Tuesday, 17 May 2011

Talking to medical students about social media and medicine

This afternoon I had a short session with about 25 medical students talking about social media and medicine.We had a general chat and discussion around twitter and blogs and I also used this short presentation.

A few snippets from the discussion:
-all students had a Facebook account
-most had adjusted privacy settings, some hadn't because they didn't know how or weren't worried as they rarely used
-some had heard about FB profiles being checked by recruitment firms but were unsure if that happened in medicine
-all thought it was inappropriate to become friends with a patient on FB.
-there was a lot of discussion about how or why we might keep different aspects of our identity separate from our professional identity, eg being political
-no students used Twitter
-we thought that @shazmo showed great ingenuity in using her Twitter learning network, as described here.
-there was surprise that doctors sharing pictures of the 'lying down' game on FB had made it to the press, but were not surprised that they were 'let off'.
-there was a feeling that students did not need guidance about how to use FB for example. This was 'common sense' and there was a feeling that guidelines may represent the more general encroachment of medical education in to apsects of life outside medicine, in the same was as other discussions of 'professionalism'.
- thinking about the paper of Farnan et. al, there was surprise that the medical school changed its mind over what was appropriate. We thought this reflected general ambiguity over how to use social media.
-they wondered what it was like to be a medical student before the internet. I told them about Index Medicus.
-we wondered how technology would affect our work in the future. Would we be skyping with patients. This was thought to be unlikely but it was thought that when with a patient we might use video-calling to access a sepcialist opinion for a patient.
-the main reasons for not thinking that telemedicine would be useful were: duplication (time spent discussing remotely and then face-to-face), not being able to examine the patient, and why bother as doctors and patients are local so why not benefit from richness of face-to-face communication
-there was mention of this New Scientist article on 'digital souls'
-the TV series Junior Doctors told a story, as all media do. The difference is that with social media you might be able to tell your own story.

A big thank you to the group. I learnt a lot from you. If I've forgotten anything- let me know!


  1. Sounds really interesting! Seems a lot of medical students haven't caught on yet to using Twitter. But then again I get the feeling from my peers that you have to be a certain 'type' to 'get' twitter. Most of them roll their eyes when I mention it. But it's a fantastic place for networking, general chit-chat, a whole world of people who can often challenge your ideas and make useful suggestions. It's so dynamic.

    In view of recent blog posts I've thought more lately about medics posting on the internet. You have to be so careful if you are going to combine personal and professional online. This can be frustrating sometimes as it can take away elements of your freedom of speech. So perhaps these things should be kept separate, but at the end of the day you only have one identity - so how is that ever going to be possible?

    I wanted to raise another point about the cult of celebrity and the fascination of the public and press with bad examples and the phrases 'what we don't know wont hurt us' and 'mountains out of molehills', whilst linking it to current discussion on super injunctions. However, I am firstly not eloquent enough to put it into words that relate these points in a realistic way to medics and secondly not entirely sure if I was trying to make a point or simply raise further discussion topics.

  2. Thanks Natalie. The more discussion the better! At the start of our session I said "I have quite an extensive digital identity- what does that mean to you?" Some asked if it meant I was famous! :) But I guess while not known nationwide we are all famous to much smaller groups of people- students, staff, patients, friends and family. And rather than worrying about hitting the headlines we have to think about our reputation with them.

    You can't take out a super-injunction against gossip. So I suppose we will never really be able to manage how others represent us, but we can think about how we represent ourselves.

  3. I know that we have to censor ourselves and that it is very important in maintaining a professional persona, but I always come back to the question: why? I mean the answer seems very obvious for many reasons, but less obvious for others.

  4. This is a great question Natalie. I'm not sure I know the answer but I did write a long blog post about it before

  5. As a tech savvy Junior doc,

    The picture above draws up many bits of the reality which I notice as well working in a community hospital with often interns around. In neurology not many colleagues embrace twitter as yet. Among my friends, many people have a twitter account, few are active. Among students few have a twitter account.

    I think it's a great thing to discuss social media with your students and the way they shape their online identity as use of these tools is powerful in the sense that it may prove to be a magnifying class on stuff you do/don't do.

    As early adopter I use the following rules:
    - do I want to be associated with the message
    - do I want my professional identity associated with the keywords & context of my message if people search for me (patients, colleagues, boss, friends).

    In that context I try to even balance use of keywords in neurology in my tweets w keywords in education as I don't want anyone to get the impression that my professional interest for education would be stronger than for neurology (as this is not true), yet in my private life education place a big role.

