“The history of human opinion is scarcely anything more than the history of human errors,” Voltaire said a long time ago.
Health professionals are trained to give opinions. It’s what we do every day in caring for our patients and leading our teams. Sometimes, however, it’s better not to give an opinion – or at least sit on it for a while.
Admittedly this is not always easy to combine with busy clinics, fast-paced lifestyles, opinion-based social media and rapid news cycles.
Nobel Prize winner Daniel Kahneman described two ways of thinking in his well-known book ‘Thinking, Fast and Slow’.
The first method, which he called system one, is fast, intuitive, runs automatically and cannot be switched off. It generates first impressions and intuitions based on experience. It is however subject to errors and biases and is poor at performing statistical estimates.
The second way of thinking, referred to as system two, takes more conscious effort and time. It is normally in low-effort mode but when system one runs into difficulty, system two will be engaged.
The two systems can work effectively together, as long as we are aware that our first guess, based on system one thinking, may not always be right and that we need to verify it by applying more analytical system two thinking.
The challenge, as I see it is, to have an opinion and an open mind at the same time.
This is an edited version of an article originally published onNewsGP.
I always enjoy a good podcast. There is something appealing about listening to people’s stories via the cloud – and at a convenient time and place. I usually listen in the car on the way to work.
In 2014 I posted 6 great podcasts for primary care, one of the most visited articles on this blog. As podcasting seems to be more popular then ever and new podcasts for family doctors have been launched since my last post, it is time for an update (October 2018).
So here is my top 10. Since I’ve been involved with the BridgeBuilders podcast (shamelessly placed @ no.4) my respect for podcasters has grown even more; it takes many hours to edit one episode.
Click on the iTunes or SoundCloud logo to listen, and feel free to share your favourites in the comments section. Big thanks to all podcasters – keep going!
#1: The Good GP
The Good GP has been around since September 2016 and has grown into one of the most popular education podcast ‘for busy GPs’, hosted by Western Australian GPs Dr Tim Koh and Dr Sean Stevens, in collaboration with RACGP WA.
Guests are GPs or other specialists and a range of mainly medical topics is covered, for example: acute pain, allergies, immunisations, the future of general practice, euthanasia and the registrar -supervisor relationship.
This is another popular medical education podcast – hosted by Queensland GP and medical educator Dr Sam Manger.
Sam interviews guests covering a wide variety of topics including case studies and guideline reviews. The podcast is aimed general practitioners, family physicians, other specialists, allied health, nurses, registrars/residents, medical students and anybody interested in health, science and medicine.
Just a GP is a popular newcomer in 2018, run in collaboration with RACGP New South Wales. Hosts Dr Ashlea Broomfield, Dr Charlotte Hespe and Dr Rebekah Hoffman discuss leadership, quality in clinical practice, self care and wellbeing, difficult consultations, starting or running a private practice and GP research.
They explore the layered complexities with each other and other GPs with expertise in these areas. In each episode they share a favourite resource or clinical pearl.
Hosted by Dr Edwin Kruys, Dr Ashlea Broomfield and Dr Jaspreet Saini, the themes of the BridgeBuilders podcast are collaboration in healthcare, fragmentation, team care and working together to the benefit of our patients.
A wide variety of guests, including some of our healthcare and thought leaders from e.g. the RACGP, ACRRM, Consumers Health Forum (CHF) and the Pharmaceutical Society of Australia (PSA), give their view on trust, integrated care, quality care, leadership and what needs to happen to make Australian healthcare an even better connected place.
Broome GP & emergency doctor Casey Parker has been podcasting since 2012. He discusses topics related to emergency medicine and (procedural) general practice . In the Broomedocs journal club relevant research studies are critically appraised, often with guests.
The Health Report by Norman Swan and other ABC reporters features health topics such as ‘fishy fish oil’, insomnia, asthma, chiropractic controversies, the cranberry myth and lyme disease. Often several national and international guest discuss various topics in one episode.
The Best Science (BS) medicine podcast is a Canadian show which critically examines the evidence behind commons drug therapies. GP and associate professor Michael Allan and professor James McCormack present many myth busters and topics relevant to general practice, such as the treatment of back pain, osteoporosis and common cold.
I joined Twitter back in 2011. In those days, the social media platform felt like taking a leisurely stroll around the old village, stopping along the way to have a friendly chat with locals.
We had Sunday night Twitter chats, discussing anything to do with social media and healthcare in Australia and New Zealand. There were patients, doctors, nurses, midwives, pharmacists and others happily chatting with each other, sharing information and offering support, following professional codes of conduct and rules of courtesy.
It was an inspiring place, there at the Twitter village square.
In recent years, however, social media has become a ubiquitous part of the mainstream. As a result of the rapid growth of various platforms and the number of users and networks, it now feels like driving at high speed on a five-lane freeway.
I still occasionally see the locals from the village in their fast cars, but there’s no time to chat. I usually get distracted by the billboards or the other drivers, overtaking, blowing the horn and, not seldom, making angry gestures.
Interestingly, we all seem to be copying each other’s behaviors on the social media highways. And, somehow, I often end up in the lane for doctors. There is also a lane for patients, pharmacists, midwives and so on.
Although the doctors in my lane don’t always see eye to eye, we often agree on things like the abominable road conditions or the dangers of a fast-approaching storm. And, not infrequently, we get frustrated about the drivers in the other lanes, especially when they cross the double white unbroken dividing line or, heaven forbid, end up in our lane.
On the other hand, social media still has a lot to offer. There are many amazing, inspiring and funny people out there.
I was asked to write about the do’s and don’ts of social media, but I’m not the highway patrol. I have instead listed six simple things to remind myself of what I should already know when I’m participating in the traffic on Twitter, Facebook, LinkedIn or any other social media network.
Giving feedback is of course best done in person. However, in the digital era this may not always be practical or possible and a lot of feedback already occurs via email, text messages or social media.
There are many ways to give feedback, some more effective than others. I have probably made every mistake possible. I’ve also seen really good and some not so good examples, including on this blog.
