#rctforapps - a twitter discussion

@amcunningham	We need a hashtag .... #rctforapps ? (Wed, 22 Feb 2012 10:41:58 +0000)
@amcunningham	#rctforapps RT @AliHandscomb : @amcunningham what would be the purpose and value of doing this? Who would benefit? (Wed, 22 Feb 2012 10:42:36 +0000)
@amcunningham	#rctforapps RT @JosephFreeman : What sort of harm? Do you mean apps giving false info/assurances? Agree there needs to be control. (Wed, 22 Feb 2012 10:43:03 +0000)
@amcunningham	#rctforapps RT @frozenwarning : @amcunningham Not sure I agree that apps should be prescribed tbh. (Wed, 22 Feb 2012 10:43:24 +0000)
@amcunningham	#rctforapps MT @martinwhite33 Because of risk of harm and opportunity cost - if ineffective wastes everyone's time (Wed, 22 Feb 2012 10:44:22 +0000)
@amcunningham	#rctforapps RT @PatParslow : if they can't cause harm it seems unlikely that they could cause benefit... (Wed, 22 Feb 2012 10:44:51 +0000)
@amcunningham	Ok, so if necessary to have #rctforapps before being prescribed, should they be available to public to pay without regulation by MHRA, say? (Wed, 22 Feb 2012 10:46:38 +0000)
@JosephFreeman	@amcunningham @PatParslow Really depends on what the app is doing, and how much influence it has over a person's health. #rctforapps (Wed, 22 Feb 2012 10:48:52 +0000)
@amcunningham	@helenareeves I'd guess possible harm from an app for health is poorer QoL, lower self-estee, lower self-efficacy #rctforapps (Wed, 22 Feb 2012 10:49:12 +0000)
@amcunningham	. @helenareeves I'd guess possible harm from an app for health is poorer QoL, lower self-estee, lower self-efficacy #rctforapps (Wed, 22 Feb 2012 10:49:42 +0000)
@TheLancetTech	Establishment of an evidence base for medicine has been slow/painful. Let's not throw that away when it comes to shiny new tech. #rctforapps (Wed, 22 Feb 2012 10:50:12 +0000)
@Suziebells	RT @amcunningham : We need a hashtag .... #rctforapps ? (Wed, 22 Feb 2012 10:51:42 +0000)
@amcunningham	Who should regulate health apps? Do we regulate self-help books? MT @lygidakis : Agree! Trials & regulation framework needed! #rctforapps (Wed, 22 Feb 2012 10:51:42 +0000)
@amcunningham	#rctforapps RT @frozenwarning : @amcunningham We have enough drug reps sniffing around, don't need app sellers too. (Wed, 22 Feb 2012 10:52:25 +0000)
@butlerceri	#rctforapps evidence on user involvement indicates variation in involvement based on condition/severity. Same might be case for apps. 1/2 (Wed, 22 Feb 2012 10:53:18 +0000)
@amcunningham	#rctforapps I agree MT @frozenwarning : Cost of testing wld be astronomical compared to probable benefit. App writers aren't going to fund (Wed, 22 Feb 2012 10:53:36 +0000)
@butlerceri	#rctforapps Pts like to see and be reassured by doctors which costs more than an app. so danger is app see as cost effective solution. 2/2 (Wed, 22 Feb 2012 10:53:55 +0000)
@martinwhite33	@amcunningham @helenareeves #rctforapps & could fail 2 help u: lose wt, reduce alc, stop smoking, be active, reduce UV exp, have safe sex... (Wed, 22 Feb 2012 10:54:33 +0000)
@amcunningham	#rctforapps RT @MAC_Research : @amcunningham offering credibility to apps could open the door to ""cowboy"" apps too. (Wed, 22 Feb 2012 10:54:34 +0000)
@butlerceri	@amcunningham @frozenwarning #rctforapps mobile tech is becoming widespread in community care so already apps/software sellers around 1/2 (Wed, 22 Feb 2012 10:55:01 +0000)
@amcunningham	@martinwhite33 failure to help isn't harm... many medical interventsion don't help people #rctforapps (Wed, 22 Feb 2012 10:55:14 +0000)
@butlerceri	@amcunningham @frozenwarning #rctforapps eg iNurse and other products developed by Advanced Health and Care. See EHI for more info 2/2 (Wed, 22 Feb 2012 10:55:35 +0000)
@amcunningham	#rctforapps RT @thomasllewis : @amcunningham yup absolutely. Also need regulation in the same way drugs are regulated. (Wed, 22 Feb 2012 10:55:41 +0000)
