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.
This week the Australian Medical Association joined the campaign against the Medicare cuts. The Consumer Health Forum, the Royal Australian College of General Practitioners (RACGP) and others have expressed grave concerns about the extended Medicare rebate freeze.
Doctors, nurses and patient organisations are concerned that the sickest and most vulnerable patients will not be able to afford care, because the cuts to Medicare will push doctors to stop bulk billing. Many GP practices are preparing to introduce more fees.
So far we have seen three interesting responses from the government – none of them are very reassuring:
The government proudly presented the record high bulkbilling rates, completely ignoring the concerns of patients and health groups.
The government made a deal with Pathology Australia that a returned Turnbull Coalition Government will take immediate action to cut the rent multinational pathology corporations are paying for the use of facilities within GP practices. This would take even more money out of general practices.
The Minister for Health Sussan Ley issued a warning for GPs. She said on Twitter: “GP’s beware! Labor not only cut $664m from Medicare, Bill shorten today refused to rule out doing it again.”
Here are some of the responses; they speak for themselves:
I guess we will be seeing more spin from political parties. The patient rebate freeze will result in higher out-of-pocket-costs for patients. Australia needs accessible general practice care to keep people healthy and out of hospital.
“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 – see the video below. Have fun!
Ok, so I was wrong. I really liked the RACGP good GP television commercial. It had some flaws but I thought they were small in the grand scheme of things (see my last post). But many patient advocates did not agree and were unhappy about the lack of communication portrayed in the video.
Blogger Michelle Roger commented: “My current GP asks me what I want to do, what I think is most important and together we sort through the problem at hand and potential solutions. I feel valued and heard and trust her more knowing that she listens and knows me and my family.”
“That for me was missing in the video. It was one-sided and the patients appeared little more than props to be talked at. In fact the patients had no voice at all. A problem that still permeates a lot of medicine.”
Crockey health blog posted an article titled ‘The Good GP never stops learning: the RACGP video that made doctors cry – and patient advocates wince’. In a response to this article Irish blogger Marie Ennis-O’connor wrote on her blog: “We can’t just talk about a commitment to patient centred care – we have to live it. It is only by bridging the divide which places patient and doctor expertise on opposite sides that we can achieve more personalized and meaningful care of the patient.”
I wondered why the patient opinion was so different to mine. On Twitter it was suggested to me that more doctors should read patient blogs to understand their view better. I thought that was a good idea so I asked for some recommendations and started reading.
I can tell you, it didn’t cheer me up but it was enlightening. It felt a bit like a refresher course “do’s and dont’s for doctors”. What I read was that, in the eyes of patients:
Doctors often don’t know how to deal with disabilities
Doctors sometimes blame patients for treatment failures
Some doctors find it hard to accept patients as experts
Doctors don’t always communicate well.
Now that I’ve read the blog posts I feel that I can better appreciate the patient response to the RACGP video – and I learnt a lot more along the way.
I have been given permission to share parts of these blogs and I recommend anyone who works in healthcare to read on. It may help to bridge the divide. Doctors beware: don’t expect flattery.
Empathy towards disability
In one of her posts writer and speaker Carly Findlay tells the story of how doctors gave up on her and told her parents to prepare for her death, and how she later met one of these doctors.
(…) “Over the Christmas holidays, I introduced myself as an adult to the dermatologist who gave me a pretty dismal prognosis as a baby. He pretended not to remember me until he told me I always had blocked ears. I think he was surprised to see me. I told him some of my achievements including how I am now educating dermatologists about my condition (something he needed when he treated me).”
(…) “Other people with Ichthyosis tell me that doctors didn’t give them a chance either. My friends have said that their parents were told they wouldn’t make it into mainstream school, that they wouldn’t have relationships or children, and that they would be social outcasts.”
(…) “The political models of disability can determine a person’s compassion and empathy towards disability. And so a doctor’s low expectations for a baby born with a disability can set the scene for their attitude through the lifespan of that patient.” (…) Doctors need to move past the textbook and immerse themselves in the disability community to truly learn and empathise with our experiences.”
