1

The age of the tweetiatricianCommunicating with patients in the digital worldNov 28, 2013

Regina

Pat Rich – Managing Editor, CMA Communications

(@cmaer)

2

My life on Twitter

• Social media staff resource at CMA

• Monitors and writes on health IT development

• Monitors Twitter on a continuous basis

• 3100+ followers and follows 2000

• Interacts with MD peer leaders in social media on daily basis

3

Social media is BAD

In a newly revised policy statement released today, the American Academy of Pediatrics recommends that parents make a media plan for their families that takes into account not only the quantity, but the quality and location of media used, and includes mealtime and bedtime curfews for media devices. It also encourages keeping all screen media (TVs, computers, tablets, etc.) out of kids' bedrooms.

USA Today, Oct. 28

“Social media is dangerous for kids, so we can’t model it.”

Conversation with CHEO Communications Director Ann Fuller about attitudes of some senior staff at her hospital

4

Not so fast

“Docs need to be role models for their patients/parents. There is definitely conflict. It’s like pediatricians having TVs in their waiting rooms when they should be recommending no TV for children <2 YO. I’d say the conflict is best managed by sticking to themes like balance, moderation, etc.”

Personal Twitter exchange with Dr. Daniel Flanders, Nov. 25

Clinical research published by American Academy of Pediatrics showing social media can have beneficial impact on children and adolescents

Prologue

I think there are too many people on the Web offering advice to you on how to use social media. Most of this advice is just regurgitated advice from people you may never have heard of before, …

You really don’t need “How To” tips on blogging or Twitter. Oh, I’m confident that you’ll be told otherwise – but those folks, well-intentioned as they may be, don’t understand that you’re smarter than that.

You’re bright – you got through organic chemistry and medical school and years of residency.

Rather than learn bad habits from the get-go, take advantage of your lack of experience. It’s okay to make mistakes that don’t cause harm and violate the privacy and dignity of others.

From: Physician Social Media: Has Advice About It Become a Crock? Yes @philbaumann, Jan. 1, 2013

6

▸ The digitally connected pediatric clinic of tomorrow …. today

▸ Belleville, ON

▸ Pop: 50,000

7

▸ “Back in 2009 our patients were young, early adopters of social media so we wanted to be where they were.”

▸ “One of the jobs of a physician is communication. I know patients are going to Dr. Google. It drives me nuts. I want them to have credible sources online so that even if they never come through my doors, they’ve got an incredible source of information that will answer their questions.”

▸ Dr. Paul Demsey

8

Digital/social media tools used at Quinte Pediatrics

Secure email/patient portal Website Facebook Twitter Blog YouTube Secure email/patient portal Instagram Foursquare Vine (in development)

9

It’s a digital world out there

Telemedicine/telehealth well established on a clinic to clinic basis for remote delivery of health care

Use of mobile devices in health care ubiquitious Patients requesting/demanding ability to interact more

immediately with health care providers using new technologies

Millions of people in US and other countres using email for communications with physicians

10

“In the largest reform of family doctor services in a decade, GP surgeries will be given extra resources to open from 8am to 8pm, and patients will be offered the chance of consultations through a Skype service.”

UK announcement – Oct. 2013

Oklahoma Physician Disciplined For Using Skype

A doctor living in eastern Oklahoma was disciplined for prescribing violations and using Skype to treat patients under his care, the NewsOK.com web site reports.

12

E-mailing between doctors and patients

“The use of e-mail between physicians is becoming more common and a number of patients are expressing a strong interest in being able to communicate with their physicians in this way. Both physicians and patients should be aware of the legal risks of such a method of communication and agree to assume those risks.”

Source: College of Physicians and Surgeons of Saskatchewan, June 2012

E-mail communications with patients

The Canadian Reality

11% of Canadian family physicians report patients can email their practice with questions or concerns

10% of Canadian patients report they can email their regular practice with clinical reasons

BUT….

Only 2% of patients report emailing their regular practice with a medical concern in the last 2 years

Source: Commonwealth Fund Survey, 2013

College of Physicians and Surgeons of Saskatchewan – June 2012

Physicians must make every effort to ensure that information is sent to a confidential e-mail address specific to the patient (e.g. not a corporate address accessed by others in the patient’s workplace).

