Social Media and Trauma:Life in the Fast Lane

Vicente H. Gracias MD, FACS, FCCP, FCCMProfessor and Chief

Division of Acute Care Surgery(Trauma, Emergency Surgery, Surgical Critical Care)

Department of SurgeryUMDNJ-RWJ

Objectives

• Discuss the Value of Social Media in Healthcare

• Risk Assessment– To block or not to block?– Monitoring usage in staff, trainees, faculty

• Institutional Policies for Social Networking and Medical Photography

• The Future of Social Media in Patient Care – How to Use it Safely

Making Social Media work for surgeons and patients; ACS Bulletin Volume 96, Number 7- July 2011

The Big Four

• 600 million active members – Carlson, MSNBC 2011

• Real-time microblogging 140 characters at a time

• Business-oriented network, on-line resumes

• Video is king, 2nd largest search site

Social Media Uses in Healthcare

• Facebook– Profile physicians– Hospital and community outreach programs– Marketing

• Twitter– Daily wellness tips– Seminars and discoveries

• LinkedIn– Recruitment– Professional community

• YouTube– Diseases and conditions– Patient stories– Surgical procedures

RWJUH Facebook Pagewww.facebook.com/RWJUH

RWJUH Facebook Pagewww.facebook.com/RWJUH

RWJ Traumahttp://www.facebook.com/rwjtrauma

RWJ Traumahttp://www.facebook.com/rwjtrauma

Social Media Uses in Healthcare

• Facebook– Profile physicians– Hospital and community outreach programs– Marketing

• Twitter– Daily wellness tips– Seminars and discoveries

• LinkedIn– Recruitment– Professional community

• YouTube– Diseases and conditions– Patient stories– Surgical procedures

Patient Communitieshttp://www.patientslikeme.com/

Patient Communitieshttp://www.caringbridge.org/

Digital Photography Uses in Healthcare

• Documentation of disease and clinical progress

• Physician-to-physician consultation/communication (even remotely)

• Medico-legal documentation (assault, domestic violence)

• Used for medical education and research

What are the Risks?

Risks of Digital Photography in Healthcare

• Use of personal digital photography is on the rise – Taylor, J Plast Recon Aesth Surg 2008

• Potential consequences:– Consent

• Of 30 UK plastic surgeons, only 14 always gained consent• 9 surgeons usually obtained verbal, but not written, consent

– Patient Confidentiality• Only half took measures to ensure patient anonymity

(blanking or blurring eyes and face)– Authenticity

• Patient label, signature of photographer– Image Quality

Risks of Digital Photography in Healthcare

• 117 UK Emergency Departments surveyed – Bhangoo, Emerg Med J, 2005– 41 (36%) had formal policy for medico-legal

photos• 21 (17%) permitted photography

– 74 (63%) had no policy for medico-legal photos• 53 (45%) took clinical photos without

formal policy• 32 of these include photos in the

medical record

Risks of Social Networking in Healthcare

• May threaten professionalism– Distribution of personal identifiers

• Study of 813 UF medical students and residents with Facebook accounts -- Thompson, J Gen Intern Med 2008• 80% listed field of study• 78% showed personal photo• Only 37% of accounts made private

– Posting unprofessional content• 78 US medical schools surveyed -- Chretien, JAMA 2009

• 60% reported unprofessional postings • 52% use of profanity• 48% discriminatory language• 39% depicting intoxication• 38% sexually suggestive material

Moubarak G, Journal of Medical Ethics, 2011

Survey of Facebook Activity

• Survey completed by 202/405 (50%) residents and fellows

• 73% had Facebook accounts– 99% provided real name– 97% provided birthday– 59% listed current college/university– 91% provided personal photo

• Only 61% had modified at least one confidentiality parameter

• 6% received a friend request from a patient and half accepted it

Moubarak, J Med Ethics, 2011

Survey of Facebook Activity – Recommendations

“…encourage doctors to read Facebook’s privacy settings and understand how the settings may be customized, and to monitor the regular updates of Facebook’s privacy policy to adjust their data protection accordingly.”

RWJUH Procedure for Obtaining Medical Photographs

Consent for Photography

RWJUH Policy for Social Networking Website Use

1.      Employees are prohibited from using any and all hospital computers to participate in or view social networking sites.

2.      During the employee’s own time off premises, when accessing such sites, employees are advised to refrain from identifying themselves as a RWJUH employee, the employee must adhere to the following guidelines:

a)      The employee must make it clear that the views they express are those of the employee and that they do not necessarily represent those of the organization.

b)      The employee is expected to adhere to all policies and procedures that apply to the work place setting. In addition, the employee is expected to uphold the hospital’s values of CULTURE and avoid making defamatory statements about the Hospital, any of its affiliates, employees, members of the Medical Staff, volunteers, auxilians, patients, visitors vendors.

c)      The employee cannot disclose any information that is confidential or proprietary to the Hospital or which they know to be confidential to a third party that has disclosed such information to the Hospital.

d)      The employee may not disclose a patient’s Protected Health Information or any other patient identifiable information.

e)      The employee may not post photographs of patients, hospital property or hospital employees, members of the Medical Staff, volunteers, auxilians, patients, visitors or vendors.

If the employee’s activities compromise RWJUH’s policies and procedures in any way, the hospital will request

that the employee cease such activity. Any violations of this policy, depending on the circumstances, may result in corrective action, up to and including termination.

Why Does This Matter to Me?