@JosephFreeman	@amcunningham @frozenwarning I think prescribing is prob wrong but being encouraged to use to monitor health is a good thing? #rctforapps (Wed, 22 Feb 2012 10:56:14 +0000)
@amcunningham	#rctforapps RT @Neil_Mehta : @amcunningham do they need RCTS? ""GPs in UK 'to prescribe health apps"" see this http://t.co/YfjXu469 (Wed, 22 Feb 2012 10:56:22 +0000)
@amcunningham	#rctforapps RT @lygidakis : True we don't regulate self-help books but apps have immense power compared to them (Wed, 22 Feb 2012 10:56:53 +0000)
@JosephFreeman	RT @amcunningham : #rctforapps RT @MAC_Research : @amcunningham offering credibility to apps could open the door to ""cowboy"" apps too. (Wed, 22 Feb 2012 10:57:56 +0000)
@martinwhite33	@amcunningham #rctforapps DH wants GPs to Rx Apps. We have to protect patients from harm & false promise. NHS shouldn't promote profiteering (Wed, 22 Feb 2012 11:00:08 +0000)
@amcunningham	If we need #rctforapps then maybe only people with as much money as pharna might be able to afford evaluation? @andrewspong (Wed, 22 Feb 2012 11:00:34 +0000)
@PCTCassander	. @amcunningham If apps to be prescribed, also need #equality assessment - will vulnerable grps be excluded? #rctforapps (Wed, 22 Feb 2012 11:01:14 +0000)
@amcunningham	RT @PCTCassander : . @amcunningham If apps to be prescribed, also need #equality assessment - will vulnerable grps be excluded? #rctforapps (Wed, 22 Feb 2012 11:01:31 +0000)
@PCTCassander	. @amcunningham also, would hope there'd be some good #opensource health apps available w/o cost. #NHS #opendata could feed. #rctforapps (Wed, 22 Feb 2012 11:02:15 +0000)
@amcunningham	#rctforapps RT @frozenwarning : Encourage to take up GP health checks better. Excessive home monitoring might create influx of worried well? (Wed, 22 Feb 2012 11:03:02 +0000)
@thomasllewis	#rctforapps apps need some form of regulation as drs need to be able to have accurate reliable apps (Wed, 22 Feb 2012 11:03:37 +0000)
@JosephFreeman	Of course this does all seem to be Mr Lansley using apps as a way to save money by keeping patients out of the GP surgery... #rctforapps (Wed, 22 Feb 2012 11:04:36 +0000)
@thomasllewis	#rctforapps Apps can be notoriously insecure-need regulation to protect patient data and confidentiality (Wed, 22 Feb 2012 11:04:40 +0000)
@JosephFreeman	And the idea of someone using a blood pressure app to monitor their health does scare me #rctforapps (Wed, 22 Feb 2012 11:05:12 +0000)
@amcunningham	#rctforapps RT @frozenwarning : @PCTCassander @amcunningham Opensource apps would still need testing and costs would be high. (Wed, 22 Feb 2012 11:05:23 +0000)
@thomasllewis	#rctforapps also what about conflict of interest. Imagine if pharma-sponsored app recommended its own drugs over other (better) Rx (Wed, 22 Feb 2012 11:06:49 +0000)
@andrewspong	@butlerceri I'm sure #rctforapps must already have addressed that question, however :) @amcunningham (Wed, 22 Feb 2012 11:07:38 +0000)
@amcunningham	#rctforapps RT @andrewspong : Which does prompt Q: bearing in mind v high # downloads, but very low continuing use, is evaluation feasible? (Wed, 22 Feb 2012 11:07:57 +0000)
@JBBC	RT @thelancettech : Estab. of evidence base for medicine has been slow Let's not throw that away when it comes to shiny new tech. #rctforapps (Wed, 22 Feb 2012 11:08:03 +0000)
@amcunningham	@andrewspong well I started form position that #rctforapps were not feasible as tech shfts by time RCT is reported unless we change methods (Wed, 22 Feb 2012 11:08:46 +0000)
@MAC_Research	RT @thomasllewis : #rctforapps also what about conflict of interest. Imagine if pharma-sponsored app recommended its own drugs over other (better) Rx (Wed, 22 Feb 2012 11:10:05 +0000)
@butlerceri	@andrewspong @amcunningham granted this is not a full RCT but would provide sufficient evidence to support case for futher study #rctforapps (Wed, 22 Feb 2012 11:11:27 +0000)
@drcjar	MT @PCTCassander : @amcunningham wd hope for some good #opensource health apps avail #NHS #opendata #rctforapps <- http://t.co/0xhERXSU (Wed, 22 Feb 2012 11:14:06 +0000)
