Friday, 13 December 2013

Social media as part of a new professionalism : #GMCConf

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Two years ago I attended a GMC education conference in the London. The conference had no hashtag so I and some others decided to use #GMCEd11 . The GMC didn't have their @gmcuk account at that time but they did have a @gooddoctoruk account launched around the time of initial consultation on the updating of Good Medical Practice. Altogether there were just over 300 tweets made on the day and about half of those were by me. Most of this activity probably bypassed those who were attending except when I had a chance to ask a question to an afternoon panel on behalf of Alastair McLellan, editor of the Health Services Journal. Alastair had posed the question to me in a tweet. I remember a frisson of laughter that a question was coming via twitter and I think that it was Fergus Walsh who joked that at least 140 characters created  usefully brief and succinct questions.

Fast forward to 2013 and the first national GMC conference on 'Medical professionalism : whose job is it anyway?' is held today in Manchester with 400 attendees- over 50% of them medical students and jobbing doctors, but with other stakeholders including patients well represented. There is an official conference hashtag #gmcconf and it is used more than 1500 times today. Throughout the day there is reference to taking questions from tweets and no-one seems to be in any way surprised.

I make about 1/2 the tweets I do at the last event, in part because this time I was giving a lunch-time seminar with Gareth Williams from the GMC office in Cardiff on the social media in practice. A strong conference theme is the nature of professionalism in a post Berwick and Francis report world and so my part of the session focussed on how social media is being used to drive improvement and ensure patient safety by doctors in the UK today.

10 reasons why any doctor should explore social media

I concentrated on a few stories - Elin Roddy's experiences of learning and reflecting in social media which lead to her taking on the role of lead for End of Life care in her trust ; raising patient safety through openness and transparency of sharing the #Wrongfooted storify ; NHS Change Day ; the FOAMed initiatives of ECGClass, Gasclass and TeamHaem ; and Kate Granger's #HelloMyNameIs campaign.

A few years ago I was not confident that I could justify urging every doctor to explore social media. But it is now beyond doubt that some of the most innovative, creative and transformative conversations about improving the care of and with our patients are happening within social media.

We must ask ourselves what we can do to help our colleagues and students be part of these conversations.

Thursday, 12 December 2013

Reflections from #DotMed13

The last year has been very good for meeting great people. I first met Irish rheumatologist Ronan Kavanagh in Dublin in this year. That was in February when Shane O'Hanlon got us both to take part in a pre-conference workshop on social media at INMED (the annual scientific meeting of the Irish Network of Medical Educators). Next we met as a rheumatology conference in the UK- this time brought together by Philip Gardiner.

We Banjo 3 at #dotmed13
Last week I was back in Dublin for #dotmed13 - a conference curated by Ronan and Muiris Houston, a GP and medical journalist. It was a fascinating event. I ruminated this morning that it was like #med2 ( a tech driven conference) meets #mu13voice (medicine unboxed- a conference that seeks to explore ' a view of medicine that exceeds the technical' - Alexa Miller had similar thoughts in her blog post about the day and I think she explains it a lot better than me.

So at #dotmed13 we had banjo music and some of the most powerful storytelling I have ever heard- Jordan Grumet told some of the stories he tells in his blog of how medicine broke him and how he got back together again. Architect Ed Gavagan told us how life had broke him but how he got life back together again - helped in no small part by the bartender who took the time too listen when others didn't - and who eventually became his wife. I see many patients who have not been through exactly what Ed experienced but they have been unlucky and experienced hard and tragic lives. I must find the time to listen to them.

And after watching Alexa Miller speak at the Millenium Medicine conference in Texas earlier this year (it was live-streamed- I was at home in Cardiff- and it's well worth catching the video here) I was really excited about taking part in her workshop on how exploring art works could expand our creative approaches to medicine. She couldn't really stop us talking about Picasso's 'Girl before a mirror'!

Of course we had the techy stuff too. Lucian Engelen could not fly to Dublin because of bad weather but wowed us all by taking a picture of the audience through Google Glass from the Netherlands!  It was a great pleasure to finally meet Berci Mesko and Bryan Vartebedian who I have known for years through their blogs and twitter. They were both talking about their visions of the future of healthcare and the part that doctors would play in it. Medical student Mahmood Mirza and recent graduate Alan Corbett talked about social media and medical education- and presented a very balanced view of what students see as the pros and cons.