Professionalism

“Competency in professionalism will be assessed by direct observation of the resident's responsibility in carrying out their professional duties - including continuity of care, responsiveness to changes in clinical situations, overall responsiveness and availability, and self-sacrifice, and their following of ethical principles in their dealings with patients, their families, and other physicians and health care workers. The resident's sensitivity to different patient populations will be evaluated by direct observation and comparison of the professionalism and responsibility demonstrated when caring for patients of different ethnic and economic backgrounds that are treated in the different hospitals within the Baylor-affiliated system. “

http://www.acgme.org/acWebsite/RRC_280/280_coreComp.asp

What is “Unprofessional”

• Medical students making negative comments about their institution or profession on a Facebook posting?

• Using profanity in a video of a medical student satire performed at the school and distributed on YouTube?

“The line separating protected First Amendment rights and inappropriate postings maybe unclear.” – Chretien, JAMA 2009

THE FUTURE…

Education

• Formal professionalism curriculum should include a digital media component– Privacy settings– Periodic Web searches of oneself– Instruction on HIPAA law– Assessment of “digital footprint” as part of

assessment of professional competence

Chretien, JAMA 2009

Education

Teaching students how to choose privacy settings on Facebook led to an 80% decrease in public accounts

Coutts, paper presented 2007

Social Media Bandwagon

• Does social media play an important role in healthcare? YES.

• Does the use of social media risk patient confidentiality and physician professionalism? YES.

• Can we learn to safely use digital photography and social networking websites to improve patient care and medical education? YES.

JUMP ON THE BANDWAGON!

References• “Social media in healthcare” (video clip). Q1 Productions, released April 17, 2009 at

http://www.youtube.com/watch?v=qLeNGykRAvU• Carlson, N. (2011). “Goldman to clients: Facebook has 600 million users.” Retrieved January 3,

2012 from http://www.msnbc.msn.com/id/40929239/ns/technology_and_science-tech_and_gadgets/.

• RWJUH Facebook page. Retrieved January 23, 2012 from www.facebook.com/RWJUH.• RWJ Trauma Facebook page. Retrieved January January 30, 2012 from

www.facebook.com/rwjtrauma.• Patients Like Me homepage. Retrieved January 15, 2012 from http://www.patientslikeme.com/.• Caring Bridge homepage. Retrieved January 15, 2012 from http://www.caringbridge.org.• Taylor DM, Foster E, Dundin CSJ, et al. A study of the personal use of digital photography within

plastic surgery. J Plast Recon Aesth Surg 2008;61:37-40.• Bhangoo P, Maconochie IK, Batrick N, et al. Clinicians taking pictures – a survey of current practice

in emergency departments and proposed recommendations. Emerg Med J 2005:22:761-765.• Thompson LA, Dawson K, Ferdig R, et al.The intersection of online social networking with medical

professionalism. J Gen Intern Med 2008:23(7):954-7.• Chretien KC, Greysen SR, Chretien JP, et al. Online posting of unprofessional content by medical

students. JAMA 2009;302(12):1309-1315.

• “Social media in healthcare” (video clip). Q1 Productions, released April 17, 2009 at http://www.youtube.com/watch?v=qLeNGykRAvU

• Carlson, N. (2011). “Goldman to clients: Facebook has 600 million users.” Retrieved January 3, 2012 from http://www.msnbc.msn.com/id/40929239/ns/technology_and_science-tech_and_gadgets/.

• RWJUH Facebook page. Retrieved January 23, 2012 from www.facebook.com/RWJUH.• RWJ Trauma Facebook page. Retrieved January January 30, 2012 from

www.facebook.com/rwjtrauma.• Patients Like Me homepage. Retrieved January 15, 2012 from http://www.patientslikeme.com/.• Caring Bridge homepage. Retrieved January 15, 2012 from http://www.caringbridge.org.• Taylor DM, Foster E, Dundin CSJ, et al. A study of the personal use of digital photography within

plastic surgery. J Plast Recon Aesth Surg 2008;61:37-40.• Bhangoo P, Maconochie IK, Batrick N, et al. Clinicians taking pictures – a survey of current practice

in emergency departments and proposed recommendations. Emerg Med J 2005:22:761-765.• Thompson LA, Dawson K, Ferdig R, et al.The intersection of online social networking with medical

professionalism. J Gen Intern Med 2008:23(7):954-7.• Chretien KC, Greysen SR, Chretien JP, et al. Online posting of unprofessional content by medical

students. JAMA 2009;302(12):1309-1315.

References

• Moubarak G, Guiot A, Benhamou Y, et al. Facebook activity of residents and fellows and its impact on the doctor-patient relationship. J Med Ethics 2011;37:101-1-4.

• Pichardo EM, Chen L, Rhodes SC, et al. 21st Century trauma care and the social media revolution. Presented in poster format at EAST Annual Meeting, January 2012; Lake Buena Vista, FL.

• ACGME.org (2001). “Core Competencies.” Retrieved January 26, 2011 from http://www.acgme.org/acWebsite/RRC_280/280_coreComp.asp.

• Coutts J, Dawson K, Boyer J, et al. Will you be my friend? Prospective teachers’ use of Facebook and implications for teacher education. Paper presented at: Proceedings of Society for Information Technology and Teacher Education International Conference, 2007; Chesapeake, VA.

• Moubarak G, Guiot A, Benhamou Y, et al. Facebook activity of residents and fellows and its impact on the doctor-patient relationship. J Med Ethics 2011;37:101-1-4.

• Pichardo EM, Chen L, Rhodes SC, et al. 21st Century trauma care and the social media revolution. Presented in poster format at EAST Annual Meeting, January 2012; Lake Buena Vista, FL.

• ACGME.org (2001). “Core Competencies.” Retrieved January 26, 2011 from http://www.acgme.org/acWebsite/RRC_280/280_coreComp.asp.

• Coutts J, Dawson K, Boyer J, et al. Will you be my friend? Prospective teachers’ use of Facebook and implications for teacher education. Paper presented at: Proceedings of Society for Information Technology and Teacher Education International Conference, 2007; Chesapeake, VA.