Giving effective feedback requires more than stating errors or shortcomings. Problem identification, clarification and advice or suggestions for improvement are useful parts of the feedback process.
To make feedback acceptable and useful for the recipient, it is best delivered in a supportive way, including both positive and negative observations. We all know this is not always happening on social media, comments sections and blogs. Sometimes basic elements of respect and dignity are forgotten, which may undo the positive effects of feedback.
Most doctors and other health professionals are passionate about what they do, but we also experience excessive occupational demands and sometimes lack of personal support. Electronic means of communication can play an important support role, but can also be a source of stress.
Some research suggests that doctors have high expectations of self, are achievement-oriented and have a tendency to self-blame. Together with the often non-disclosure of personal distress, this makes the profession vulnerable for burnout. Let’s be kind to ourselves and our peers.
Consequences & effect
We all appreciate helpful and constructive feedback, so it is good to think about the way we give feedback to others and the consequences our comments may have in the digital space.
The Medical Board’s Code of Conduct mentions ‘communicating respectfully’ and ‘behaving professionally and courteously to colleagues and other practitioners, including when using social media’.
An honest, well-formulated feedback message can be powerful and may have a positive impact. To achieve this I recommend the following 10 do’s and don’ts:
Be kind & respectful
Help create positive, safe environments at work and in the digital space
Base comments on direct observations and facts, not rumours or hear-say
Be specific and to-the-point (and try to separate multiple issues)
Apply the feedback rules of constructive criticism (e.g. include positives and negatives)
Try to use positive words such as appreciate, suggest, improve, assist, solution, like, right, thanks
Before posting on public forums try to give direct feedback first
Only say things on social media you would be prepared to repeat face-to-face
Be prepared to listen and examine your own actions and behaviour
Always keep the social media policies and code of conduct of your organisation or profession in mind.
Don’t just list problems, propose solutions too
Don’t psychoanalyse or judge people, instead focus on actions & effect
Don’t give feedback before fully understanding the issues (there are always two sides to every story)
Try to avoid using words such as should, never, always, why, you(r), but – and especially the stronger ones like dumb, fail, ludicrous, crazy, farce, ridiculous, shambles
Don’t press the send/post button when you are upset, angry or tired
Avoid using exclamation marks and capital letters midsentence (comes across as shouting)
Avoid giving the same feedback multiple times
Avoid irony and humour as it may be misinterpreted
Don’t phrase feedback as a question
Don’t speak for others unless you are a representative.
What is your preferred method of giving effective feedback?
Video: 10 Common mistakes in giving feedback (Source: Center for Creative Leadership):
A while back I came across a new tool for those who, like me, use Dr Google but are concerned about the quality of some of the available online health information.
The tool contains two checklists and has been designed for medical education resource producers, editors, end-users, and researchers. I’ll let the authors explain:
“Through a rigorous research process, a list of 151 quality indicators for blogs and podcasts was formed and subsequently refined to elicit the most important quality indicators. These indicators are presented as Quality Checklists to assist with quality appraisal of medical blogs and podcasts.”
The checklists have three domains: credibility, content and design, and cover topics such as avoiding bias and conflict of interest, providing clear information about the identity and qualifications of the author, and referring to sources. The checklists also focus on design and didactic value.
I believe they can be useful for patients to assess the quality of online health resources. For more information read about the 6 warning signs that will help you stay clear from quackery sites.
This tool has the potential to take many health blogs and podcasts to the next level. It is available at no cost and can be found here.
“It’s like being delivered a newspaper whose headlines you’ll always find interesting.” ~ Twitter
Yesterday I was at a conference in Brisbane, organised by the Australasian Medical Writers Association. I met some interesting people and learned a lot about writing from speakers like Dr Justin Coleman and Ben Harris-Roxas.
Interestingly, many speakers mentioned Twitter. Social media are essential if you want to bring a health message across. Twitter is also a great tool to connect and collaborate with others and learn new things. It’s my favourite social media platform.
Twitter seems a bit daunting in the beginning, but it’s really easy to use. After reading this post, which should take you no more than five minutes, you will be ready to take the plunge.
Because of the limited character count of 140, Twitter is called a microblogging platform. The social media giant describes itself as an information network made up of 140-character messages called tweets. A tweet is the expression of a thought or idea. It can contain text, links, photos and videos. Millions of tweets are shared in real-time, every day, all over the world.
You can read the tweets of people or organisations you follow in your timeline, and your followers can read your tweets, click on any links or hashtags you have included in your messages, or they can retweet your tweets, which means that they share your messages with their followers. I’ll explain it in more detail below.
You can use twitter from your phone, computer or tablet.
To get started, first sign up at twitter.com or directly from the app on your phone or tablet, and choose a public Twitter username (also called a Twitter ‘handle’). The user name is always preceded by the @ symbol. I recommend to use your own name or business/practice name, but any available name is fine.
I picked @EdwinKruys, and Twitter has assigned this Twitter URL (or web address) to me: https://twitter.com/EdwinKruys. Twitter users will see your preferred name next to your Twitter username. This is how my names appear: ‘Dr Edwin Kruys (@EdwinKruys)’. It doesn’t matter if you use capitals or not.
You may want to register a few variants of your name or business name. I have also registered @DrKruys and @DrEdwinKruys.
Australian College of Rural and Remote Medicine: @ACRRM
Next, you will have to set up your profile. Make sure you add a profile photo or Twitter will give you an egg-head. For professional accounts I recommend a 400×400 pixels close-up photo of your face – not the dog, cat, flowers or a stethoscope. Fill out a short description of yourself and a link to your website or blog.
If you like you can add a background header photo (recommended dimensions are 1500×500 pixels). Once you’ve done all this, start following people. See who others follow and follow the interesting people, organisations and businesses.
Click here for my list of Australian GPs on Twitter.
There is a bit of Twitter lingo you need to learn, but it’s easy. Let’s start with hashtags. A hashtag is any word or phrase preceded by the # symbol. Conferences and television shows often use a hashtag, e.g. #GP15Melb. Hashtags are also used for advocacy campaigns, like #AHPRAaction, #ScrapTheCap and #CopayNoWay.