My own presentation revisited an idea about 10 reasons for a social media presence. In the past my orientation had been medical education alone- but I was able to share some great examples which I think make it reasonable for me to say that any doctor should explore social media. You can find the slides below.

Why does a twittering doctor tweet? - 10 reasons for a social media presence from Anne Marie Cunningham

If you get a chance to go to a conference like #dotmed13 then go. 

#1carejc - Primary Care Journal Club

This was an idea that started last summer- why don't we have an online primary care journal club? #twitjc - Twitter journal club is still going strong, but we always had the idea that wanted to try something different and try different forms of social media. A few weeks ago I spoke to Peter Sloane, an Irish GP, on google plus and he mentioned that he wanted to explore the potential of G+ for education so I suggested that #1carejc would be a great thing to try and get going.

We picked a paper on osteopathy in primary care that was suggested by David Lewis a few weeks before his death last summer. On our panel we had primary care researcher Ceri Butler who has also lived with chronic back pain for many years. Joining us from Australia was Karen Price, an Australian GP and educationalist who knew David Lewis well. I was just off the train from Cardiff to Manchester. Unfortunately we couldn't get Prof John Licciardione, the 1st author of the paper to join  the conversation- but we hope to catch up with him again.

Was it a success? Well yes, we had a good discussion about the context of this research on back pain- the experience of GPs and of patients. We had a little bit of time to discuss the research itself but we were missing the voice of the researcher. Our teething technical problems limited the amount of time we had to discuss the paper but it was only ever intended that the google plus hangout should be one part of a wider discussion about the research topic.

We hope that the discussion can continue in the google plus community we have started. And that the videos will be a resource that people can look back on. We'd appreciate any feedback you have especially if you can leave it in the google plus community.

So here it is! Skip the 1st part (technical mishaps) and start at about 27 mins in - or even at 32 mins in when Ceri starts speaking very powerfully about her experiences.

Monday, 9 December 2013

Confessions of a Lazy Blogger....

Terminal 2 Dublin Airport

I'm just back from a lovely weekend in Ireland. I had the chance to speak at #DotMed13 (of which more later) and also to travel up North to see my family. On Friday night we went out for dinner after the conference and Berci was telling me that hos definition of a lazy blogger was one who didn't post twice a week. By this reckoning I have always been a lazy blogger. Since I've started my blog I've averaged just over 30 posts a year -a few posts a month rather than each week.

I aim to write when I have something to share. So has there been less to share in the past year? No, there has probably been just as much as in the other years but I haven't been giving as much time to doing that as I should have been. So by my definition I have been a lazy blogger and I aim to try and make it up before the end of the year.

Year ends are always good for reflection so I'll try and make sure that I end the year having got many more of the things I have been thinking about and experiencing down on paper in html.

Thursday, 7 November 2013

Burlesque medical student calendar... unprofessional or not?

A brief post. The above image is on the Facebook page for a 2014 charity calendar, Medemoiselles, and features female medical students. Last year the calendar featured male medical students in their underwear.

This morning it was tweeted by one of the medical students pictured. Here are her own thoughts on the response to the calendar.
Is the calendar unprofessional? Is it inappropriate for medical students to take of their clothes for a charity calendar? What are your thoughts?

Friday, 11 October 2013

Digital healthcare - a road paved with good intentions?

Digital healthcare - a road paved with good intentions? from Richard Stanton on Vimeo.

A treat for all those interested in the use of technology in healthcare, this is a lecture that Professor James Morgan, who leads the implementation of the open-source electronic health record, Open Eyes, gave in Cardiff earlier this year. You can find out more about the Science in Public series of lectures here.

Sunday, 6 October 2013

Is your conference really 'trending'?

I've attended quite a few conferences (virtually and physically) in the last year since Twitter introduced 'tailored trends'. At nearly every conference someone will make an announcement that the hashtag is 'trending worldwide'.  Usually it isn't and in fact the person who has thought this is instead looking at tailored trends. These are based on who you follow and where you are; so that you see topics which are popular amongst the people you follow. It means that if you are at a conference with many of the people you follow, then it is quite likely that you will see that hashtag trending as a 'tailored trend'.

