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):
In the ‘Blogging on Demand’ series you get to choose the topic. If you have a great idea you want the world to know about, send an email, contact me via social media or leave a comment below. Dr Kellie West suggested the topic of this post. She tweeted: “Love to see you tackle the social justice responsibility of doctors [and], health care worker’s responsibility to refugees and asylum seekers.”
I arrived in Australia by plane. My introduction in Australian medicine took place in an empty emergency department and lasted for one hour. The compulsory 4WD course took about eight hours. Afterwards I was flown to a remote hospital, and the next day I found myself on the ward treating patients.
Some people refer to me as an IMG (international medical graduate), others call me an OTD (overseas trained doctor), but according to the government I’m a skilled migrant.
I’m grateful to have been given the opportunity to live and work in Australia. I feel welcome here and I see Australia as an example of a tolerant, multicultural immigration country. In the past ten years I have treated thousands of people, mostly in rural areas where many Australian doctors don’t go.
Australia shares in the benefits of global trade, including skilled migration. Annually about 130,000 skilled migrants enter the country. Australia has not paid for my expensive education, which is fair enough. The skilled migrant program is designed to address specific skill shortages and enhance the skill level of the Australian labour force.
Asylum seekers, on the other hand, are a different kettle of fish.
Who’s afraid of boat people?
In nearly forty years, about 70,000 asylum seekers have arrived by boat; an average of 1,750 per year. Compare this to the 130,000 skilled migrants arriving every year, and I can’t help but wonder how a political party can win an election over such a relative minor issue.
It appears strangers in boats change something in the usually tolerant ozzies. Journalist Christos Tsiolkas writes:
We’ll lock up asylum seekers in offshore detention centres, we’ll stand idly by as they slowly go crazy or harm themselves, we’ll refuse journalists the right to speak to them or to name them, we’ll redefine our borders to not let them in, we’ll farm them off to our impoverished, under-developed neighbours rather than construct a humane and efficient system to process their claims for asylum.
Tsiolkas feels that Australians are not convinced about the benefits of globalisation.
Yet, healthcare in rural areas is predominantly delivered by overseas trained doctors like me. Yet, a quarter of the Australian population has been born overseas. Yet, the Australian economy depends on international trade, and millions of Australians travel to Asia, Africa, and other destinations for leisure and business purposes.
Many people have preconceived ideas about asylum seekers. The risk is that prejudice leads to acceptance of a questionable approach to asylum seekers.
Are they economic migrants instead of refugees? Depending on the source you read, between 70-92 percent of arrivals is ‘genuine’, meaning they are not coming for economic reasons but because they are being persecuted.
Are boat people queue jumping? The queue refers to resettlement: The assisted movement of refugees who are unable to return home to safe third countries. Unfortunately these queues do not exist (it’s more like a lottery) and resettlement is only available for the ‘lucky’ one percent of the world’s refugees.
Somehow we have forgotten that seeking asylum is a correct and legal procedure; asylum seekers are not ‘illegal’ and cannot not be penalised for arriving without travel documents.
Australia is one of 147 signatory countries to the UN Refugees Convention, which means we are obliged to protect refugees. But is Australia taking its responsibilities? Paul Power, CEO of the refugee council of Australia says:
“The view from Indonesia is of a very wealthy, largely unpopulated country pushing unwanted people back to a much poorer, overpopulated neighbour.
The question is: How sustainable is Australia’s solution? The boats have stopped, but global humanitarian crises haven’t. Power: “I can’t see the international pressures which result in refugee movements and desperation migration decreasing in years to come.”
Australia has been heavily criticised by the UN and other countries for its treatment of asylum seekers and refugees. Power recommends a major review of Australia’s treatment of asylum seekers. We must make sure, he says, that they have the following:
Access to refugee status determination, with access to information, interpretation, funded legal advice and review
Freedom from detention, using existing detention alternatives in all but the most exceptional of circumstances and develop detention alternatives in Nauru and PNG
Giving all asylum seekers the right to work – even if work is hard to find, not robbing them of the hope associated with looking for work
Ensuring all asylum seekers have access to basic services, including adequate shelter, physical and mental health care and education
Access to durable solutions – providing prompt decisions and outcomes and living conditions which are sustainable for recognised refugees
The option to explore alternative entry options for people at risk.
