz (@MtnMD) posted on her blog, discussing her concerns with how physicians and others define professionalism on social media (especially on Twitter), who determines that definition, and what happens if someone violates that definition.

Here is my response:



Your concerns are well put, and I think they reflect the fact that we are still establishing the roles of physicians on Twitter and social media. The rules are not well-defined, and there are few useful guidelines out there to help us.

I feel that the movement away from anonymous accounts is a good one: each of us should be able and willing to say what we want to say and then we should be willing to stand behind it in public. So, in general, I think moving towards accountability is a good thing.

Having said that, I don’t really see how it is any one person’s role/position to police what others are doing and to criticize others as if they were the sole authority. They certainly have a right to their opinion, and to be critical of others’, but they should do so respectfully. And, I think they should expect that the general audience out there can make their own decisions: if a post or comment is truly offensive or “unprofessional”, then they can make that decision for themselves.

I follow @BurbDoc’s Twitter account, and I agree that his (?) language and comments can make me cringe. But I view him as an “EveryDoctor” dealing with “EveryPatients”: I wonder if any if the patients he describes are real, or if they are archetypes set up to describe the challenges, frustrations, and difficulties of being a physician in this day and age. Even if they are real, there would be no way to identify them as described: they are generic enough (unlike the @MommyDoc case) that they really could be anyone. That, I think, is the point.

I think we are all entitled to reacts as individuals as to whether we like or dislike something on Twitter. I have done that a few times, when I felt comments (or accounts) had done something egregious. But I did it as myself—not trying to lead a movement or define “professionalism” overall or for all.

I do think physicians who are on Twitter as identifiable physicians should be professional—but should be able to retain our own voices and our own opinions. We have to be willing to stand by what we say, and we should say what we say for the greater good. But before trying to set the rules you expect all of us to follow, it should be determined if all of us agree upon those suggested rules. I agree that identifiable is better than anonymous. But I also feel that anonymous (and pseudonymous) posts have their roles. Professionalism is, to some extent, in the eye of the beholder—both on the wards, in the office, and on Twitter. Just an action doesn’t meet my definition of professionalism doesn’t mean it is, inherently, unprofessional. For example: I tweeted picture a few weeks ago showing me, in a fake moustache, drinking a beer at a party. Some might consider that unprofessional. Why? By whose standards? Who is setting the definition of professionalism? The AMA’s definition? Someone else’s? Who decides?

I think there is enough room on Twitter for many voices to share many opinions—some agreeable, others not. I think that, as physicians, we need to guard our patients’ privacy (which was part of the issue with @MommyDoc), and we need to work towards our patients’ (and society’s) wellbeing. We need to provide information that is valid and reliable, and we need to do so in a way that advances discussions and ideas. These are my beliefs, and I will try my best to abide by them. However, I do not feel that I need to force others to do so.

More Social Media Guidlines for Physicians. Should We Care?

July 17, 2011

Late last year, the American Medical Association published guidelines to guide how physicians use social media.  Once the recommendations were made public, I posted that I did not think the guidelines were very helpful.  My overall sense was that the guidelines were designed more to discourage or limit physicians’ participation in social media…or at least highlight the risks of using social media.

Now, two other sets of guidelines have been released.  The Massachusetts Medical Society (MMS) released their guidelines about two months ago, and the British Medical Association recently made their guidelines public.

I’ve been meaning to review the guidelines in detail, but have not had the time to do so.  So I thought I would try and give an overview of where the guidelines are similar and where they differ.

Highlights of the MMS guidelines include:

  • Patient privacy is of the utmost importance.
  • Physicians should maximize privacy settings, but should not assume these settings are absolute.
  • Physicians must maintain professional boundaries if interacting with patients online.
  • Physicians should separate personal/private and professional information online, and should not connect with patients in public social media settings.
  • Physicians should be responsible for monitoring others’ use of social media: “when physicians see content posted by colleagues that appears unprofessional, they have a responsibility to bring that content to the attention of the individual, so that he or she can remove it and/or take other appropriate actions. If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities.”
  • Physicians should disclose any relationships they have with any services or products that they review or discuss online.
  • Physicians must realize that any information posted online may affect how the public views physicians and the medical profession, might impact individual physicians’ reputations, and may have career consequences (especially for trainees).

I do not believe that these guidelines differ very much from the AMA guidelines I mentioned earlier.

Meanwhile, the BMA guidelines largely tread the same paths: protect patient privacy, disclose conflicts of interest when they exist, be aware of how your online posts and comments might reflect upon yourself and the medical profession, etc.  The BMA also specifically notes that “It would be inappropriate to post informal, personal or derogatory comments about patients or colleagues on public internet forums.” Of note, the BMA does not suggest that physicians should be responsible for policing each others’ online posts.

As was the case with the AMA guidelines, the BMA guidelines also emphasize the potential harms and risks of physician involvement in social media.

Maybe this is the nature of guidelines: to highlight how potential risks without focusing on the potential benefits.  But none of the guidlines–AMA, MMS, or BMA–discuss how to use social media effectively and successfully.  If physicians are only provided with cautions and warnings about social media, and are not given guidance on how social media can be used to enhance the health of individuals and communities, then physicians are hearing an unbalanced perspective.

In fact, some physicians have argued that health care professionals have an obligation to engage in social media: read Brian Vartbedian (@Doctor_V)’s perspective here, and watch a video of Dr. Wendy Sue Swanson (@SeattleMamaDoc)’s thoughts here.

So: on the one hand, physicians are called to engage with patients via social media.  On the other hand, professional organizations continue to urge physicians to exercise caution and care without discussing possible benefits and values of engaging with patients via social media.  So what do we do?

My thoughts: I put very little weight on these guidelines.  The AMA, MMS and BMA guidelines all tend lack specifics, and many of the cautions seem to be self-evident.  Responsible, professional physicians should not disclose patients’ private information while using social media, and responsible, professional physicians should be aware of the limitations of online privacy.  So long as a physician is using their common sense, then these guidelines offer little guidance.

So: I will continue using social media and I will continue encouraging fellow physicians to use social media.  I believe the value outweighs the potential risks, and that reasonable caution provides sufficient protection.  I will continue to look for guidelines that offer guidance an insight in the positive sense (how to get the best results and value from using social media) as opposed to only offering warnings and cautions.  Until those guidelines are released, I will continue to put very little weight on social media guidelines for physicians.

Can Social Media Reduce Medicare Readmissions?

July 10, 2011

Ben Miller (@Miller7) and I were recently invited to give a presentation at the Third National Medicare Readmissions Summit, to discuss whether we thought social media could reduce or prevent unnecessary hospital readmissions.  This is an issue that is becoming increasingly important, as Medicare will soon stop paying hospitals for any readmission within 30 days of hospital discharge.

As I’m short on time (I have been absent from here for a very long time), I am posting our slide set here:

I think the latter part of the presentation (after we highlight some of the social media tools we felt would be most useful) is the most interesting: we tried to come up with ideas and ways to use social media within currently-accepted guidelines/best practices/HIPAA requirements.

I’ll try and give this some additional thought later…I hope the slides suffice for now.

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