@lygidakis	opensource apps can still offer tailored help potentially harmful to consumers MT @amcunningham @frozenwarning @PCTCassander #rctforapps (Wed, 22 Feb 2012 11:14:45 +0000)
@amcunningham	#rctforapps RT @thomasllewis : There are specialist journals such as JMIR which try rush app analysis to combat the problem you describe (Wed, 22 Feb 2012 11:15:44 +0000)
@nigelpraities	RT @amcunningham : #rctforapps RT @frozenwarning : @amcunningham We have enough drug reps sniffing around, don't need app sellers too. (Wed, 22 Feb 2012 11:15:56 +0000)
@amcunningham	@thomasllewis if data was reported live as trial was ongoing them peole could make up their mind? #rctforapps (Wed, 22 Feb 2012 11:16:35 +0000)
@amcunningham	#rctforapps RT @ellyob : re regulation -hv u seen this? 'first app to be registered as a medical device by the MHRA' - http://t.co/ER3a04LC (Wed, 22 Feb 2012 11:18:58 +0000)
@butlerceri	@andrewspong @amcunningham #rctforapps RCTs are not the only way of proving impact. Small scale is probably the most viable way forward here (Wed, 22 Feb 2012 11:19:36 +0000)
@thomasllewis	@amcunningham Not a bad idea at all. JMIR is on twitter- @JMedInternetRes #rctforapps (Wed, 22 Feb 2012 11:19:51 +0000)
@andrewspong	@thomasllewis w/ regard to # apps published vs # apps reviewed, cd this ever be anything other than a partial solution, though? #rctforapps (Wed, 22 Feb 2012 11:20:15 +0000)
@dean_jenkins	Agree! @amcunningham . Without #rctforapps patients are going to be fobbed off with stuff as ineffective and distracting as homeopathy. (Wed, 22 Feb 2012 11:20:15 +0000)
@amcunningham	""Regulation of health apps: a practical guide"" http://t.co/CUAjBXrH #rctforapps via @ellyob (Wed, 22 Feb 2012 11:20:27 +0000)
@amcunningham	@dean_jenkins oops- apologies! I thought you said it was a RT of me... you haven't :) #rctforapps (Wed, 22 Feb 2012 11:21:34 +0000)
@thomasllewis	#rctforapps @amcunningham Check out @devices4 and http://t.co/FrZjbneH (Wed, 22 Feb 2012 11:21:36 +0000)
@amcunningham	@thomasllewis yes, I've just linked to that! #rctforapps (Wed, 22 Feb 2012 11:21:53 +0000)
@mdTalk	#rctforapps There are specialist journals such as JMIR which try rush app analysis to combat the problem ... http://t.co/KRwpLpqi (Wed, 22 Feb 2012 11:22:07 +0000)
@thomasllewis	@andrewspong Good question. Key is to have sites like @iMedicalApps and teach drs skills required to critically appraise apps #rctforapps (Wed, 22 Feb 2012 11:23:02 +0000)
@lygidakis	I think there's supposed to be a revised 2012 guide to address the issue of apps as medical device RT @amcunningham @ellyob #rctforapps (Wed, 22 Feb 2012 11:23:32 +0000)
@thomasllewis	#rctforapps I think we need a fundamental shift in attitude towards #medapps if we are to integrate successfully into modern healthcare (Wed, 22 Feb 2012 11:25:06 +0000)
@lygidakis	RT @thomasllewis : #rctforapps I think we need a fundamental shift in attitude towards #medapps if we are to integrate successfully into modern healthcare (Wed, 22 Feb 2012 11:25:52 +0000)
@martinwhite33	RT @PCTCassander : . @amcunningham If apps to be prescribed, also need #equality assessment - will vulnerable grps be excluded? #rctforapps (Wed, 22 Feb 2012 11:26:11 +0000)
@jonathanmason	@amcunningham @ellyob #rctforapps whether an app needs to be registered/regulated should depend on what the app is for - is it a device? (Wed, 22 Feb 2012 11:29:05 +0000)
@thomasllewis	@lygidakis @amcunningham @ellyob @devices4 I think that will make for some very interesting reading! #rctforapps (Wed, 22 Feb 2012 11:29:46 +0000)
@martinwhite33	RT @amcunningham : ""Regulation of health apps: a practical guide"" http://t.co/CUAjBXrH #rctforapps via @ellyob (Wed, 22 Feb 2012 11:30:46 +0000)
@richardblogger	As a software dev, and someone familiar with software life cycle, I am not sure #rctforapps is a good idea (Wed, 22 Feb 2012 11:35:10 +0000)