Blogger Caf explains how doctors told her to see a psychiatrist when their attempts to treat her chronic pain failed.
“I had arrived at the appointment of the reveal, hobbling with a pair of forearm crutches. I could hardly bear any weight on the offending ankle. It didn’t take long for him to deliver his message, laced with condescension and arrogance. ‘There’s nothing wrong with your ankle. Why are you on crutches?’”
(…) “Chronic pain has been misunderstood and stigmatised for so long that many people probably don’t know what to believe. Even patients themselves often wonder if they’ve just gone crazy because their symptoms are so utterly illogical.”
Caf says that her experiences have affected her trust: “I’m not sure that I truly trust any doctors, despite having a lovely GP.”
Michelle also writes about pain in this post: “And there is a pervasive idea of the drug-seeker, seen in every patient who has chronic pain. That those who simply don’t get over pain and require ongoing pharmaceutical management are weak.”
“Friends who have used pain clinics tell stories of dismissal and blame. That they are not trying hard enough when they don’t recover, when I know the lengths they have gone to to try and alleviate their pain. And compassionate pain doctors who become the exception not the rule.”
The patient as expert
In another post she writes: “As a patient with an unusual, complex, and poorly understood disorder, 9 times out of 10 when I see a new doctor I am the expert in the room.”
(…) “I spend my spare time researching my disorders on Medline. I flip through Cochrane Reviews, and review consensus statements regularly. I read up on the drugs I’m taking and keep abreast of current research trials. On forums, I can ask questions of other patients.
“The constant fight to be heard is exhausting
(…) “Some doctors are quite happy to acknowledge that I may know more about my disorder than they do. For example, my GP is happy for me to take the lead on my treatment needs. Even my cardiologist is happy to discuss my disorder in more of a collegiate manner, than the traditional doctor-patient relationship.”
(…) “Yet there are many others who are nothing short of dismissive. Should I dare to suggest a potential treatment or line of investigation the appointment can become adversarial. At times what I say is outright ignored.”
“Case in point my recent hospital admission. Despite having a red allergy band on my arm, sharing the information from my Allergist, and speaking to both my neurosurgeon, anaesthetist and senior nurse about my allergy to adhesives, I awoke to welts and rashes across my body. My pre-op information met with eye rolls, a sense that I was over-anxious, and thus completely ignored.”
(…) “The constant fight to be heard is exhausting. We are told that we must be our own advocates. That the future is patient-centred medicine. That rapport and making a patient feel part of the decision-making model leads to more compliance and more successful outcomes.”
Michelle: “Patients no longer live in a bubble where they are reliant upon their doctors as the only source of information. With the advent of social media and the ease of access to medical journals, patients can be as up to date, and at times, in front of their doctors, with regard to advances within their various disorders. We come empowered and informed to our appointments and have an expectation that our doctors will be equally informed or at the least, willing to listen and work with us.”
“We have an expectation that our doctors will be equally informed or at the least, willing to listen and work with us
“The medical community needs to be aware of the new ways information is being shared, especially the speed at which information can now travel. Instead of criticising patients for researching their ailments, they should instead be working with them, especially to direct them to more appropriate medically sound sources of information.”
“Patients are already distrustful of big pharma and the way research is funded. If their physicians also refuse to help them navigate these areas or are dismissive of their efforts, such distrust will also pass to them, to the detriment of both practitioner and patient.”
Carly: “I went to hospital earlier this year. I was so sore, and a bit miserable. I saw a junior doctor, one I had not seen before. I spent an hour in the consult room, talking to her about Ichthyosis, but also my job, blogging, wedding plans, travel and the Australian Ichthyosis meet.”
“Their compassion means I am a human being first
“She said I was the first patient she’d met with Ichthyosis and she wanted to learn more than what she’d seen in the textbook. Her supervisor came in to provide further input into my treatment. Again, we talked about life, not just Ichthyosis.”