A hashtag is like a label added to your tweets to better file and retrieve messages with a certain topic or theme. It doesn’t matter where you place it. And you can add a few hashtags if you like, although two is probably ideal. When you click on a hashtag in someone’s tweet, you will see all other tweets containing the same word or topic.
Here are some other Twitter buzzwords:
Tweet: A Twitter message
Tweeting: the act of sending tweets
Tweeps: Twitter users
Favouriting a tweet: this indicates that you liked a specific tweet
A follow: someone following your Twitter account. You can see how many follows (or followers) you have from your Twitter profile
Home: your real-time stream of tweets from those you follow, also called a timeline.
Your first tweet
When you compose your first tweet, you could write something like:
“Hi there, I’m new on Twitter. Still figuring out how this works.”
But if you haven’t got many followers, few people will read it. So you could tell someone that you have joined Twitter by adding their username to your tweet. I’ll use my username as an example, but of course anyone’s username can be inserted instead:
“Hi there, I’m new on Twitter. Still figuring out how this works. @edwinkruys”
Now I will receive a notification that you have mentioned me, and I may respond, retweet your message or suggest a few people to follow.
If you would put my username at the beginning of your tweet, your message is still public but only those who follow you and me will see the message:
“@edwinkruys. Hi there, I’m new on Twitter. Still figuring out how this works.”
If you put something in front of my name, all your followers will see your message (instead of only those who follow you and me):
“Hi @edwinkruys, I’m new on Twitter. Still figuring out how this works.”
You can link to websites, pdf-files, videos etc. The hashtag increases the chance that others with similar interests will read your tweet.
Retweets and replies
A great way to get started is to retweet someone’s message. Ask questions or make some friendly comments to get a conversation going.
A tweet from someone else, forwarded by you to your followers, is known as a retweet or RT. Often used to pass along interesting messages on Twitter, retweets always retain original attribution. Respect the original message and make sure you don’t change the original tweet when you retweet. If you do change it, for example when you delete a few words to save characters, it will become a modified tweet or MT instead of a retweet.
Here is one example of a retweet. Imagine I have just tweeted this message:
There are other ways to retweet, for example by retweeting the complete original message without adding your own text, or by retweeting the original message in a box and adding your own 140 character message. Press the retweet button under a message (the two arrows going up and down) to discover the various options.
You can send the same message by replying. Note that, by putting my username at the beginning of your tweet, your message is still public but only those who follow you and me will see the message:
Use Twitter direct messages to start a private or group conversation with your followers. It is possible to enable a setting to receive direct messages from anyone, not just followers, which may be useful for businesses. Direct messages have no character-limit so you can type as much as you want.
You can add images to your Tweets and even a link plus an image. Although you’re limited to 140 characters, it is easy to get around this by taking a screenshot from a large amount of text and attaching it as an image to your tweet.
Twitter lists are often used to create a group of other Twitter users by topic or interest. Lists contain a timeline of tweets from the users that were added, offering a way to follow individual accounts as a group on Twitter.
There are many third-party apps available to manage your Twitter account(s). I often use buffer to schedule tweets. To avoid getting hacked I recommend using two-step login verification. Have fun!
On his blog Dr Yong shares ideas about healthy living: “It’s about getting back to basics and building a strong foundation of health. It’s about turning your good intentions into lasting change. It’s about you taking control and living a better life.” Very inspiring.
‘The healthy GP – Live intentionally, love relentlessly and enjoy your health.’ By Dr Jonathan Ramachenderan
Dr Ramachenderan and his family live in the country in Western Australia where he practices as a General Practitioner and anaesthetist. He has some excellent advice for men and dads.
“We are in the busy, child rearing season of life coupled with the beginning of my career and hence achieving a balance is important. I am passionate about men’s health, helping and communicating with other dads, building stronger relationships with our wives and becoming wiser, stronger and more insightful men.”
‘Armchair rants from Dr Deloony, musings on Medicine and Life.’ By Dr Claire Noonan
Dr Noonan is a country GP and freelance writer. “My interests, medical and otherwise include but are not limited to: humans, science, general practice, bariatric medicine and surgery, fiction, music, travel, food/nutrition, mental health, philosophy and kittens. I am VERY interested in kittens.” Personal and well-written posts.
‘DrJustinColeman – Medical writer, editor, blogger.’ By Dr Justin Coleman
Dr Justin Coleman is a well-known GP-writer who looks sceptically at health interventions where the evidence suggests they might not actually be worthwhile. This is part of his broader interest in the public health concept of equity – fair access to primary health care for everyone.
As he writes on his blog: Despite earnest intentions, he frequently breaks out into lighter reflections on GP practice, with its quirks and oddities – often discovering the oddest person in the room is him!
‘Genevieve’s anthology – Writings to amuse, teach, inspire and entertain.’ By Dr Genevieve Yates
The multi-talented Dr Yates is not only a freelance columnist and novel/play writer, but she also finds the time to play and teach violin and piano, sing, and play in two orchestras.
“This website features a collection of my writings. Here you will find links to and samples of my newspaper columns, novel, short stories, plays and creative medical educational material, plus the odd blog or two.”
‘Dr Charles – The blog musings of Dr Charles Alpren.’ By Dr Charles Alpren
Dr Alpren worked at (and blogged about!) the Ebola Treatment Centre in Sierra Leone. He is currently a locum GP who works all over Australia. He has an interest in children’s health, vaccinations and infectious disease, and is also interested in teaching and Public Health.
‘KarenPriceBlog – Hippocrates meets Xanthippe.’ By Dr Karen Price
Miscellaneous topics and reblogged posts – often with thought-provoking commentary by Dr Price. Dr Price is Chair of the Women In General Practice Committee of the Victorian RACGP.
“I am active on Twitter and interested in technology as it relates to health. I am prone to an occasional rant so the picture of me with a thistle is probably appropriate. I welcome respectful debate as it contributes to the Science and Art of Medicine.”