@JBBC	RT @amcunningham : ""Regulation of health apps: a practical guide"" http://t.co/YY8zHONn #rctforapps via @ellyob (Wed, 22 Feb 2012 11:36:34 +0000)
@richardblogger	Healthcare apps need extensive usability testing - of representative users NOT randomised #rctforapps (Wed, 22 Feb 2012 11:36:36 +0000)
@andrewspong	@thomasllewis Objectively, 'eEmninence based' revs of http://t.co/m2KXUk2m little better than gameable 'thumbing' of pocket.md #rctforapps (Wed, 22 Feb 2012 11:36:44 +0000)
@NHSHackDay	RT @drcjar : MT @PCTCassander : @amcunningham wd hope for some good #opensource health apps avail #NHS #opendata #rctforapps <- http://t.co/0xhERXSU (Wed, 22 Feb 2012 11:37:15 +0000)
@andrewspong	@thomasllewis No offence intended to either service. Just thought I'd point that out :) #rctforapps (Wed, 22 Feb 2012 11:37:32 +0000)
@doctorinsulin	Doctors told to prescribe smartphone apps to patients http://t.co/TZ9jErbg good comments from patients. #rctforapps (Wed, 22 Feb 2012 11:39:23 +0000)
@richardblogger	In software you start with a functional spec - work out what you want it to do before you start. That's where focus should be #rctforapps (Wed, 22 Feb 2012 11:39:37 +0000)
@andrewspong	Suffice to say: IMO, the idea of 'prescribing' health apps hasn't been thought through adequately. #hcsmeu #ebm #patient #safety #rctforapps (Wed, 22 Feb 2012 11:40:32 +0000)
@thomasllewis	@andrewspong I'd never even heard of pocket.md before! I think these sites offer drs constructive advice about #medapps #rctforapps (Wed, 22 Feb 2012 11:41:00 +0000)
@BrianSMcGowan	Perhaps it isn't #rctforapps that is needed, but an open & connected 'big data' play that ensures app data can be analyzed in real time? (Wed, 22 Feb 2012 11:41:18 +0000)
@TheLancetTech	RT @thomasllewis : #rctforapps I think we need a fundamental shift in attitude towards #medapps if we are to integrate successfully into modern healthcare (Wed, 22 Feb 2012 11:42:19 +0000)
@JBBC	Great convo - thanks for the #rctforapps discussion @lygidakis @andrewspong @amcunningham (Wed, 22 Feb 2012 11:45:12 +0000)
@westr	RT @amcunningham : ""Regulation of health apps: a practical guide"" http://t.co/CUAjBXrH #rctforapps via @ellyob (Wed, 22 Feb 2012 11:46:07 +0000)
@DoktorAsa	RT @amcunningham : ""Regulation of health apps: a practical guide"" http://t.co/CUAjBXrH #rctforapps via @ellyob (Wed, 22 Feb 2012 11:48:15 +0000)
@safetymd	RT @amcunningham : ""Regulation of health apps: a practical guide"" http://t.co/CUAjBXrH #rctforapps via @ellyob (Wed, 22 Feb 2012 11:50:09 +0000)
@BrianSMcGowan	perhaps GPs need to explain to patients the difference b/w evidence-base and experiential medicine.... #rctforapps (Wed, 22 Feb 2012 12:03:09 +0000)
@BrianSMcGowan	@amcunningham - it is not the apps themselves, but the act of prescribing that drives the need for #rctforapps , right? (Wed, 22 Feb 2012 12:04:07 +0000)
@BrianSMcGowan	@amcunningham - and would apps be paid for by payors? then what evidence might they need. and what of payors developing apps? #rctforapps (Wed, 22 Feb 2012 12:04:58 +0000)
@devices4	@lygidakis @thomasllewis @amcunningham @ellyob Late to the discussion here - thanks for the mentions. #rctforapps (Wed, 22 Feb 2012 12:08:53 +0000)
@devices4	@lygidakis A new MEDDEV was released by the EU on the classification of standalone software in healthcare http://t.co/EcQVRkbE #rctforapps (Wed, 22 Feb 2012 12:12:16 +0000)
@devices4	@thomasllewis Agree. See our recent blogs on clinician involvement http://t.co/uWb3tF2D and letter to BMJ http://t.co/cTNXfIiZ #rctforapps (Wed, 22 Feb 2012 12:17:55 +0000)
@lygidakis	RT @devices4 : New MEDDEV was released by the EU on the classification of standalone software in healthcare http://t.co/x96fWnFo #rctforapps (Wed, 22 Feb 2012 12:19:01 +0000)
@terrieynon	RT @PCTCassander : . @amcunningham If apps to be prescribed, also need #equality assessment - will vulnerable grps be excluded? #rctforapps (Wed, 22 Feb 2012 12:20:59 +0000)