How do you know you are looking at a 'tailored trends'? If you just see 'trends' then this is 'tailored trends'. If a geographical area is specified eg 'UK trends' then you are not seeing tailored trends.

It can be a little bit more difficult that this to tell, so I made this screencast last week which I think explains why sometimes people are confused.

At the end of the day it doesn't really matter if your conference hashtag is trending across the nation or not! If it is trending amongst the people you follow that is probably a much more important metric.

Thursday, 12 September 2013

Trying out Mozilla Popcorn Maker...

Mozilla Popcorn Maker is a tool which allows online video to be repurposed and made more 'interactive'. I learned about it today from this post by Neil Mehta.

This is a very simple edit of the 1st part of google hangout I did last week with Eve Purdy.

Was this an easy to use tool?There is certainly a learning curve- and it took me a few hours to edit this very short video. In part because it doesn't seem very stable of Chrome as it crashed a few times. So I don't think it is something that will have widespread take-up just yet, but I may be wrong!

I also don't think that it is very easy to see what the source materials are. Yes, it's visible in the code but I guess best to add attributions in ourselves. You can see the sources for any video produced by clicking on the quotes in the top left hand corner, so attribution is easy.

The next thing I want to do is see how long it would take me to have done this same editing within YouTube itself. And then I might try adding some of the fancy features in Popcorn Maker .. eg links out.

Of course as Popcorn Maker themselves have tweeted the main advantage is that someone else can take what I have done and remix it and make it better.

Maybe Eve Purdy will have a go herself!

Wednesday, 4 September 2013

Hanging out with Eve Purdy

"The future is already here – it's just not evenly distributed." - so said William Gibson in 2003. If you want to see the future of medical education then talk to students like Eve Purdy. She is a 3rd year medical student in Kingston, Ontario. She blogs and tweets. This morning I grabbed her for a quick chat. You can watch our 'google hangout on air' below. 

Wednesday, 7 August 2013

#300seconds talk on health professionals and social media

What is #300seconds about? Getting more women to speak about digital and tech issues. I was one of the 12 speakers at the 1st event in May 2013. The event was hosted in the Facebook London offices.

Speaking to digital experts was challenging.I decided to focus on some of the non-technical issues around the healthcare and social media. Thanks for watching.

Things I mention:
'Trust is the God particle' - Fugeli 2001
The Digital Doctor conference
The story behind Regina Holiday's painting 'Office Hours'
danah boyd on privacy, control and context

Please think about signing up to speak at the next #300seconds event in September.

Sunday, 7 July 2013

BMJ Hack- Developing ideas and relationships (and a little bit of software!)

Home blood pressure recording app for diagnosis of from Anne Marie Cunningham

What a weekend!

I have to admit that yesterday morning getting up before 7am to go to London for BMJ Hack didn't seem such a great idea. It was going to be a beautiful sunny weekend and I was going to spend it inside thinking about how we could use some of the BMJ datasets to address 4 key challenges.

I was most interested in the 'digital student' theme- what could we do for medical education in a weekend? Fortunately there were some wonderful students about! Jon Hilton worked with a team to gamify the questions in OnExamination to try and make answering practice exam questions more fun. And I spent a good chunk of the day working with Tom Lewis, Mike Eddy and Alice Pallot on developing a calendar tool that would help students know about the learning opportunities happening around them when out on placement. I loved this. Even more amazing was that the whole development was done by two sixth-form students Harry  and Vesko.

As we drifted into the evening the conversations continued. Rewired State had organised the hackday in a wonderful venue, The Hub. I had brought my sleeping bag and planned to stay over finding a bit of floor somewhere in the room. And I did! But before that, around midnight, I had a chance conversation with Andrea Weir, a developer who hadn't started working on a hack day project yet. She asked me what would make my life as a GP easier now. So I told her about how since the publication of the new NICE guidance on hypertension in 2012 we were increasingly using home BP monitoring to diagnose high blood pressure. I showed her the great web app that Ed Wallitt  had started a few months ago so that patients could share their BP readings online with their doctor. We talked about  how the patient is expected to take two sets of  reading a day during their normal waking hours. And in each set there should be two readings taken at least one minute apart. That's quite a lot to remember, isn't it! So we thought we would try and make an app which would work offline and simply give the patient some information about how to record their BP, what it meant, and reminders if they didn't record two sets of reading each day. It would be specifically to help patients follow the diagnosis protocol and wouldn't depend on internet access. They would be able to see their own reading on whichever device they decided to use, and would then be able to take their phone with the average result to their doctor at the practice. Simple!