Physicians must comply with the privacy requirement in Saskatchewan (see Office of the Information and Privacy Commissioner

Physicians should consider getting a written form for patient consent to the use of e-mail communications. (Sample form is included on the CMA website at http://www.cma.ca/index.php?ci_id=89745&la_id=1)

15

Other guidance

CMPA

Using email communication with your patients: legal risks (June 2013)

CMA

Online communications with patients (2005)

The pediatric hospital experience

“We get letters from parents about how great the care was or how crappy the care was and often the letters that say how great the care was do make reference to the fact their doctor was available via email. You’re seeing that it changes the perception of the engagement level.”

Ann Fuller, Communications Officer, CHEO

17

“In short, using email with patients can be really helpful and personally rewarding if they are motivated and if I set up some clear boundaries at the outset

Dr. Jessica Otte

18

Why consider using social media

To stay informed As a learning tool in medical education Communicate (engage) with peers and patients Disseminate information Advocate for/against something Because if you decide not to use social media, your decision should be

based on sound knowledge about what you are choosing not to use

“My hairdresser can text me, my car can send an email to my mechanic, and the only way I can deliver my message is through a telephone?” Dr. Nancy Burgert says. Something had to change. Digital media turned out to be the fastest, cheapest way for her to do her job more effectively …As with most physicians, she was worried about five major factors: liability, privacy, compensation, time, and technology. She learned to get over her fears. Once she started writing her blog, she found that she saved time talking to patients because they would read her posts before coming to an appointment. “What I do online positively impacts the health care of children,” Burgert says. “In order to reach that potential, your information has to be of value to your organization.”

Courtesy Jessico Levsco, Jan. 2012

20

Social media and pediatrics

Facebook (for your friends and family) YouTube (for your educational campaigns and

advocacy) Twitter

To stay informed To engage in discussions with peers and patients To follow conventions and meetings from afar To recruit patients for clinical trials

21

Case study: The Screaming Baby on Facebook

A pediatric gastroenterologist receives a Facebook friend request from a woman in his community. Unfamiliar with the woman, the pediatrician messages back by asking where they may have met or how they might know one another. The woman replies, “You don’t know me, but I have an 8-week-old baby who won’t stop crying and will only take 12 ounces of formula per day.”

From American Association of Medical Colleges: Digital Literacy Toolkit

As a physician with an online presence, how should this type of request be handled?

A. Don’t respond to request. B. Reply to the request with the suggestion that the

mother address the issue with her own pediatrician. C. Reply with specific steps for addressing the

issue. D. Reply with the intent of getting the child seen as

soon as possible.

23

Guidance

College of Physicians and Surgeons of Saskatchewan Guidelines Canadian Medical Association – Issues and Rules of Engagement Canadian Paediatric Society “Paediatricians, social media and blogs:

Ethical considerations” May 2012 Canadian Medical Protective Association

24

CMA guidance

Rules of Engagement Understand technology and audience Be transparent Respect others Focus on areas of expertise

25

American Academy of Pediatrics – 2013 meeting (#AAP13)

1,151 Tweets

361 Participants

8th most active tweeter - Dr. Dan Flanders, Toronto pediatrician,

Dr. Wendy Sue Swanson – Elevator rules

Never discuss patient-specific issues’ Never by anonymous Remember everyone’s watching Be nice

From presentation to AAP, Oct. 2013

27

Another one to follow

Dr. Bryan Vartabedian (@Doctor_V)

* Pediatric gastroenterologist, Texas Children’s Hospital, Baylor College of Medicine

* Leading US commentator and thinker on issues relating to physician use of social media

* 33charts.com – regular blog on these issues

* Contributor to Wing of Zog – blog on med ed and social media

28

-“For those of us who have the philosophy that we want to graduate docs who are better than we are, Twitter is a great thing.”

Dr. Chris Simpson, cardiologist and CMA President-Elect

29

Using YouTube

CHEO: Baby vaccination; the secret to a calm and peaceful immunization – 10,000 plus views

Courtesy Dr. Mistry, SickKids

It’s not rocket science … or even pediatric oncology

32

Thank you …..

Questions?

With thanks to Ann Fuller for use of some materials + input