@jonescarwyn	RT @amcunningham : #rctforapps RT @frozenwarning : @amcunningham We have enough drug reps sniffing around, don't need app sellers too. (Wed, 22 Feb 2012 12:41:19 +0000)
@jonescarwyn	RT @amcunningham : If we need #rctforapps then maybe only people with as much money as pharna might be able to afford evaluation? @andrewspong (Wed, 22 Feb 2012 12:41:42 +0000)
@devices4	@amcunningham @TheLancetTech Need for clinical trials is a function of whether the app is a device and its risk class under MDD #rctforapps (Wed, 22 Feb 2012 13:22:37 +0000)
@flupianez	RT @amcunningham : #rctforapps RT @frozenwarning : @PCTCassander @amcunningham Opensource apps would still need testing and costs would be high. (Wed, 22 Feb 2012 13:26:49 +0000)
@dpguinee	All HCPs! @BrianSMcGowan : perhaps GPs need to explain to patients the difference b/w evidence-base and experiential medicine.... #rctforapps (Wed, 22 Feb 2012 13:27:45 +0000)
@GeorgeJulian	Killer question from @amcunningham - shd apps be available without testing? #rctforapps reckon wld be hard define medical from behavioural? (Wed, 22 Feb 2012 13:40:30 +0000)
@GeorgeJulian	RT @amcunningham : ""Regulation of health apps: a practical guide"" http://t.co/CUAjBXrH #rctforapps via @ellyob (Wed, 22 Feb 2012 13:40:41 +0000)
@amcunningham	#rctforapps RT @flupianez : @amcunningham apps are not pills, RCT as a golden standard but new methods are indeed needed (Wed, 22 Feb 2012 14:15:03 +0000)
@amcunningham	@PatParslow do self-help books have disclaimers? has anyone ever sued one? #rctforapps (Wed, 22 Feb 2012 14:53:01 +0000)
@GeorgeJulian	@mikey3982 my point was more that behaviour change stuff isn't regulated eg weight watchers, exercise promotion #rctforapps @amcunningham (Wed, 22 Feb 2012 14:57:43 +0000)
@amcunningham	@BrianSMcGowan yes, that's what I was thinking:) #rctforapps (Wed, 22 Feb 2012 14:57:55 +0000)
@GeorgeJulian	@mikey3982 also have some concerns re the number of well meaning #ServiceDesign solutions without clear evidence #rctforapps @amcunningham (Wed, 22 Feb 2012 14:59:02 +0000)
@amcunningham	Think those interested in #rctforapps and #mapsandapps might like this research on 'book prescription' http://t.co/wwr5LS8o (Wed, 22 Feb 2012 15:03:19 +0000)
@KentBottles	RT @amcunningham : Think those interested in #rctforapps and #mapsandapps might like this research on 'book prescription' http://t.co/wwr5LS8o (Wed, 22 Feb 2012 15:08:35 +0000)
@marktully_qub	Due to speed of development, results from #rctforapps would be meaningless in time. We need to ID & test the underlying behavioural theory (Wed, 22 Feb 2012 15:21:33 +0000)
@amcunningham	RT @marktully_qub : Due to speed of development, results from #rctforapps would be meaningless in time. We need to ID & test the underlying behavioural theory (Wed, 22 Feb 2012 17:30:55 +0000)
@amcunningham	@SR_disrupt did you see the discussion around #rctforapps ? views? #mapsandapps (Wed, 22 Feb 2012 20:07:48 +0000)
@amcunningham	@markhawker ha! did you see our #rctforapps discussion? might blog! (Wed, 22 Feb 2012 20:31:43 +0000)
@markhawker	@amcunningham A friend reviewed a document on this. In some instances paper with calculations could be a medical device. #rctforapps (Wed, 22 Feb 2012 20:32:41 +0000)
@markhawker	@amcunningham Something about if the health professional validates the ""data"" then it becomes a medical device. #rctforapps (Wed, 22 Feb 2012 20:33:12 +0000)
@markhawker	@amcunningham Was just a proposal, I think. #rctforapps (Wed, 22 Feb 2012 20:33:21 +0000)
@JosephFreeman	""An app a day keeps the doctor away"". Some thoughts (and questions) on GPs prescribing apps to patients: http://t.co/Rch3ScUn #rctforapps (Thu, 23 Feb 2012 10:01:46 +0000)
@amcunningham	Nice! Post from @JosephFreeman on #rctforapps http://t.co/ZOfTgv5C #mapsandapps - good questions discussed here! (Sun, 26 Feb 2012 23:35:11 +0000)