‘FOAM4GP – Free Open Access Meducation 4 General Practice.’ Various authors
Excellent and comprehensive collection of blog posts and podcasts by various rural and city GPs.
“This blog and podcast is for Australian General practitioners, training to be one or already working as one. We cover the whole range of our medical specialty and give you what you need to pass your exams and keep learning in your clinical practice.”
The blog was founded by Dr Rob Park, Dr Minh Le Cong, Dr Casey Parker, Dr Tim Leeuwenburg, Dr Jonathan Ramachenderan, Dr Melanie Considine and Dr Gerry Considine.
‘Michael Tam – Publications archive.’ By Dr Micheal Tam
Michael Tam is a Staff Specialist in General Practice at the Academic General Practice Unit in Fairfield Hospital, in Sydney. His blog is a collection of interesting research articles and interviews.
Dr Tam’s clinical interest is in comorbid substance use disorder and mental health disorders. His research interests are in the detection of at-risk drinking in the primary care setting, and in e-learning in medical education.
‘GreenGP – Reflections of a Rural GP.’ By Dr Melanie Considine
An interesting blog with lots of medical conference reports, tips for students and GP registrars – including how to use social media. Dr Considine is a board member of the SA/NT RACGP Faculty and the RACGP National Rural Faculty.
‘Broome Docs – Medical education blog for rural GPs.’ By Dr Casey Parker
Top blog intended to provide a single source of up-to-date educational material for country doctors.
“I hope this site can expand this brain pool of rural doctors – please feel free to leave comments on the cases and posts presented – we can all learn from one another – no matter how far we are from the really smart guys in the big centres.”
‘THE PHARM – Prehospital and retrieval medicine.’ By Dr Minh Le Cong
Dr Le Cong’s comprehensive blog is for the health professionals working in remote locations, outside a hospital, on aircraft, ambulances, in outposts who have to deal with emergencies and the unexpected.
“My focus is rural Australia but my journey will be international, hearing from folks in other countries and how they deal with out-of-hospital emergencies. Of course I am a flying doctor so there will be a healthy dose of aeromedicine.”
‘KI Doc – Kangaroo Island doctor blogging about Rural Medicine in Australia.’ By Dr Tim Leeuwenburg
Encouraged by emergency medicine and retrieval medicine blogs such as EmCrit, Resus.me, BroomeDocs and Prehospitalmed, Dr Leeuwenburg has embraced the #FOAMed paradigm: “Whilst the lifeinthefastlane emergency physicians have lead this in Australasia, I reckon #FOAMed has a lot to offer rural doctors.” Excellent blog.
Ginni Mansberg is a well-known, celebrity doctor in Australia. She is a Sydney GP sidelining for Sunrise & Morning Show, various magazines, and is a self-proclaimed wannabe Masterchef and caffeine addict.
‘Do It Yourself Health DIY Health), Healthy Living and Health Information from Dr Joe.’ By Dr Joe Kosterich
Dr Kosterich is a well-known GP, author, and keynote speaker. “Your well-being is the most important thing you have. My passion is empowering you to take charge of your own health through easy to understand steps enabling you to live well for longer.”
‘PartridgeGP – professional, comprehensive and empowering healthcare.’ By Dr Nick Tellis
This is a great example of a practice website with health tips and interesting newspaper articles and reblogged posts including comments by Dr Tellis. Dr Tellis is passionate about great quality General Practice and is enjoying beach-side practice after seven years in rural South Australia.
Dr George Forgan-Smith is a GP and passionate gay doctor in Melbourne Australia: “I have a strong interest in male health, mental health and health promotion. I enjoy writing and teaching and I hope that this website may help to inspire other men to move towards health in all aspects of their life.”
‘The Influence of the Tricorder.’ By Dr Tim Senior
Dr Senior has an interest in Aboriginal health & medical education. Other themes he often writes about are environments that keep us well and social justice.
His blog is an amazing collection of various articles he has published over the years. “I write stuff. It ends up in various places on the web. This site keeps track by linking to it all from one place.”
A well-written and beautiful blog about solving healthcare problems with creativity, intuition and insight with lean and inexpensive innovations. Dr Jiwa is Professor of Health Innovation at Curtin University and a GP practicing in Western Australia. He is also the Editor in Chief of The Australasian Medical Journal.
‘Dr Thinus’ musings – This is Canberra calling.’ By Dr Thinus van Rensburg
“Canberra – we love it and, despite what the rest of Australia might think, it is not just about pollies and Public Servants. It has it’s ups and downs but this is our hometown and I hope readers enjoy my occasional posts.” Honest commentary on a variety of articles and reblogged posts by Dr Van Rensburg.
“We don’t have to engage in grand, heroic actions to participate in the process of change. Small acts, when multiplied by millions of people, can transform the world.” ~ Howard Zinn
Not many people know that the main message of one of the most successful campaigns of the Royal Australian College of General Practitioners (RACGP) against government policy was largely inspired by one patient.
At the height of all the commotion about the co-payments, patient advocate Ms Jen Morris posted a message on Twitter suggesting a different response to the government proposals: Instead of focusing the campaign on doctors, she said, we should be focusing on the consequences of the policy for patients.
I used her simple but powerful message in a leaflet (see image). It said:
“We’re sorry to hear your rebate will be slashed. (…) It’s not that we haven’t tried, but the Government doesn’t seem to listen to GPs. They may listen to you.”
Not long after I posted it on my blog and social media channels, the RACGP President contacted me. He wanted to include the message in a national campaign. I thought it was great that the RACGP was using social media and that they took notice of what was being said. Not long after, the You’ve been targeted campaign was unleashed by the college. The message was similar to the original, inspired by Jen Morris:
“Your rebate from Medicare will be CUT (…). We have been vocal with Government but it’s falling on deaf ears. They haven’t listened to us but they will listen to you.”
The RACGP had listened to patients and many of their members who wanted a patient-focused campaign. The You’ve been targeted approach showed that every GP surgery in Australia can be turned into a grassroots campaign office if necessary. After other groups, including the Consumers Health Forum and the AMA, increased pressure on the government, the co-payment plan was dropped.