Andrea thought this was something she would like to give a go and when I woke up just after 7 she was still working away on it. Alok Matta also got involved and gave us some tips (and in between times we were seeing what we might be able to do with the content on the NHS Choices conditions site so a busy day!)We didn't get as far as we wanted but when it came to presentations we had enough to explain to people what we were trying to do. There were a lot of questions and some discussion about the use of SMS- could patients be sent SMS reminders instead if they didn't have a smartphone. This was a great idea. Smartphones and broadband are not ubiquitous where I work but there are few people that don't have a phone that can handle SMS. There were questions about doing research to see the impact of using the app- great questions.

The really, really massive shock was that we won. I think people liked it because it was working to try and improve the experience of patients today. Yes, we didn't get as far as we wanted with the development but there is lots of time to work on this. I'm looking forward to getting Ed involved again too and maybe we can work on it further at an NHS hack day. It's very exciting. But now I need a good night's sleep:)

Monday, 6 May 2013

Who is your audience? - Learning about burnout through social media

Rock Audience

Image : Rock Audience by Peter Bongard

"The Rules"

Last week a new website appeared : The Moderate Doctor. The purpose of the website was to host "The Rules", which were originally described  as follows
 "The Rules have been developed to help patients maximise their experience of consulting a GP, and give GPs a chance to vent their frustration at the sometimes bewildering world of the consultation. For anyone of a sensitive disposition-do take The Rules seriously! I hope everyone can find some therapeutic benefit in them-doctors and patients alike."

So from the start The Moderate Doctor was pretty clear that this was meant to be satire, although I did suggest to him that he removed any suggestion that these would help patients because I didn't think that it would. And he did. However, less than a week after publishing the rules are gone from the website. Dr Moderate has said the he meant this as some fun but that it wasn't worth the 'vitriol' and 'grief' which he had received and the he could do without the 'GMC imitators'. Personally, I do not think that the GMC would be interested in this blog or twitter account and if someone thinks that they would, it probably means that they don't understand the guidance on social media. Dr Moderate was not breaking any confidentialities, or doing anything else that I think is in conflict with Good Medical Practice.


So what audience was Dr Moderate aiming for? He is a keen cyclist and he had based the his rules on The Rules published on the Velominati's website. Who are the Velominati? They are' cycling disciples of the highest order" who spend their days "pouring over the very essence of what makes ours such a special sport and how that essence fits into cycling’s colorful fabric".Their website is for those who are DEDICATED to cycling. Their rules might not make that much sense to the rest of us but it is pretty clear that the rules are aimed at those who consider themselves as Velominati, and only those. There is satire but they are laughing at themselves and their own healthy obsession. 

Dr Moderate was trying to achieve something much more difficult. His rules were not aimed at making fun of  a set of super dedicated GPs, but seemed to be aimed at bonding with other doctors through joking about their patients. It wasn't clear that the focus of the joke was the doctor. That made some people feel uncomfortable. One member of the public wrote replies to the rules in his own document as he couldn't fit them all into the comments. In general there was quite a lot of confusion about who the rules and the satire was aimed at.... 
When doctors quibbled about the rules they were often called into question the content not the tone of them. For example, this London GP replying on Dr. Rant's Facebook page suggests that for patients to bring lists is very useful as often problems are related. And a patient complaining of tiredness could have a serious condition so shouldn't be dismissed. I am certain that  if the list had stayed up we could have had very interesting conversations about many of the ideas that they raised. But it's clear that Dr Moderate was reaching a more diverse audience with The Rules than he was expecting.

Do The Rules raise bigger questions?

There is much talk of GP burnout at the moment. If you are a UK GP can take a survey on the Pulse website  to assess how you score for measures of emotional exhaustion, depersonalisation, and lack of personal accomplishment which are recognised features of burnout. Clare Gerada writes in Pulse that "‘Everything else has increased our workload. The insistence that perfectly healthy people “see their GP” hauls demand for access to an unreasonable level and casts us in a role that we have never asked for." One of the doctors who is sad at the withdrawal of the rules mentions that it was good to know that there were other doctors who felt the same about abuse of the service. So it seems that increased workload may be behind The Rules and behind the concerns about GP burnout.