The right tools for the job....what to say where and why.

I've been meaning to write a post about how I see different kinds of social networks fitting together and was thinking about how to structure it when lo and behold Harold Jarche linked to this post on his own blog this morning. I've posted his model above.

When I started blogging and tweeting in 2008 my aim was to find other people interested in medical education to connect with. I found some but from the start my external networks have been much more diverse and therefore fruitful that if they were just made up of people interested in people interested in medical education. These are the yellow networks in the diagram above.

Since I was appointed academic lead for eLearning in the medical school in Cardiff University, I have felt the need to try and develop a community of practice with those in similar positions in medical schools acoss the UK. So I started a LinkedIn group called eLearning in Medical Education- not very original! I knew that many of the people who I wanted to join this group were not yet on Twitter or blogging. And I thought that we needed a space that would allow threaded conversation. A few years ago I might have set up a Ning - but this would now cost me £36/year and I don't think it is a format that people are very familiar with in any case. On the other hand, LinkedIn is a social network which those who are aware of it know is work related. So far there are more than 50 members of the group with a reasonable representation of medical schools across the UK. A few medical students have also joined and made some great contributions. I set up a few polls eg Which VLE are you using in your medical school so that newcomers had very non-threatening ways of joining in. And so far the group has been very useful to me at least! It is too early to say that it is a community of practice but it is developing.

And then there are the tools that I use the project teams I am part of within the university. In Cardiff University we have access to IBM connections, a social business solution. The latest version is about to be rolled out. I am going to attempt to use this to share task, project management, information, ideas and developments with all those throughout the university, and in the medical school in particular, who are interested in how we are using technology in the existing course and as we approach a new curriculum.