I spoke to Ms Jen Morris and RACGP President Dr Frank Jones about the role of patient input, the use of social media and what we can learn from the remarkable campaign – as there is still a lot of work to do (for example to reverse the freeze on indexation of Medicare rebates)
A pay cut for wealthy doctors?
Morris: “I opposed the co-payment, but was concerned that the original approach adopted by doctors’ organisations misjudged the public’s values, as well as public perceptions of doctors’ wealth and social position. In the initial stages of the campaign against the proposed co-payment, doctors’ organisations, and thus media coverage, were framing it as a pay cut for doctors.”
“Misframing the situation like this made it harder for those of us opposing the changes to explain the various proposals, including Medicare rebate freezes, in a way which the public could understand. It also made it easier for the public to write the problem off as not their concern, but rather a pseudo ‘workplace relations’ issue between doctors and Medicare.”
“At the time, the public were reeling from a budget widely touted as disproportionately impacting the most vulnerable and disadvantaged people. In a social context of widespread public perception that doctors of all stripes are wealthy. So there was little public sympathy when the doctors’ lobby cried foul because the government was trying to ‘cut their pay’. There was a sense that as well-off professionals, GPs should take their fair share of the fiscal blows and ‘cop it on the chin’.”
“The government played perfectly into the combination of these two problems. By later touting the co-payment as ‘optional’, they painted GPs who chose to charge it as opting to squeeze patients rather than take a pay cut.”
‘Extremely poor policy’
Jones: “The RACGP repeatedly raised its concerns with government over many months regarding the impact of a co-payment on the general practice profession and its patients. As GPs we have an obligation to speak up and oppose any policy that will impact on our patient’s access to quality healthcare. We know that poor health policy drastically affects the ability of GPs to deliver quality patient healthcare, and this was extremely poor health policy.”
“When it became apparent the RACGP’s concerns were not gaining the traction required to influence change, we decided it was time to increase pressure. While advocacy has always been a major component of the RACGP’s work, it has recently taken a more public, contemporary approach to these efforts.”
“In the case of You’ve been targeted, this meant ensuring patients were also included in the conversation and encouraged to stand united with GPs to protect primary healthcare in Australia. We collectively see hundreds of thousands of patients a day and knew that a campaign bringing GPs and patients together would present a strong united voice.”
The strength of the campaign
Morris: “Like most public policy debates, successful campaigning against the co-payment was contingent on securing public support in a political PR contest, which means getting the public on side. I believed that re-framing the issue around patient interests was the key to changing public perceptions, and winning the PR battle.”
Jones: “The RACGP took notice of what patients were saying about the co-payment and listened to our members who were telling us they wanted a campaign that focused on how their patients would be impacted. This is what led to the creation of You’ve been targeted.”
“The response to the RACGP’s change.org online petition was a big step for the campaign, with more than 44,800 signatures obtained in less than one week. While the campaign gained momentum through protest posters, use of the social media hashtag and sending letters to MPs and this allowed for concerns to be heard, the online petition was a collective demonstration of the sheer extent of those concerns.”
“A campaign’s strength is intrinsically connected to how powerfully it resonates with its audience and You’ve been targeted hit all the right buttons in this respect campaigning on an issue that affected every single Australian, young and old.”
Morris: “If doctors and patients can capitalise on common ground and present a united front from the outset, the weight of political force will rest with us.”
Jones: “In terms of closer collaboration on advocacy campaigns, the RACGP feels there will be significant opportunity to work with health consumer organisations, given the mutual priorities of better supporting patient care.”
“The RACGP has already partnered with consumer organisations including the Consumers Health Forum (CHF) with whom it produced a number of joint statements. Most recently, the RACGP and CHF partnered in a joint submission regarding the deregulation of pharmacy locations and ownership.”
“The RACGP has consumer representatives on its key committees and boards. We have a history of working with consumer groups on important issues, and will continue to do so moving forward.”
“In light of the RACGP’s recent campaign successes, we will increasingly use social media as a platform to act as a voice for Australian GPs and their patients. Social media is new age media and the RACGP is committed to keeping pace with technological advances to ensure its members are effectively represented.”
It was an interesting week to say the least. I was so sorry to hear about the death of 21-year Eloise Parru, who accidentally took an overdose of slimming pills she purchased online. The pills contained a dangerous substance, dinitrophenol or DNP.
The amount of online advertising of drugs and medical devices is overwhelming. Unfortunately buying medications over the internet is a risky business. They can be fake, contain too much or too little of the active ingredient, or they may contain toxic chemicals. There is no doctor or pharmacist to give reliable advice on how to take the drugs and what adverse reactions to look out for.
The Therapeutic Goods Administration has an excellent website explaining the risks of buying medications on international websites. My advice: never do it.
Health blogger and founder of a best-selling health app Belle Gibson was a very influential woman – but unfortunately she made things up. In a recent interview she confessed that she never had cancer and wasn’t cured by natural remedies. The media are all over her, and so far she has not apologised for misleading her followers. I wonder what is going on here.
Online health scams are numerous. As the wellness industry is largely unregulated, I’m afraid this will not change.
The Australian vaccination skeptics network was in the news again after it compared vaccinations to ‘forced penetration’. A shocking image (see above) was posted on the Facebook page of the anti-vaccination group to convey their controversial message. It has caused a public outrage, which is probably a good thing. I don’t think it has done the group any good.
I believe we need more health professionals and health organisations promoting reliable, evidence-based information in the online space – including social media – to counterbalance the many untrustworthy health messages.
My first blog was a travel blog. Nancy and I were working and travelling around Australia and New Zealand and, like so many others, we blogged about our down-under experience. The audience: Family and friends. Number of daily visitors: 3-5.
In 2004 there was no Twitter, and LinkedIn and Facebook were the new kids on the block. Still, it was good fun. We were passionate about our travel adventures and we enjoyed uploading the pictures we took with our 4 megapixel Sony Cybershot.
Four years later we settled down in Western Australia and started a business. A blog became part of the new practice website.