“And she told this junior doctor how lucky they are to have me as their educator. What a compliment. I am so lucky to feel empowered as a patient at my hospital. These doctors listen to me. They treat me as a person not a diagnosis. They see my potential and are proud of my achievements. Their compassion means I am a human being first.”
I’m very pleased and honoured to give away some of my best blogging tips & secrets at the Medicine Social Event this Saturday, 16th of May in Melbourne. If you have an interest in social media and you’re working in healthcare, this is an excellent opportunity to learn how to improve your social media presence, and listen to an amazing group of Australian social media pioneers.
“MedicineSocial has been carefully created to ensure that no matter what level you are when it comes to social media you will come away educated, informed, inspired and ready to go! (Dr Helen Schulz, organiser)
Dr Brad McKay, GP extraordinaire, media celebrity and passionate advocate for evidence based medicine
Ms Jen Morris, all round splendid patient advocate and passionate public speaker
Dr Tim Senior, health educator, Croakey contributor, and carer of all matters #FOAMed
Dr Sonia Fullerton, leader in the #hellomynameis campaign and @Palliverse coordinator
Dr Joseph Sgroi, advocate for doctors in training, entrepreneur and now using social media to be the thought leader in his area of specialty
Dr Dave Hawkes, member of the brilliant #StoptheAVN campaign that led to the demise of the Tenpenny tour which was to be held at Amora
Dr Ben Veness, doctor, visionary, past AMSA president and now one of 2015’s Australian of the year ambassadors
Dr Helen Schulz, psychiatrist, author, public speaker and chair for the day.
My first blog was a travel blog. Nancy and I were working and travelling around Australia & 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. The Panaceum 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. But 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.
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.
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.
I am a strong proponent of open access to social media. I feel the decision to block staff access to e.g. LinkedIn or YouTube is often ill-advised, and it’s not beneficial to organisations in the long run.
Many times I’ve heard the following reasons for restricting social media usage at work: “We don’t want our staff to be distracted.” And: “They shouldn’t waste their time on social media.” Other reasons may include perceived cyber risks or the cost of excess data usage.
Sending out the wrong message
Any organisation that blocks social media sites may send out one or more of the following messages:
We don’t really understand what social media is all about
We don’t trust our staff
Even though consumers are using social media for health purposes, we’re not interested
Admittedly, this is probably unintentional. 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 LinkedIn, Twitter, YouTube, Blogs etc…
Social networks are powerful learning tools for staff
Social media are increasingly used as health promotion tools (e.g. embedded YouTube videos)
Shared knowledge accessible via social media will assist staff in finding answers and making better decisions
Interactions with peers and thought leaders increases 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
The benefits outweigh the risks
The benefits clearly outweigh the risks, such as increased data usage. When it comes to cyber security, I believe there are alternatives that are more effective than blocking social media access, such as upgrading outdated operating systems, updating antivirus software, improving backup procedures, clever password management and online safety training for staff.
And finally, a simple social media staff policy goes a long way.
The Transcatheter Cardiovascular Therapeutics conference (TCT) is the world’s largest educational meeting specialising in interventional vascular medicine. I only know this because I came across a tweet from cardiologist Dr Oscar Mendiz, who shared this cool picture while he was attending the conference in San Francisco. His comment: “TCT 2013 has changed medical meeting for the future”.
All registrants for the conference received a free tablet device, loaded with the official conference app and other interactive conference tools. This allowed the attendees to:
View the program
Plan their schedule
Find and rate sessions (CME)
Download speaker slides
View abstracts and case presentations
Navigate the conference center
Access exhibition materials
Communicate with other attendees
Find shuttle buses, hotels, and restaurants
Sounds & looks cool. Being an interventional cardiologist can’t be that bad after all.
‘Reputation management’ was the topic of an article in the careers-section of this month’s Medical Journal of Australia. As I have blogged about reputation management before I was asked a few questions about the way my practice has used Facebook.
I think Facebook and other social media have the potential to improve communication with our patients and colleagues and make healthcare more transparent – if used wisely of course.