    For me the question is not if I want to sensor myself, but: how do I want the world to see me. I see choice of what to say more as a freedom than as a limitation, from that perspective.

    In this perspective I use a triage on my messaging: The whole world, My extended facebook network, my facebook network and my close friends. They all see different things. The more one shares, the less easy it is to detect what is not shared.

    In context of social media I think we should teach young professionals that like to have a digital identity to build it on the notion that abundance of information / overload of information available about you, makes it much easier to keep stuff to yourself, than when there's a just a little presence.

    A recent example for current staff: when you are virtually absent on the net and one patient writes something bad about you.. that's all google will find. What google finds about you matters.

    Looking forward to hear more thoughts.

  6. This is a very important issue in the professional occupations where you can lose your job for behaving in ways that the profession judges inappropriate but society as a whole judges less harshly; sex and drinking come immediately to mind.
    For young people this is especially trying as they make the transition from student where a certain amount of experimentation is normal to professional. Social media increases risks because records are there for a very long time.
    I'm proud of my numerous youthful "indiscretions" because it increased my empathy but I'm also glad there is no record of them that people could use against me today.

  7. Thanks Deirdre. I think your point that regulators might be more harsh than society as a whole is valid. I'm reminded that in the past in the UK, the GMC has been criticised for being supposedly more interested in the moral bahaviors of doctors, rather than whether they performed their job well. Is this still true?

    Above Paul displays exceptional awareness that in the future he may be judged in part about how well he can do his job by how he portrays himself online.

    There seem to be a few facets to the discussion
    all of me vs the doctor part of me
    projecting positive vs minimising negative

    Thanks again!

  8. @egosyntonically17 May 2011 at 22:54

    There are a number of guidelines for professionals emerging about how we shoul interact with social media. I think that the speed of the phenomenon taking off has left the profession, the organisations that we work for and society as a whole lagging behind in what is expected of being a digital professional.
    In my experience the views of your students are echoed across the literature - most will be aware of privacy settings, and that patient friending is a no no. But there are more subtle risks from FB such as potentially damaging content being posted by friends, or your content being circulated more widely by FOAFs. Group membership can also be problematic, especially if revealed to everyone.
    Twitter is more straightforward in a way, as most people are aware thy it is searchable, permenant and that tweets are generally considered public domain material.

    I think that it will take time and sadly test cases in court and before the GMC before we are more clearly aware of the public expectations and limits for professionals using social media. In the meantime the GMC refer to the good practice guidance and to common sense.

    Rachael Ellaway posted a set of digital professionalism principles which are among the most sensible I've seen. I've also got a presentation on the topic that I could stick up on slideshare if folk are interested.

  9. To me, so much of the flurry about social media and Medicine has relied on inconsistency and poor adaptation to the new facts.

    The best example is the Saturday night picture. The Internet is a rich storehouse of drunken pictures of responsible people. We know that many responsible people behave on a Saturday night in a way they would not on a Tuesday afternoon. But having evidence of it seems to make it an issue. Nobody goes out of their way to find out what people do in their spare time, but when it is on the Internet it seems to make it worse.

    Ten years ago, you had nothing on anyone. Only by bribery or asking people could you have found out anything not on the electoral roll. Now there is so much and it is so permanent. It may be that the permanence of the Internet turns things more serious. But I think, frankly, that we have just not adapted to such a proliferation of permanent evidence.

    We are treating a 2011 problem in a very old-fashioned way. I think that issuing guidelines on social media usage is a similar thing, using an outmoded tool for a new application.

    With time we will be forced to take a more rounded view of people, as their whole characters can become organised neatly in content management systems. Dossiers that a Private Investigator could only have dreamed of are now available on all of us. We have started leaving a massive electronic trail.

    We could resist it, but many people like me are unwilling to. Our Internet use enhances our lives. We should accept and embrace that - and learn how to take the rough with the smooth.

  10. @egosyntonically Thank you! Please do post to slideshare. I'm more optimistic that we won't have courtcases. I thought the rejection of guidelines was interesting. We may want to talk about best practice but may meet resistance if it seems like a voice from on high. Faculty need support too and that's where Ellaway's paywalled guidance is useful.

  11. @Alasdair many thanks! Yes we know these behaviours exist. But when we see them we might assume that this is an image that the protagonist actively wants to associate with their identity. For a limited audience perhaps they do. They mightn't know or care about the bigger audience. And probably we shouldn't care either. If the behavior is acceptable then so should it's image and it's attachment to an identity. Or don't we think that yet?


I am reintroducing word verification to cut back on spam posts. I'm sorry if you find it frustrating,