In the early days the blog attracted 20-30 visitors per day, but after a while the number grew to 40-60. Connecting the blog to the practice social media accounts made a big difference. I learned a lot about content – what works and what doesn’t.
In 2013 we decided to move back to Queensland and I left the practice. I began to focus more on my Doctor’s bag blog (it’s good to see the Panaceum blog is still very much alive).
Keeping a blog going is hard work. There is no ‘easy way’ to do it. The competition is fierce and as there are many great bloggers out there, it’s not that simple to get noticed.
I really enjoy blogging – which helps of course. I am fortunate to work in an industry that’s a constant source of inspiration.
Slowly the visitors number started to climb to 80-100 per day.
But just as I thought my blog was taking off, writer’s block hit me hard. My creativity was gone. I didn’t blog for a while. The longer I didn’t post anything, the more attractive the thought of deleting my WordPress account.
English is not my first language and I often struggle to find the correct words. So, I argued, why not save myself the trouble and stop blogging altogether?
One evening I was reading an article about writer’s block. It was the break-through I needed. The author, Jeff Goins, simply said: “You overcome writer’s block by writing.” His message was short & sweet: It doesn’t matter what you write, as long as you get going.
That’s what I did and somehow it worked. Before I knew it, the inspiration was back and the blog ideas started flowing again.
The first time my daily visitors number reached 1K, I couldn’t believe it. I thought it was a one-off, just luck, but last month over 15,000 people visited Doctor’s bag.
Although I want people to read my posts, it has never been my goal to get more visitors – nor do I think the hit counter is a measure of success. I enjoy producing content that makes others think. If it leads to change – even in the smallest way – I’ve reached my goal.
There will always be people with more writing talent, better posts and more followers, so I try to keep Bill Gates’ words in mind:
“Don’t compare yourself with anyone in this world… if you do so, you are insulting yourself
But there is one thing that is more important than anything else…
The best tip
The one thing that determines success in blogging, and in many other ventures in life, is perseverance. It is important to follow your passion. If you enjoy writing, the best tip I can give you is: Don’t give up.
Everybody has a story to tell, so keep writing. You will get better at it and people will find your blog.
Picture from my first travel blog in 2004, dropped off at Lizard Island, North Queensland, with food, water, tent & map.
You don’t see or hear doctors talk about themselves in public very often. Yet it happened last night – on Twitter.
Just when I thought I had seen it all, the Royal Australian College of General Practitioners organised its first twitter chat for GPs. The topic was ‘doctors treating doctors’.
It was a great example of effective social media use and a free, open access learning opportunity for social media savvy GPs. Doctors are usually not the best patients, nor are they always comfortable looking after colleagues. It was heartening to see that the RACGP and many doctors were willing to discuss these personal topics on Twitter.
The chat was unique for several reasons:
It took place on a public forum
Doctors openly discussing their own care doesn’t happen every day
It was the first twitter chat organised by the RACGP
Doctors could earn CPD points by participating
Twitter chats go at high-speed – especially when there are many participants. This can be a challenge, but the amount of valuable information shared within that one hour was amazing. I certainly learned a lot, and for me it was a reminder to book an annual check-up with my GP.
Thrilled to see this first live Twitter Ed event for Aussie GPs run by @RACGP. It’s been a long time coming! Peer to peer at its best.
Couldn’t agree more. You can check it all out under the Twitter hashtag #RACGPed.
Many thanks to the RACGP(WA), Dr Penny Wilson, Dr Hilton Koppe and Dr Sean Stevens for organising the first RACGP Twitter chat.
If you are using Dr Google to find information about a health problem – like most people do – you will come across unreliable information. Here are 6 warning signs that will help you stay clear from quackery sites.
Information may simply be outdated or incomplete. But sometimes it is deliberately incorrect or manipulated, for example to make you buy something. How to differentiate between the good and the bad? (I admit, this is not always easy).
#1: The site wants to sell something
If a website is trying to sell a product, the information provided may not be objective. Be careful if the site is:
Showing lots of advertisements or testimonials, difficult to distinguish from the website content
Offering a free trial, money back guarantee or special offer
Using phrases or words like: Recommended by doctors, used by professionals, scientifically proven, patented technology, or guaranteed results.
A site may not explain that its main purpose is to sell something. Stay clear if it sounds too good to be true, for example if the website is promising you a miracle or magic cure, amazing results, or a new, quick or easy way to fix your health problem.
Are links to original sources or scientific research provided? Missing or insufficient information may be a clue that a website is not reliable. Websites carrying the HON Code or HealthInsite logos are usually reliable.
#3: The website is out-of-date
Always check how old the information is. Has the website recently been updated? If the information is more than 2-3 years old it’s best to look for a different source of information – or talk to a health professional.
#4: The site has a less reliable domain
Trustworthy health websites contain the domains .gov, .org or .edu, indicating that the information comes from the government, a not for profit organisation or a university.
This doesn’t mean that other websites are always unreliable, but it’s good to find out who is sponsoring or paying for a commercial website (.com or .com.au) before relying on the information. You particularly want to know if the information favors the sponsor.
Websites written by a single person are less reliable than websites run by professional organisations. Yes, that includes this blog (I just shot myself in the foot, didn’t I?)
#5: You have landed on Wikipedia
Wikipedia scores high in search engines so it’s easy to arrive at a Wikipedia page. As much as I like Wikipedia, one study showed that it may contain errors.
#6: The site is requesting your information
Reliable health information is freely available online (at no cost), so there is no need to give a website your details, like your email address. If you must submit personal information, check what will happen with your details first.
A rule of thumb: Don’t rely on one source. Try to find other reliable websites or sources confirming a message or claim about a product or service. Ask an AHPRA-registered doctor or health professional if you’re not sure.
If you would like to know more about finding reliable health information online, have a look at this 16-minute tutorial by the US National Library of Medicine.
“If you are working on something exciting that you really care about, you don’t have to be pushed. The vision pulls you.” ~ Steve Jobs
It’s great to see the steady increase in interest for social media in healthcare. What’s your passion? If you are keen to start a blog or further improve your blogging skills, there are amazing bloggers you should follow, like Seth Godin, Jeff Goins, Michael Hyatt.