Unfortunately the Australian Health Practitioner Regulation Agency (AHPRA) has scared the healthcare community with their social media guidelines. Doctors are now being told by medical defence organisations to be even more careful with social media, but I’m not sure I agree with the advice given.
Do’s & don’ts
Here are the do’s and don’ts as mentioned in the MJA article:
“Do allow likes and direct messaging on the practice Facebook page, but don’t allow comments. This will avoid any dangers associated with comments classed as testimonials by AHPRA. It also avoids problems such as bullying that may occur when comments are made about other comments.”
“Don’t respond to negative remarks online, as it risks falling into the category of unprofessional conduct if brought before the medical board.”
“Don’t befriend patients on Facebook if you are a metropolitan practice, Avant’s Sophie Pennington advises, so as to keep some professional distance. She says that in regional and rural areas it can be unrealistic to have this separation.”
“Do link your Facebook page to your website, LinkedIn and any other profiles you have set up online. This will help to ensure that these options appear higher on the search-page listings when others look for your name.”
“Don’t google yourself!”
Negative vs positive feedback
I think negative comments online are a great opportunity to discuss hot topics (such as bulk billing and doctors shortages) and to engage with the community in a meaningful way. Positive feedback by patients is wonderful and should not be discouraged, as long as it’s not used as a way to advertise health services.
Health practitioners should be supported to communicate safely online. But not allowing Facebook comments is defeating the purpose of social media.
Who said GPs don’t have time to blog? Here’s the evidence to the contrary: An impressive list of awesome Australian GP bloggers, also present on Twitter and other social media. You’ll find some amazing stories here. It’s definitely worth checking out on a lazy afternoon…
You can also follow the list on Twitter. Please let me know if I have forgotten anybody or if the list is otherwise incomplete or incorrect. Enjoy!
Dr Linda Calabresi
GP, blogger, writer, Australian Doctor stalwart, mother, wife, friend. Sydney, Australia. Blogs at: Cirrus Media
Sydney GP w extracurricular activities at Sunrise & Morning Show (Channel7), Embarrassing Bodies Down Under, various mags + lots of kids & failed opera career. Sydney, Australia. Blogs at: Mane Creative
GP in Aboriginal health & medical education. Find almost anything interesting. Amateur writer, violist, gardener. Opinions could be mine, and aren’t employers’. Tharawal Nation, Australia. Blogs at: Blogspot
We’ve come a long way with technology in general practice. Technology should make our lives easier. However, in health-IT a good idea can easily go bad. But the opportunities are mind-boggling and we’ve got exciting years ahead of us.
Let’s have a look at the good, bad and ugly in eHealth, including cyber insurance, liability issues, telehealth, mobile apps, social media and of course the PCEHR.
The PCEHR has gone ugly. Sidelining doctors and clinical leads didn’t do the project any good. A basic requirement of a successful project is effective stakeholder management. Healthcare evolves around GPs, and if the main stakeholders are not on board for 200%, the project will fail. Meanwhile, the government has started data-mining our patient’s eHealth records. A colleague recently said on an IT forum:
I demand legislation that simply states something like: Information stored in the PCEHR can exclusively be accessed by health professionals directly involved in the patient’s treatment and exempt from access by any other third-party including by means of subpoena
I’m not holding my breath here but it’s a clear message, shared by many GPs. By failing to listen to doctors the PCEHR will be added to the already impressive global scrap heap of major health IT fiascos.
But the good news is: there are alternatives. Instead of wasting more tax dollars, we should adopt one of the already fully functioning, cheaper Australian shared record systems, like RecordPoint from Extensia.
Video consultations between rural patients and specialists save time and travel costs. But some patients would benefit more from Telehealth access to their GP. The RACGP budget submission to fund Telehealth for people living with a chronic disease was a great suggestion.
Initiatives like Telederm where GPs can get send a picture of a skin condition to a dermatologist and get advice, are worth their weight in gold. And eventually we really have to agree on a simple, but professional alternative to Skype that cannot be accessed by (foreign) governments or other third parties.