Is workload related to burnout? A study of medical students who applied to medicine in 1990 (McManus, Keely and Paise, 2004)   measured personality traits and approaches to learning at baseline, and then followed them up in their final year or medical school, their PRHO year and again a few years later. They found the personality and learning style at baseline, predicted feelings of burnout at graduation and approach to work 5 years later. Medical students who were more extravert, had a deeper approach to learning, were less neurotic, and more agreeable were less likely to report burnout, stress and exhaustion later, and then a more positive attitude to work and a greater sense of accomplishment later still. So does personality lead to stress and burnout which then leads to work dissatisfaction rather than the other way round?

But there is some confusion about burnout too. How important is it?  Does it affect the way that doctors practice or communicate? Two studies suggest that it might not. A study in the US by Ratanwongsa et al (2008) measured burnout in primary care doctors and then taped consultations with patients, assessed them against the ROTER scale  and measured patient satisfaction. Burnout was correlated with patients saying more negative things as an attempt to build rapport, but otherwise there was no correlation with patient satisfaction. And in the UK a cross-sectional study of GPs by Orton et al (2012) found high levels of burnout, but when consultations with patients were examined the burnout was not obvious to observers, and there was no correlation with patient satisfaction. So when the results of the Pulse survey are announced we will need to ask what the significance is.

Where can doctors tell their stories?

Cole and Carlin (2009) write in the Lancet, that burnout is "also a euphemism for what many physicians experience as a crisis of meaning and identity". One of the solutions is for doctors to be able to tell their stories and to be compassionately and non-judgementally listened to. Can social media have a role in this? Jonny Tomlinson's blog is probably one of the most potent examples of this. His latest post is on the impact that loneliness can have on patients and how they present to their doctors. Last year he moved many people, including me, with his post on how medicine, and we doctors. might make our patients feel shame. But his blog is only one place that he can tell his story. He has written about how he still meets every three weeks with a group of GPs who he trained with 11 years ago.

But social media is not somewhere that one can be guaranteed that one will be listened to compassionately and non-judgementally. Dr Moderate took quite a risk when he decided to share The Rules with the world. He has raised important issues and I do hope that we get the chance to explore them meaningfully. But at the same time I wouldn't blame him for wanting to avoid this space. I'll admit that my first reaction to his setting up a website to support one publication, which seemed to be based around a humourous denigration of patients, was not one of empathy or compassion. But perhaps it should have been.

Cole, T., & Carlin, N. (2009). The suffering of physicians The Lancet, 374 (9699), 1414-1415 DOI: 10.1016/S0140-6736(09)61851-1
McManus IC, Keeling A, & Paice E (2004). Stress, burnout and doctors' attitudes to work are determined by personality and learning style: a twelve year longitudinal study of UK medical graduates. BMC medicine, 2 PMID: 15317650
Orton, P., Orton, C., & Pereira Gray, D. (2012). Depersonalised doctors: a cross-sectional study of 564 doctors, 760 consultations and 1876 patient reports in UK general practice BMJ Open, 2 (1) DOI: 10.1136/bmjopen-2011-000274
Ratanawongsa, N., Roter, D., Beach, M., Laird, S., Larson, S., Carson, K., & Cooper, L. (2008). Physician Burnout and Patient-Physician Communication During Primary Care Encounters Journal of General Internal Medicine, 23 (10), 1581-1588 DOI: 10.1007/s11606-008-0702-1

Saturday, 4 May 2013

Balancing personal and professional presence in social media.

During the week I was talking to some of the doc2doc team and they asked me what I thought about the GMC guidance on social media.

I think that the guidance is good in that it states that the use of social media can very positive and worthwhile for any doctor. I think that it is likely to increase engagement with social media for doctors, and through that provide many opportunities for learning. It doesn't provide guidance on some of the issues which I think are important, for example, what responsibilities does a doctor have before encouraging patients to engage in a social media space. We will have to wait for future iterations to deal with these scenarios.
But within the twittersphere and blogosphere the reaction has been dominated by controversy over the  statement that "If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name."
I still hear people talking about the guidance being impossible to operationalise because how will the GMC identify these pseudonymous doctors? But why would they be trying to? No one would know if that person was really a doctor or not. The GMC have clearly said that the guidance does not "change the threshold for investigating concerns about a doctor's fitness to practice". This means that being anonymous/pseudonymous will never be an issue in itself. But if it was established that a doctor was for example bullying a colleague, or breaking patient confidentiality, then the fact that they were doing this without revealing their identity might be seen as being an aggravating factor.
Some people say that the guidance can't protect the public from charlatans who represent themselves as doctors when they are not. Well, in a way it does. If it is good practice to identify yourself then we can tell the public that they should not trust the authority of any one who represents themselves as a doctor, but  does not identify themselves, and then tries to give them advice.