My slideshow How to create a blog that makes a difference (above) contains quotes and tips from some of my idols in the blogosphere. I have also attempted to collect and present the (many) reasons why people start a blog in healthcare, common pitfalls, 3 steps for putting a great blog idea into action, and lots of tips for writing awesome posts.
There seems to be a significant growth of social media usage in the Australian healthcare industry.
In the past years we have seen surprisingly influential social media campaigns, like AHPRAaction, ScrapTheCap, InternCrisis, and very recently NoAdsPlease. These campaigns not only rally for better health care policies; they also signal a shift towards more transparency and accountability.
Characteristics of the social media campaigns are:
They spread quickly and generate a lot of media attention
The participants are very passionate about their cause
They are often supported by different groups including consumers
They may or may not be supported by professional organisations
They are very effective.
At the same time other social media movements, like FOAM (free open access medical education) are gaining momentum. Again, these grassroots initiatives are driven by passion – a powerful force. It won’t take long before health care professionals can do their continuing professional education via free social media sources.
I don’t think many professional and health care organisations are ready for these changes – yet they are coming whether we like it or not.
Psychiatrist and blogger Dr Helen Schultz is a social media enthusiast. Helen was involved in the successful AHPRAaction campaign. She believes social media skills are important for doctors: “I feel in the next 6-12 months there will be even more awareness of the need for doctors to know how to use social media professionally, but also how to use it to your advantage, building your brand, your platform and your voice.”
“The time has passed where we can be complacent and think patients will listen to us just because we are doctors,” she says. “We are largely absent from health debates currently, and others educate about health which may not always be necessarily evidenced based. In addition, we must claim our social media real estate, ie own our domain names and twitter handles to prevent others pretending to be us.”
Helen has taken it upon herself to organise a social media workshop for doctors and managers, and she has invited me to speak about blogging. Helen: “On the back of the success of the AHPRAaction campaign – and because I was so inspired by my colleagues around Australia, I thought we had to meet and put our heads together about how doctors can use social media in Australia to join health debates and run really successful campaigns.”
Some excellent speakers presenting at the workshop: Ms Dionne Kasian-Lew, Dr Brad McKay, Ms Jen Morris, Dr Jill Tomlinson, Dr Amit Vohra, Ms Mary Freer, and Dr Marie Bismark. Dr Mukesh Haikerwal is guest of honour.
Social Media by the Sea is a full day interactive workshop with practical tips and insights from the experts about their successful use of social media, whether it be as a blogger, advocate or part of campaign building. Time: Saturday, 15 November 2014. Place: Peppers “The Sands Resort”, Torquay, Victoria. Send email.
What is it like to be a General Practitioner in Australia? What are Australian Family Doctors passionate about? What do they struggle with? The Amazing Australian GP Bloggers 2014 give readers a rare look behind the scene.
Bloggers like Justin Coleman, Jacquie Garton-Smith, Genevieve Yates and Penny Wilson are great storytellers with an impressive writing talent. Penny’s post Sorry… But are you really a doctor, reached number 7 in the most popular WordPress blog posts worldwide.
Then there are the GP bloggers who focus on teaching and sharing skills and knowledge, like Michael Tam, Casey Parker, Tim Leeuwenburg, Minh Le Cong and Robin Park. They are responsible for a vast amount of freely accessible medical information. Much of their work can be found via the excellent foam4gp blog.
It is good to see that some GP bloggers post valuable information for patients, such as Jo Kosterich, Brad McKay and Nick Tellis. Duncan Jefferson is creating a nice podcast collection on his blog.
The stream of stories, confessions, opinions, experiences, tutorials, interviews and podcasts just goes on. It is impossible to mention everyone here, so I refer to the list below.
I would like to finish with acknowledging the hard work these doctors are putting into their blogs. From experience I know it can be a challenge to keep the momentum of writing going. Even though it is a passion, it is not always easy.
All these creative GP bloggers have inspired me, and I’m sure you will (continue to) enjoy their posts! Click on the WordPress/Blogger logo to go to a blog.
Resuscitate-Differentiate-Prognosticate: Roadkill, Diff Awy & Checklist Fan – ATLS-EMST Director – Quality Care. Out There via FOAMed &ruraldoctors.net. Kangaroo Island, Australia. Blogs at: WordPress.
Social media is here to stay. A lot of registrars and young doctors have one or more social media accounts, and I have yet to meet a medical student who is not on Facebook. Patients are already sharing online (health) information via Facebook, Twitter and other social media accounts – so sooner or later health professionals will need to decide whether or not to participate.
Social media is increasingly used for medical education, and sharing knowledge and information such as tips, resources, literature and links. It’s also useful to build an online community. Clinics can share health information and other practical information.
Social media is more interactive than a website and you can reach a wider audience in real-time. Another benefit is the value of health promotion and lifting the profile of a medical practice or organisation. I’d like to mention the use of blogs, pictures and videos. I find they are a great way to communicate a message, and I use my social media accounts to let my followers know when I’ve posted something new.
Make the most of social media
Organisations need to be prepared to put aside time to manage their online presence, and there is no easy way out here. It takes time to post useful material and interact with others. Social media is a two-way street and not just another promotional channel. If you use social media for branding or promotional purposes only, you may lose followers.
Your online presence should have a consistent approach. Too many organisations set up a Facebook account without first developing a clearly defined strategy. It is recommended to take some time to plan and figure out the purpose of the social media campaign, which medium to focus on, and how to keep it sustainable and current. This usually requires a motivated person within the organisation.
Preparation is key, and implementing a social media policy should be part of the preparation. Some things to include in the policy are, for example, how to respond to negative feedback and/or complaints received via social media; and how to comply with AHPRA regulations.
The AMA has a useful document that outlines the risks. I also felt that the social media workshops organised by MDA National are an excellent way to become familiar with the common pitfalls.
Is social media for you?
Due to the time commitment, and the effort it takes to set up and maintain social media accounts, it may not be ideal for everyone.