Social media & mobile apps
Whether we like it or not, social media is slowly becoming part of mainstream healthcare. We’ve figured out how to use social media wisely. More and more GP conferences now include workshops and session about how to sign up for Twitter, linkedIn or WordPress.
Registrars use Facebook and Twitter for e-learning. A new launching pad has been created to assist GPs interested in the professional use of social media.
Mobile and sensor-based technologies enable our patients to monitor just about anything, and with a push of a button this data could come our way – from blood pressures to continuous holter monitor results. GPs will have to figure out a way to deal with this data. This will be a challenge, but ignoring it will not make it go away.
Security & legal issues
When we introduced free WIFI for patients in our practice we discovered security risks that had to be mitigated first. The explosion in cyber crime fueled by cloud computing results in more data breaches, and GP practices are not exempt as we’ve seen not long ago in Queensland.
Technology in health care always creates liability. Recent national concerns about e-dispensing alerts and the doctor’s duty of care are a good example. New national privacy legislation will include mandatory breach notification. This means GP practices have to report all data breach events, even the minor ones, and failure to do so will incur high penalties.
AHPRA didn’t want to stay behind and introduced a social media policy, as well as a revised Code of conduct, revised Guidelines for advertising and revised Guidelines for mandatory notifications – which now include social media clauses.
The problem with regulations like this is that it further increases liability for doctors, already operating in a highly regulated industry. We don’t need more regulation. Risks are: less innovation and progress, a defensive attitude by doctors, higher legal and insurance costs, increased AHPRA fees and eventually higher costs for patients.
It’s not surprising that cyber insurance is going to be the next hot topic. Cyber insurance should cover us against threats like cyber extortion, identity theft, crisis management, business interruption and disaster recovery. The PCEHR already has it’s own legal pitfalls. My indemnity insurance now provides cover in case of:
PCEHR privacy breaches.
Allegations of negligence for failing to detect critical patient information contained within the PCEHR.
Loss or corruption of electronic documents or data.
Intellectual property disputes.
The insurance policy does not cover fines and civil penalties related to the PCEHR – another reason why our practice will not sign up. IT security upgrades of practice systems as well as connected home and mobile devices will be unavoidable, and GPs and practice managers may have to do some upskilling to get their heads around this.
This article has previously been published in AMA(WA)’s Medicus Magazine, June 2013.
The 2012 draft social media policy by the Australian Health Practitioner Regulation Agency (AHPRA) caused a lot of upheaval. Health professionals expressed concerns it was too prescriptive. Now there’s a new version and the organisation is requesting feedback.
A 76-page consultation paper has been posted on the AHPRA website and it includes drafts of the social media policy, revised Code of conduct, revised Guidelines for advertising and revised Guidelines for mandatory notifications.
It looks like AHPRA has taken the feedback on the earlier version on board. The new draft Social media policy is less prescriptive. Health professionals have to follow strict professional values, no matter if they’re in the elevator at work, the pub, or on Twitter or Facebook.
What does it say?
Most of it is common sense, but I thought these two changes were worth mentioning:
Health practitioners are expected to behave professionally and courteously to colleagues and other practitioners, including when using social media (Code of conduct 4.2c).
Testimonials on Facebook and other social media networks have to be removed by health practitioners (Guidelines for advertising 7.2.3).
I’ve read all 76 pages but it’s not entirely clear to me what exactly a testimonial is and whether I’m now required to remove my LinkedIn testimonials and endorsements by colleagues from around the world.
Also, it will require some explaining when removing or refusing friendly, unintended testimonials from our patients on e.g. Facebook, and worse, it may even put health practitioners off social media. I won’t mention Google testimonials – they are impossible to remove. It would be great if AHPRA can provide some clarification and reassurance here.
Interestingly, an issue that causes heated debates has not been mentioned, namely anonymous posting on social media networks by health practitioners who are identifying themselves as such, but are using a pseudonym instead of their real name. Some say it’s important for e.g. whistleblowers to be anonymous, others say health professionals always have to be identifiable. But perhaps it’s a wise decision by AHPRA not to open this can of worms.
Good or bad?