When I tweeted the link to this interview earlier, Phil replied

Is it possible to separate medical and personal presence on Twitter? Why would you want to? Are doctors concerned that their personal interests or feelings will affect their relationships with colleagues or patients? If so then they may wish to try and separate our these different parts of their identity by setting up more than one account. But personally  I'm happy enough to tweet about going to a gig from my @amcunningham twitter account. Why would or could a tweet like the one that follows be an issue?

A few weeks ago I was asked to write a few paragraphs on how I think about how I present myself online for this ebook on "Social Media and Mental Health Practice".

How do I present myself online?

I first started using social media because I wanted to network so that I could do my job in medical education better. Yes, I am also a GP but I did not see social media as something that would help me to be a better doctor. I’m still not sure that it does, although I certainly do not think that it makes me a worse one. But I am very aware that most of what I say and do within social media is public. I want it to be that way. I do not aim what I say at my patients (or students) but I’m aware that they might read it, and I do not want them to be shocked or upset or worried by anything that they see me write. I aim to be professional, and I aim to respect professional boundaries.

When I am in the consulting room I reveal very little personal information. I doubt that patients are really interested. They walk in to see me and want and need to talk about them, not me. They often politely ask how I am. If I’m running late, I might smile and say, ‘Busy!’ But I would not share my own personal woes and worries with a patient. It would be wrong for me to burden them with my personal concerns. Of course, if they ask did I enjoy my holiday we might chat briefly about that. I don’t close down these conversations but I would never initiate talk about myself.

I share very little personal information online. I do not usually talk about my friends or family publicly online, and this is often to protect their privacy. However, this year I am sharing a photo that I take every day. In some ways this often reveals more personal information about me that what I write. It is something that I am aware of but rarely feel constrained by. I think that in many ways I am quite a private person, so this maybe more than being ‘professional’ defines how I am online.

Of course I might share some difficulties online, for example struggling to make technology work just the way I want it to! I don’t think that is a problem. It shows a different side of me and it is unlikely to impact in any way on the professional relationships which are important to me.I have thought about how I present myself online over the years. I try to be calm, collected, honest and independent. I hope that I come across as I do when I am offline. I am proud that when I meet people offline, who have first known me through social media, they often say that they feel as if they know me already. I would be unhappy if my online presence was considered inauthentic, so this pleases me.

 How do you manage the boundaries between personal and professional? What are the issues for you?

Thursday, 18 April 2013

What you need to know about Twitter...

What you should know about twitter..... from Anne Marie Cunningham

This morning I had the great pleasure of giving this talk at a workshop on mobile learning in medicine and dentistry as part of the Changing the Learning Landscape project.

Arriving at the venue I thought it would be useful to record the audio of my session and share it on Slideshare. I didn't have my Zoom Q3 audio recorder with me so decided to record the audio on my iPhone. I downloaded an app Audio Memos and set it running.

When I got home I set about figuring out how to get the audio file off the iPhone and on to my computer. I tried emailing it but it was too big and I was advised to purchase the full version for 69p, But it was still too big to email. I tried and failed to enable servers but the solution was to send the file to google drive and then download it to laptop. It then needed to be converted from a .wav to mp3 file. Fortunately I had written a blog post about the first time I had made a slidecast, so I was able to refer to the screencast I had made in 2010 to remind myself how to use iTunes to do this! (Yay for self-archiving!)

It is still as easy as ever to sync audio with slides in Slideshare so the last stage was easy.

I think the end result is worth the effort. And I do think that when you are using mainly images in slides, hearing what someone is actually saying is pretty essential to understanding the point of the presentation. So I will try to do it again as I do more presentations this year.