For those who want to contribute to online health promotion or interact and share health information with their patients or other health professionals, social media is not without risks, but it can be an effective tool if used wisely.
This article appeared in MDA’s Defence Update in April 2014. Original title: ‘Social media in modern medicine’.
Restricting social media usage at work is sometimes done out of fear. “We don’t want our staff to be distracted.” And: “They shouldn’t waste their time on social media.” Other understandable reasons may include perceived cyber risks or the cost of excess data usage.
An organisation that blocks social media sites may send out one or more of the following messages:
We don’t trust our staff
We don’t really understand what social media is all about
Even though consumers are using social media for health purposes, we’re not really interested
In most cases decision makers are probably unfamiliar with social media and may see it as a threat.
Why staff should have access
Here are five reasons why health care staff should have access to sites like LinkedIn, Twitter, YouTube, Blogs etc:
Social networks are powerful learning tools for staff
Social media are increasingly used as health promotion tools (such as embedded YouTube videos)
Shared knowledge accessible via social media will assist staff in finding answers and making decisions
Interactions with peers and thought leaders can increase work satisfaction (and will contribute to staff retention)
Participating in social media and other new technologies will raise the (inter)national profile of an organisation
When it comes to cyber security, I believe there are alternatives that are more effective than blocking social media access including upgrading and updating operating systems, updating antivirus software, improving backup procedures, clever password management and online safety training for staff.
A simple social media staff policy also goes a long way.
And so the AHPRA Action came to an end this week. The Medical Board announced on Wednesday it would work with the other Boards to change the advertising guidelines.
The media statement: “(…) practitioners are not responsible for removing (or trying to have removed) unsolicited testimonials published on a website or in social media over which they do NOT have control.”
Hats of to the Medical Board and AHPRA for listening to the feedback. I have learned three things:
#1: We now all know the rules
The media attention and focus on the law and advertising guidelines has made the road rules clearer than ever. Testimonials mentioning clinical care & used in advertising are out, and unsolicited comments including thank-you’s are in. Of course we will have to wait for the final revision, but it seems we all know where we stand.
#2: Consumers and health care professions united
The controversial advertising guidelines united not only health professions, but also consumers and professionals. This should happen more often. Some have already raised ideas to bring the health care social media community together on a more structural basis – watch this space.
#3: Big government should involve stakeholders
Consumer health advocate Anne Cahill Lambert noticed that AHPRA had not received consumer submissions during the guidelines revision. In this Crickey Blog she wrote: “Genuine consumer participation is sometimes difficult. But it should not be dismissed out of hand because of its difficulty.”
AHPRA has already started engaging and listening via Twitter. Here’s hoping that AHPRA will genuinely engage all stakeholders during future guidelines and policy revisions – without further increases in registration fees of course.
The AHPRA Action campaign has stepped up a notch. Medical Observer is now media partner, the protest action has a new logo (see image) and a new public petition kicked off yesterday.
A Parliamentary Inquiry found that the National Registration and Accreditation Scheme, managed by AHPRA “remains a large and complex bureaucracy with potential confusion over lines of responsibility and accountability.”
AHPRA’s new advertising guidelines are exposing Australian health professionals to unnecessary risks and create more red tape and confusion.
AHPRA regulates over 600,000 Australian healthcare practitioners and charges registration fees. Lawyers said about the new guidelines: “(…) the very broad wording in paragraph 6.2.3 of the updated advertising guidelines potentially exposes all health practitioners to a risk of breaching section 133(1)(c) of the National Law.”
Enough is enough – the advertising guidelines must be changed.
The Australian Health Practitioner Regulation Agency now says in its new guidelines that practitioners can be fined if patients post online testimonials praising the clinical care they received.
Last Friday, it seemed as if AHPRA had backed down on the harsh regulation. But is this really the case?
What does AHPRA say?
First of all, here’s a quote from the current guidelines:
a review (…) that states ‘Practitioner was quick to diagnose my illness and gave excellent treatment’, is a testimonial which references clinical care and is considered in breach of the National Law.
The guidelines also state that health practitioners must take steps to remove unsolicited testimonials appearing on any (social media) website not under their control. However, last Friday the medical board put out a media statement on the AHPRA website saying this:
The advertising guidelines apply to testimonials in the context of advertising (…) there is a clear difference between advertising – which requires an intent to promote the health services – and unsolicited online comment over which practitioners do not usually have control (…). The Board recognises that practitioners are unable to control what is written about them in a public forum.
Indeed, this sounds a lot better than the official advertising guidelines – the medical press have used the words ‘backflip‘ and ‘backdown‘. However, the guidelines have not been updated, which leaves the following three questions unanswered:
1. If a patient posts a comment on my Facebook page stating that I gave excellent treatment, this is still considered in breach of the National Law according to AHPRA’s guidelines and I may be up for a fine if I don’t delete this friendly post. Will I be able to defend myself by referring to the media statement posted on the AHPRA website on 7 March 2014? If AHPRA is serious, the guidelines should be changed in accordance to their statement.
2. Health professionals need to know why our feedback about exactly this issue has not been taken on board in an earlier stage. The first draft guidelines appeared in 2012 and health practitioners were not impressed. The rules were already clear: we knew that testimonials in advertising are a no-go (and I don’t mean unsolicited Facebook comments from patients) – and of course this applies to websites, social media, the classroom, the elevator and anywhere else.
In AHPRA’s udated draft guidelines (2013) the issue of patient feedback vs testimonials had not been addressed, which again led to a storm of online comments as well as another lot of official submissions. See also this post (April 2013). As we know, the final version was published last month and positive patient feedback is not allowed, but then again on Friday the board seemed to think that patient comments are not advertising.
3. As the advertising guidelines are common to all national boards (e.g. dental, nursing & midwifery, psychology etc) we need to know if and how the statement by the medical board will be applied to the other 13 disciplines.
I’m happy with the clarification by medical board chair, Dr Joanna Flynn, and I agree it is a step in the right direction. But it still seems unnecessary government interference, and, after three revisions, the guidelines leave important questions unanswered.