The problem with regulations like this is that it increases liability for health professionals and practices already operating in a highly regulated industry – especially against a backdrop of the recent national eHealth developments and the legal issues that health providers are facing when signing up for the PCEHR. Some of the risks are: less innovation and progress, a defensive attitude by practitioners, higher legal and insurance costs, increased AHPRA fees and eventually more costs for patients.
That brings me to the risk management paragraph in AHPRA’s draft Code of conduct, which states that it’s good practice “to be aware of the principles of open disclosure and a non-punitive approach to incident management”. I wonder if AHPRA is going to follow this advice when a practitioner breaches a social media clause. Something tells me that the regulator will follow a punitive approach if we forget to delete Mrs Jones’ friendly Facebook recommendation.
AHPRA is requesting feedback via email@example.com by close of business on 30 May 2013.
To learn from others via the comments she receives on her blog.
To help develop her thought process and “get some way to understanding what has been perplexing me”.
US cardiac electrophysiologist Dr John Mandrola gives another six reasons in his blog:
Doctors are passionate about what they do and blogging is a way of sharing this.
To educate; both the student and the teacher can learn from a blog.
To help others help themselves.
To give a look behind the medical scene.
To archive useful thoughts and notes.
To show that doctors are humans too. He writes: “Though doctors seek perfection, we tire, become frustrated, make mistakes, and harbor regrets. We are you. We are human.”
If you can email you can blog
A common question patients ask me is whether the influenza vaccine can bring on an infection with the viral disease – so I wrote a post why the flu shot cannot cause flu. I refer patients actively to my blog. This gives people the opportunity to read about what we have discussed in the consulting room and think things over.
Most doctors are experts in discussing health concerns and educating their patients in a one-on-one situation. There are many health messages doctors share with their patients day-in-day-out. All that is needed is to write these down, just like writing an email, and post the information on the web in blog format.
Setting up a blog takes 20 minutes. Not sure how to start? Here’s an easy guide. Need inspiration? Here are some suggestions.
Our practice accountant looked concerned when I told him our practice had joined Facebook and I had started tweeting. He rightly said that even de-identified patient data had the potential to create a medico legal nightmare.
But I wanted him to join social media because he has a wealth of knowledge about general practice and health care, and I thought it would be great for doctors to follow him.
In the months after our little chat I kept feeding him articles and blog posts about the benefits of Twitter and social media in health care and business. He read all the articles and did some thorough background research. Finally he made the jump.
He revamped his website, opened social media accounts, and started tweeting and posting on Facebook. He even started sharing recorded YouTube videos. Now, a few years later, his LinkedIn account has over 500 connections.
He really got it. He understands the power of social media like no other and is using it to share his ideas and dreams about a sustainable and socially responsible health care system. He interacts with clients and reaches a larger audience than ever before.
Tweeting has also changed my life. Everyday I’m learning new things – from the awesome people I’ve met online, including patients. Tweeting forces me to think things over. I firmly believe Twitter makes me a better person and a better doctor.
Publisher and social media coach Michael Hyatt has written a blog post everybody should read: 12 reasons to start twittering. His reasons range from staying up to date, to enriching his life, and sharing friendships. If you’re new to Twitter he also has a useful beginner’s guide to Twitter.
And yes there are some risks. I already mentioned sharing patient data on Twitter which is a big no-go, like it would be anywhere else outside the health care setting. The RCGP (UK) has published a very good ‘Social Media Highway Code’ for doctors, which deals with the most common pros and cons of social media. When promoting services, keep the AHPRA guidelines in mind.
Doctors and social media
The time I spend on social media is usually down-time, when I’m waiting, or taking a break. I spend about 30 minutes per day on Twitter and other social media, mostly reading posts and articles – like the one shared by GP Gerry Considine (Twitter handle:@ruralflyingdoc) about the use of social media by doctors. The conclusion of the article:
[…] the use of social media applications may be seen as an efficient and effective method for physicians to keep up-to-date and to share newly acquired medical knowledge with other physicians within the medical community and to improve the quality of patient care. (Article here)