There has been a lot written recently about the failure of internal networking platforms. A post in the Harvard Business Review last week suggested there is no simple explanation for the poor uptake of internal social networking platforms compared to informal social networking like Twitter and Facebook. A multitude of factors might be responsible including "investing in technology with no clear intent or use in mind" (but who knew why they were signing up to Facebook or Twitter when they fist did? and do all of those corporate accounts know why they are there?). The comments are also well worth reading. One of my favourite comments is the first one "Information flow among desk-sized fiefdoms is usually not free. Attempts to lower the price are almost always met with resistance." The reason that people don't attempt new ways of working is because the cultures of the organisations that they are working within do not give them messages that this is supported and valued. But this intransigence is being challenged by an increasing emphasis on social approaches external to the organisation, and the realisation that to be, as Lee Bryant says, 'social on the outside' also needs good connections and the free flow of information on the inside.

What does 'social on the outside' mean for a university? Who should we be relating to externally as an organisation and as individuals, and as a medical school specifically? Most of the posts on this blog,and the links here, are about me relating externally to other researchers, educators, medical students and patients and a public across the UK and the world. If as educators we are to help students develop digital literacies then we need to consider how these literacies fit with our own identities as researcher and academics and health professionals. And internal social networking platforms may be a safe place to explore identity and utility.

If health organisations also actively engage with 'social on the inside' solutions then perhaps this may impact on how the NHS engages with the use of social media externally. Perhaps.

Do the organisations that you work within provide you with the spaces you need to work with others effectively? Do you think that internal social networking platforms are a waste of time? And is social over-hyped?

EDIT: 24/2/3012 It is really work checking out this post by lecturer in digital media Dr Kelly Page, a colleague in Cardiff  University, on "Social Ways of Working in Higher Education".

Are medical schools abusing 'fitness to practice'?

In 2005 the GMC introduced guidance on 'Professional values and fitness to practice' for medical students. Some have said the notion that a student could be 'fit to practice' is nonsensical....as they aren't licensed until after graduation. But the case has been made that medical students are placed in a position of trust with regards to patients and public as students so they should be held to higher standards than other students.

However, a conversation on Twitter today suggests that some medical students feel that medical schools are abusing their responsibility to ensure students 'fitness to practice' by threatening to carry out FTP procedures for what students perceive as minor misdemeanours  such as missing a day on placement.

You can find the fitness to practice guidance of many medical schools online. They specify serious and severe health and professional issues, but often have a line which says 'and any other matter which may call into question a student's fitness to practice'. This ambiguity is retained in a lot of professional guidance because it is impossible to specify every single circumstance that may mean that concerns would be justified, but it may be that this alarms students as they feel that the guidance then leaves too much leeway to the medical school and potential for abuse as suggested.

So do you think that medical schools are becoming unnecessarily disciplinarian? If so what is driving them to do this? Or are standards slipping? Were higher standards expected of medical students 'in your day'?

UPDATE: Thanks to @jomciver for this link to a very helpful blog post from senior staff in Birmingham medical school on what Fitness to Practice means (and what it doesn't)  and how they are trying to make the process clearer.

Would you block your patient on Twitter?

Road Block, a photo by PSP Photos on Flickr.

@amcunningham I see the logic of not being friends on FB, but if a pt. follows you on Twitter, should you block them?#DifferentPlatform
— WelshGasDoc (@welsh_gas_doc) February 6, 2012

This question came about because I had tweeted a link to some research which had shown that 1/3 of practicising physicians, who responded to a survey (with a 14% response rate)  and said they used Facebook , had been issued with a friend request by a patient or their carer. This was much higher than the level reported in more junior doctors and medical students.

So should doctors refuse friend requests from patients? I have never had a Facebook request from a patient but if I had I would explain that I keep that account for close friends and family. A Facebook request can just be ignored which is an essentially passive act.

But I wouldn't block a patient from following me on Twitter. My Twitter presence is not orientated towards patients but I don't think that they would find anything shocking or surprising in my tweets. It would give them an insight into what I do when I am not in the practice. I consider that patients, or colleagues or students might read everything that I write here or on Twitter or anywhere else publicly online so I wouldn't worry about that.