Thanks to Jane and the team behind today's workshop for the great organistation, and to all the other really interesting presenters and such an engaged audience. A special plug for my colleague Duncan Cole for his great prezi on Digital Curation

Wednesday, 10 April 2013

Hospital doctors contacting GPs...

The following storify is from a conversation earlier today. Many hospital doctors talk about finding it hard to contact primary care, just as GPs find it hard to get in touch with them. I'm posting it here so that you might share some of your solutions.

My first podcast!

You might have noticed that I took a little break from blogging. I've been very busy though and one of the things that I was involved in was organising the first Digital Doctors conference that took place last December. The team have been producing a series of podcasts which you can find here and iTunes. All those which I have listened to have been excellent so I strongly recommend them.

Last week it was the turn of Jeremy Walker, technical director at Meducation (@ihid) and I to join Stevan Wing, neurology registrar and digital doctor (@stevancw) for a chat about social media. Here is the result. Hope you enjoy!


Talking about social media and health professionals....

I came across a Guardian  article on how to delete yourself from the internet this evening. That would be quite a task for me. It mentions a search engine,, which does not track internet searches. I decided to check out how good it was by searching for myself. It is good.

Through it I managed to find this video of a conversation between Clare Gerada, chair of the Royal College of General Practitioners (@clarercgp), Stephanie Bown, director of policy, comms and marketing at the Medical Protection Society (@drstephbown), and myself. We were ably chaired by Sharon Alcock, journalist and  founder of Lime Green Media (@LimeandGinger).

The chat took place at an event last year where we were discussing the RCGP and DNUK producing guidance on social media. The final version of the RCGP Social Media Highway Code was published last month.

I had seen this before on the DNUK website but as far as I knew it was not available publicly so I am very pleased to be able to share it with you now. It's quite a lively discussion! Should GPs be discussing patients' underwear on their blog? <- No! Will we be doing consultations via Tweetdeck in the future? <- I doubt it. How will be deal with the digital divide? <- to be decided.

Let me know what you think.

Response and clarification from GMC to criticism of their social media guidance

Last Monday the GMC published this response to the discussion of their new social media guidance on their Facebook page.  I'm posting it here in case some people do not want to access it through Facebook, and because my previous blog post on the topic has over 100 comments.

Jane O'Brien from the GMC's standards and ethics team on our new social media guidance.

On the 25  March 2013 we published new explanatory guidance on Doctor's use of social media (PDF) alongside the new edition of Good medical practice for all UK doctors.

The response from the  profession has been lively — particularly about the phrase:
'If you identify yourself as a doctor in publicly accessible  social media, you should also identify yourself by name.'

Like all our  guidance, Doctors' use of social media describes good practice, not minimum standards.  It's not a set of rules.

But the response from the profession shows that doctors are unclear or uncertain about:
  • Why  we included this in the guidance
  • What  'identify yourself as a doctor' means in practice
  • Whether  this curtails doctors' rights to express their views
  • Whether  the GMC would take disciplinary action against a doctor because they used a  pseudonym
  • Why  doctors shouldn't raise concerns anonymously
We’ve answered these questions below and also provided some background information about how the guidance was developed.

Why identifying yourself as a doctor is good practice?
Patients and  the public generally respect doctors and trust their views — particularly about  health and healthcare. Identifying yourself as a member of the profession gives  credibility and weight to your views. Doctors are accountable for their actions  and decisions in other aspects of their professional lives - and their behaviour must not undermine public trust in the profession. So we think  doctors who want to express views, as doctors, should say who they are.

What does 'identifying yourself as a  doctor' mean in practice?
There is a bit of judgement involved here. For  example, if you want to blog about football and incidentally mention that  you're a doctor, there is no need to identify yourself if you don't want to.

If  you're using social media to comment on health or healthcare issues, we think it's  good practice to say who you are.

In the guidance we say 'you should' rather than 'you must'. We use this language to  support doctors exercising their professional judgement. This means we think it  is good practice but not that it is mandatory.

We've  explained the difference in our use of these terms in paragraph 5 of Good medical practice, and at:

Does this restrict doctors' freedom  of expression?
We are not  restricting doctors' right to express their views and opinions except:
  • Where  this would breach patient confidentiality 
  • Where  comments bully, harass or make malicious comments about colleagues on line. (A  colleague is anyone a doctor works with, whether or not they are also doctors).
One of the  key messages in the guidance is that although social media changes the means of  communication, the standards expected of doctors do not change when  communicating on social media rather than face to face or through other  traditional media (see paragraph 5 of the social media guidance). 