The deaths of asylum-seekers Reza Berati and Hamid Kehazaei were preventable according to many. The Australian Medical Association feels strongly that asylum seekers and refugees should have access to proper healthcare. The AMA’s 2013 pre-election position statement:
The AMA wants humanity restored to an otherwise inhumane approach to asylum seekers
The next Government must establish a truly independent medical panel to oversee, and report regularly on, the health services that are available to asylum seekers in immigration detention facilities, both onshore and offshore
The Panel would inspect the available health services, and detainee access to them, and report quarterly to the Parliament, the Prime Minister, and relevant Ministers.
As far as I can see, these recommendations have not been implemented.
In fact, a recently leaked draft consultant report obtained by the ABC revealed that the government feels that medical staff contracted to take care of asylum seekers were advocating too strongly for refugees.
Don’t cross the line
The AMA’s code of conduct dictates that doctors should refrain from denying treatment to patients because of a judgement based on discrimination.
It also stipulates that, regardless of society’s attitudes, doctors do not support ‘cruel, inhumane, or degrading procedures, whatever the offence of which the victim of such procedures is suspected, accused or convicted.’ This is in line with the Declaration of Geneva and doctors have to uphold this – no matter what the government says or does.
Immediate past president of the AMA Dr Steve Hambleton once said at the National Press Club:
“Let’s stay out of where they are from and why they’re here and all the other stuff. Once we are in control or once we take responsibility for people, we should be providing them with first-rate health care.
Thanks to Dr Kellie West for the topic suggestion.
A patient complained about a doctor on Facebook and generated a lot of online traffic. The story was reported in the newspapers. The Medical Board started an investigation. Pending the outcome the doctor relocated to another city. This left the local community without a doctor as no replacement could be found.
A year later the doctor’s name was cleared by the board. But the damage was done. And for many years the article kept showing up in Google search results in relation to the doctor as well as her old practice.
The good news is that I made this scenario up. The bad news: reputation damage can happen to all of us. Pro-active online reputation management should be part of a healthy risk mitigation strategy.
Here are 10 simple tips about how I manage my online reputation and improve Google rankings. You can do it too, it’s easy. It is applicable to your personal brand (your name) as well as your organisation.
#1: Respond to customer needs and expectations
Prevention is better than cure. Our managers act on complaints immediately, as negative comments have the potential to spiral rapidly out of control, especially online. Here is an example of how not to handle a social media crisis.
Our quality assurance committee starts its meetings with a ‘good, bad and ugly’ review of the past month. The group looks at any problems or feedback received, including e.g. Facebook comments. We’re not perfect by any means, but this approach allows our organisation to improve patient services on an ongoing basis.
#2: Create, promote, and update your own online content
Develop a professional website but don’t stop there! Start a Blog. Create social media profiles on LinkedIn and Twitter, and update your profiles regularly. This will improve search engine rankings so your own content will show up first.
#3: Interconnect your online profiles
This will further improve rankings. Splash pages like about.me help to connect your profiles in one place.
#4: Encourage constructive criticism and respond timely to feedback
Engage when people post comments. Respond preferably on the same day. Look at feedback as free business advice. Thank the reviewer and explain your point of view. We have learned from the comments on our practice website and practice Facebook page.
#5: Don’t argue online (and offline)
Set an example. Be a leader. I know this is not always easy, but an angry response is as bad as no response. Be aware that clients/patients/customers may be watching. Avoid deleting comments as this will usually not help your case.
#6: Monitor the web
Google yourself and your organisation at least weekly. Set up Google alerts for your own name and other brands or topics you would like to follow. Free services like peekyou.com, Socialmention.com, and Veooz.com can be helpful. There are lots of other tools to watch your web presence.
#7: Correct and improve information on external sites
Most sites will update your details at no cost. Some sites like HealthEngine or HealthOptions Australia may have added your name and address but will only allow you to update details or improve your listing after paying a subscription fee.
If you feel a review about you or your organisation is incorrect or unfair ask the owner of the website to make amendments. If that’s not an option request to write a comment on the feedback. Google will only remove reviews if they contain unlawful content, are spam, off-topic or if there is a conflict of interest.
#8: Improve positive content, push down negative content
There are many reputation management services on the web. They improve rankings and make it harder for negative content to show up high in search results. Brandyourself.com is a free reputation management tool to improve your personal search results. You need to have a social media profile and a website before you start.
#9: Be ready to engage with traditional media
Have an official spokes person. Consider media training. I like to give journalists a written summary of the main message our organisation wants to bring across.
#10: Know the rules
The AHPRA guidelines explain the advertising limitations under the ‘Health Practitioner Regulation National Law Act 2009’. The Good Medical Practice Code of Conduct includes principles about how to respond to complaints. If in doubt, ask your medical defence organisation.
If you want to know how not to use social media – and stay out of trouble – have a look at the AMA social media guidelines.