A few people did think that patients should be blocked however. We discussed that this wouldn't necessarily stop them accessing the tweets as one only has to look at the profile instead. And blocking someone on Twitter is quite a hostile and aggressive act. I think I would find it hard to explain why I was doing that. One doctor said that he had blocked a young, female patient from his Twitter account because he wanted to set clear boundaries.

Another option, as the BMA guidance on the use of social media suggests, is to consider protecting your Twitter account and only allowing approved followers to see Tweets. In my experience the vast majority of doctors in the UK do have public accounts and I don't know if patients accessing tweets is a factor for those who choose to protect their accounts.

And how would I respond to a patient asking me for information on Twitter? Say they asked me where was the best place to find information about diabetes? Well, I would reply and point them to some good sources of information. And what if they were to ask me about their medical condition? If they were following me I would send them a DM advising that I can't give medical advice on Twitter but to get in contact with me in the surgery. I'd also advise them that their tweets are public and that that they might want to be careful about sharing sensitive information so it might be best to delete them. Normally I wouldn't send a DM to someone who I was not following as they would not be able to reply. But I think that in this case it might be the easiest way to deal with the situation. I wouldn't feel comfortable talking to a patient about a medical problem in 140 chtrs even if they were private messages. Essentially, I would treat a patient no differently to any other person I meet on Twitter. And since many people do not use real names on Twitter, and I have no way of remembering the names of all the patients registered with our practice it would be an impossible task to block all patients anyway.

I wouldn't follow my patients on Twitter. But perhaps I will change my mind about this. Perhaps following people from the area could give me better insights into what it is like living in the area and how I might be a better advocate for the community. Have no doubt however that the digital divide is real. A few weeks ago we were having a #nhssm (NHS social media) discussion on using video services such as Skype with patients when Evan Hilton, the executive director of Gofal, the Welsh mental health charity tweeted about the issue of digital in/exlusion in the South Wales valleys. He followed it up with this statistic:

@buzzumi @amcunningham in context of community based mental health services @gofal_ less than 10% of service users on line at home
— Ewan Hilton (@EwanHilton) January 18, 2012

Our patients face many challenges (often beyond their control) in staying health or living with illness. We haven't yet figured out how social media can be best used to help them but perhaps there is a case for not putting more blocks in the road. What do you think?

Doctors getting people back to work

The YouTube video above was shared by the GMC as part of their pre-consultation on updating the guidance on Good Medical Practice(GMP).

Reward to doctors for getting patients back to work is not mentioned in the draft version of Good Medical Practice.  However, for the first time the GMC guidance to doctors includes specific mention of encouraging patients to stay in or to return to employment. I am not aware of the reason why this has been included at this time. The wording is

"51 You must support patients in caring for themselves to empower them to improve and maintain their health. This may include encouraging patients, including those with long-term conditions, to stay in or return to employment or other purposeful activity. You may also advise patients on the effects of their life choices on their health and well-being and the possible outcomes of their treatments."
(my emphasis)

This is specifically raised in the consultation questionnaire:

"At paragraph 51 of this section, we advise doctors that they must support patients in caring for themselves to empower them to improve and maintain their health. This is essentially the same as GMP 2006. But we also now say that such support may include ‘encouraging patients, including those with long term conditions, to stay in or return to employment or other purposeful activity’. 
30 Do you agree this is a reasonable expectation of doctors "

What do you think of this guidance to doctors? The consultation closes on Friday 10th February 2012. Any member of the public can take part.  Find out more here including the link to the e-consultation.


"Doctors to encourage long-term sick to return to work" Daily Mail 1/11/2011
"Who is in charge of doctors and consultants- the DWP?" Twisted News 1/11/2011

"New section of the Department of Health" Jobbing Doctor 1/11/2011

"Work guidance for long-term sick" Guardian 1/11/2011 

EDIT Full GMC guidance published on 25/3/2013 The requirement to encourage patients back to work is absent. Full wording of para 51 is 
"51 You must support patients in caring for themselves to empower them to 
improve and maintain their health. This may, for example, include:
a advising patients on the effects of their life choices and lifestyle on 
their health and well-being 
b supporting patients to make lifestyle changes where appropriate."