Will the  GMC take disciplinary action if I decide not to identify myself online?
This is  guidance on what we consider to be good practice. Failure to identify yourself  online in and of itself will not raise a question about your fitness to  practise.

Any concern  raised is judged on its own merits and the particular circumstances of the case.  But a decision to be anonymous could be considered together with other more  serious factors, such as bullying or harassing colleagues, or breaching  confidentiality (or both) or breaking the law. The guidance doesn't change the  threshold for investigating concerns about a doctor's fitness to practise. 

Does this guidance apply to personal use?
The GMC has no interest in doctors' use of social media in their personal lives —  Tweets, blogs, Facebook pages etc. But doctors mustn’t undermine public trust  in the profession. Usually this means breaking the law, even where the  conviction is unrelated to their professional life. 

For an example, read the recent Fitness to Practise Panel decision on the MPTS web page (PDF).

Why can't  I raise concerns anonymously in social media?
We are not trying to restrict discussion about important issues relating  to patient safety and certainly don't want to discourage doctors from raising  concerns.

However, we wouldn't encourage doctors to do so via social media because  ultimately it's not private and it might well be missed by the people or organisations who are able to take action to protect patients.

Our confidential helpline — where you can speak to  an advisor anonymously — enables doctors to seek advice on issues they may be dealing  with and to raise serious concerns about patient safety when they feel unable  to do this at local level. Our Confidential Helpline number is 0161 923 6399.

If  you want to talk to an independent organisation, we work with Public Concern at  Work whose legal advisors are trained in managing whistleblowing calls. They  can support and direct doctors who wish to raise concerns.

Why do publications like the BMJ  allow anonymous blogs/letters articles? Does the guidance mean they can't do  that anymore?
BMJ is entirely  independent of the GMC, and it is a matter for them to decide what is  appropriate for their website. However the Committee on Publication Ethics  considered a case and published their conclusions at 

Many blogs  are published without formal editorial or publisher control — although there  may be moderation on some sites. Using your name (or other identifying  information) provides some transparency and accountability.


How did we consult on the guidance?
We consulted  on the explanatory guidance in 2012 and wrote to all registered doctors via our publication GMC News in May 2012 asking them to tell us their thoughts on the  draft social media guidance. 

As part of this  public consultation, we received 80 responses from organisations and  individuals (with 49 of the individual respondents identifying themselves as  doctors). Specifically we asked whether it was reasonable for us to say that  doctors should usually identify themselves when using social media in a  professional capacity and 63% (49 respondents) agreed while 16 respondents  disagreed and 13 were unsure. 39 of those who responded commented on this  point.

Some of the responses from doctors in the consultation included: 

'Doctors should take ownership of  information given in a professional capacity as it is important that we are  accountable for our professional actions.'

'Too often, people hide behind  usernames on internet and on social media — if you have something to say,  don't be a coward.'

Patients groups also felt that being  open and honest when communicating online was important saying:

'Doctors should also be conscious of the widespread access to much social media, e.g. Twitter, which could mean that their social media engagement could endanger public confidence in the profession.'

Of course, some expressed the opposite view including:

'A doctor should be able to state that they are a medical professional without having to publicise their personal data. For example, when commenting on an online article it may be relevant that the comments come from a doctor but it should not require full identity disclosure. Where a comment is formal and part of a professional role, it would be more reasonable to expect identity disclosure.'

What does the final guidance say?
So after  careful consideration of all the views and the arguments on both sides the  final guidance says:

If you identify yourself as a doctor in publicly  accessible social media, you should also identify yourself by name. Any  material written by authors who represent themselves as doctors is likely to be  taken on trust and may reasonably be taken to represent the views of the  profession more widely.

What's happened since we published?
We  acknowledge the level and strength of feeling the petition represents. However,  there is nothing in the guidance that restricts doctors' freedom of speech  online or stops them from raising concerns. The guidance is a statement of good  practice, and the paragraph on anonymity in the guidance is framed as 'you should'; rather than 'you must'; to support doctors exercising their professional judgement.

To read the new edition of the Good medical practice for UK doctors, please visit GMC website.