You are What You Tweet: Physicians, Professionalism, and Social Media

David A. Marcus, MDEMIMDoc.org - @EMIMDocAttending Physician, Northwell Health Division of Medical EthicsDirector, Professionalism Thread, Hofstra-Northwell SOMDelivered at Lenox Hill Hospital GMEC Retreat - March 31, 2016

GoalsWe will

•Talk about some things you know•Talk about some things that may be new•Explore future directions

Background

Found under creative commons at: https://www.flickr.com/photos/briansolis/2735401175

A Little About the World Wide Web

•Web 1.0 – Static, unidirectional, limited access

•Web 2.0 – Dynamic, interactive, by and for users. Social networks and file sharing sites as a manifestation.

•Web 3.0 – The Semantic Web. AI, Intelligent networks predicting our needs.

You are here!

Sorting It All Out•Social Networks

•Professional/Niche Networks

•Blogging/Microblogging

•Photo/Video Sharing Services

•Social Bookmarking

Doximity

So What? •It’s where our learners are

▫> 95% of medical students are active on SoMe

▫75% of students access their accounts multiple times daily

▫> 90% of residents (IM, Peds) have SoMe accounts, >50% use them more than once daily.

▫30% of Midwestern surgical residents have identifiable Facebook accounts

So What? •It’s where our faculty are

▫25% of Midwestern surgical faculty have identifiable Facebook accounts

▫48% of surgeons use LinkedIN

So What? •It’s where our patients are

▫56% of people online over age 65 use Facebook

▫73% of US adults use SoMe▫Dr. Google and the ePatient movement▫75% of patients do not verify authenticity

of online medical information

It’s also where other educators are

http://www.aliem.com/em-im-residency-on-twitter/

The Case for Participation•Education

•Research/Practice

•Professional Development

•Physician and Trainee Wellness

•The Ethical Imperative

Examples•Students who participated in moderated, blog

based discussions scored higher than non participants.

•Professionalism course with online component associated with preserved empathy in MS3

•EM Lyceum (NYU)•#FOAMed ; #EMconf•SMART-ME (Hopkins) – Twitter based

educational intervention, viewed favorably, quickly adopted.

Challenges to Participation•Patient Privacy/HIPAA Violations

•Violation of the public trust, unclear expectations

•Fear of legal liability

•Technical challenges

•Lack of perceived benefit

Professionalism•A contract between physicians and society

which forms the foundation of patient-physician trust.

•Expectations outlined by various codes of ethics

•Large gray zone

Online Misconduct•Sexual remarks about a patient? •Privacy violations? •Images of doctors with a glass of wine? •Intoxicated docs? •Medical student O.R. photos? •Complaining about a colleague? Consultant?•Physician/student comedy skits?•Using medical equipment in videos? •Doctors at a party?•Political remarks?

Mixed Perceptions•Students are more likely than faculty to

report having posted unprofessional content.

•Students and faculty are much more likely to report having seen unprofessional content than to have posted it themselves.

•26% of surgical residents have unprofessional content on their profiles

Mixed Perceptions•Students are more likely than faculty to

use identity protection strategies.

•Students are more likely than faculty to identify the link between current account content and future implications.

Don’t I Get to Have a Life?

Man Woman by Victor Victori https://en.wikipedia.org/wiki/Victor_Victori#/media/File:Man_Woman_Multiplism_by_Victor_Victori.jpg

Trainees undergoing professional identity formation may not yet appreciate the changing societal expectations and

professional boundaries facing them in the online world.

Where to From Here?

The Educator’s Approach

Maslow’s Hierarchy of NeedsSoMe in Medicine Hierarchy of Needs, from Chretien and Kind, Climbing Social Media in Medicine’s Hierarchy of Needs. Acad Med. 2014;89:1318–1320.

1) Play Safe

•Caveat emptor•Anonymity is dead•Nothing is deleteable, everything is

discoverable•Treat people with respect•Maintain professional standards•Do not violate local policies and laws•You and your digital persona are

inseparable

2) Foster ReflectionCurricula to help trainees:•Reflect as they develop their professional

identity•Define how professional boundaries relate

to online patient interactions•Deal with technical challenges•Critically evaluate educational resources•Understand the importance of personal

branding to their future careers

3) Promote DiscoveryCurricula also to guide: •Networking and generation of new

content•Lifelong learning•Exploration of resources

“Anything that is in the world when you’re born is normal and ordinary and is just a natural part of the way the world works. Anything that’s invented between when you’re fifteen and thirty-five is new and exciting and revolutionary and you can probably get a career in it. Anything invented after you’re thirty-five is against the natural order of things.” - Douglas Adams

THANK YOU.

All images used in this slideset are Creative Commons, except for the “Hierarchy of Needs in Social Media”

Citations and Other Readings – Page 1• Azoury et al. Surgeons and social media: Threat to professionalism or an

essential part of contemporary surgical practice? Bulletin of the American College of Surgeons. Published online: August 1, 2015. Accessed: March 20, 2016. http://bulletin.facs.org/2015/08/surgeons-and-social-media-threat-to-professionalism-or-an-essential-part-of-contemporary-surgical-practice/

• Barlow et al. Unprofessional behaviour on social media by medical students. Med J Aust. 2015 Dec 14;203(11):439.

• Cartledge,et al. The use of social-networking sites in medical education. Med Teach (2013) Oct;35(10):847-57.

• Cheston et al. Social Media Use in Medical Education:A Systematic Review. Acad Med. 2013;88:893–901.

• Chretien and Kind. Climbing Social Media in Medicine’s Hierarchy of Needs. Acad Med. 2014;89:1331–1334.

• Chretien et al. Online posting of unprofessional content by medical students. JAMA. 2009 Sep 23;302(12):1309-15.

• Galiatsatos et al. The use of social media to supplement resident medical education the SMART-ME initiative. Med Educ Online 2016, 21: 29332

• Herron, PD. Opportunities and ethical challenges for the practice of medicine in the digital era. Curr Rev Musculoskelet Med (2015) 8:113–117

• Kesselheim et al. A National Survey of Pediatric Residents’ Professionalism and Social Networking: Implications for Curriculum Development. Academic Pediatrics, 2016;16:110–114

• Kitsis et al. Who's misbehaving? Perceptions of unprofessional social media use by medical students and faculty. BMC Med Educ. 2016 Feb 18;16(1):67. 

• Langenfeld et al. An assessment of unprofessional behavior among surgical residents on Facebook: a warning of the dangers of social media. J Surg Educ. 2014 Nov-Dec;71(6):e28-32.

• Langenfeld et al. The Glass Houses of Attending Surgeons: An Assessment of Unprofessional Behavior on Facebook Among Practicing Surgeons. J Surg Educ. 2015 Nov-Dec;72(6):e280-5

• Lewis, MA and Dicker, AP. Social Media and Oncology: The Past, Present, and Future of Electronic Communication Between Physician and Patient. Semin Oncol. 2015 Oct;42(5):764-71.

• Pereira et al. Thou shalt not tweet unprofessionally: an appreciative inquiry into the professional use of social media. Postgrad Med J 2015;91:561–564.

• Peters et al. A Twitter Education: Why Psychiatrists Should Tweet. Curr Psychiatry Rep (2015) 17: 94

• Weiner, J. A personal reflection on social media in medicine: I stand, no wiser than before. Int Rev Psychiatry (2015) Apr;27(2):155-60.

Citations and Other Readings – Page 1