Transcript GAP APA 2011 Poster

Assessing and Managing Online Presence and Clinical Use of Social Media:
Lessons from the Group for Advancement of Psychiatry (GAP)
2010 Fellows Plenary Session
2010 GAP Fellows: Neil Aggarwal, MD; Benjamin Brody, MD; Gwyn Cattell, MD; David Cochran, MD; Mandy Garber, MD; Stephanie Giannandrea, MD; Hesham
Hamoda, MD; Steve Koh, MD; Aaron Krasner, MD; Fred Langheim, MD; Chad Lemaire, MD; Rebecca Lewis, MD; David Sasso, MD; Megan Testa, MD
Introduction / Background
GAP Survey – Methods and Results
Discussion
 Many physicians are posting professional and
personal information on organizational and nonprofessional websites
 Research is only now being done on the impact of
online presence vis-à-vis the doctor-patient
relationships and mutual safety and privacy
 Ethical, legal, safety, privacy and other concerns are
being raised about the physician online presence
 Electronic media is still unfamiliar to many practicing
physicians and many are unaware of the potential
risks posed by the Internet
 More and more physicians are using email to
communicate with patients and colleagues
The Group for the Advancement of Psychiatry (GAP) is
an American professional organization of
psychiatrists, founded in 1946, dedicated to shaping
psychiatric thinking, public programs and clinical
practice in mental health. Its 29 committees meet
semi-annually and choose their own topics for
exploration. They explore issues and ideas on the
frontiers of psychiatry and in applying psychiatric
insights into general medical, social, and
interpersonal problems.
SURVEY METHODS
SURVEY RESULTS – DEMOGRAPHICS
Anonymous survey of GAP membership
178/212 (84%) members responded
Distributed at annual meeting and by mail
Mean age: 58.3 ± 14
Results collected and analyzed
using SPSS and Microsoft Excel
Practice patterns: 56% academic; 41% private
Effort: 73% FT; 27% PT
LessonsLearned
Learned
Lessons
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Social Media Penetration
 Social Media usage has increased
exponentially in the past decade
across all segments of society
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FACEBOOK STATISTICS
•>500 million users
•50% log on in a given day
•36% of time on the internet
•70% of Facebook Users outside the US
•Average User:
130 “friends”
80 community pages, groups, events
90 pieces of content each month
> 55 minutes per day on Facebook
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- Data from Facebook.com
Establish acceptable means
of communication
Establish expected response
time
Avoid friending a patient
Discuss friending requests
with patients
Consider how to respond to
requests to view online
information about a patient
Are your decisions going to
advance or hinder
treatment?
Understand your
institution’s
guidelines/policies
Create your own guidelines
Obtain written informed
consent from patients about
expectations for
communication, response
time, potential risks and
benefits of electronic
communication
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Treatment
Patient
Frame
Privacy
What information gathered
online enters a patient’s chart?
Security of electronic
communication (with patients,
other clinicians)
Security of electronic devices
(phone, computer, etc.)
Selected Currently Available Guidelines
• E-mail Guidelines (Kane and Sands, JAMIA, 1998)
– Establish turnaround time and types of transactions
– Inform patients about privacy issues
– Print all messages in chart
– Avoid sarcasm, anger, etc.
– Get informed consent to use email
• Social Networking Guidelines (Guseh et al., J Med Ethics, 2009)
– Avoid dual relationships (“friend” requests)
– Respect patients’ privacy
– Exercise restraint in personal social networking
– Read and understand site-specific privacy settings
• Patient-targeted internet search guidelines (Clinton et al., Harv Rev Psych, 2010)
– Why am I conducting search?
– Would it advance or compromise treatment?
– Should I obtain consent?
– Should I share results with patient?
– Document findings in medical record?
– How do I monitor my motivations and risk-benefit profile?
What is missing in current guidelines
• Texting
• Online presence
• Comprehensive guidelines covering various modes of electronic communication
• Discipline-specific guidelines endorsed by professional organizations
Why are there so few guidelines?
• New technologies emerging quickly
• Few legal precedents
• Generation gap
Future Directions and Limitations
FUTURE DIRECTIONS – What is needed
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A comprehensive set of guidelines covering issues of treatment frame,
patient privacy, medico-legal issues, and professional issues, across multiple
domains of electronic communications that addresses discipline-specific
issues and is accepted by the professional community as the standard of care.
LIMITATIONS OF STUDY
• Nonrepresentative Sample of Practicing Physicians
• Overrepresentation of Academic Clinicians, Age >50
References and Acknowledgements
Medicolegal
Professional
Issues
Issues
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What is online about you?
Think twice about posting online
about yourself
Understand the privacy settings
of the online sites you use
* The above may apply to multiple domains of online
communication, e.g., email, texting, social networking, etc.
1. Chretien KC, Greysen SR, et al., “Online posting of unprofessional content by medical students,” JAMA
2009, 302(12):1309-15.
2. Clinton BK, Silverman BC, Brendel DH, "Patient-targeted googling: the ethics of searching online for
patient information," Harv Rev Psychiatry 2010, 18(2): 103-12.
3. Eysenbach G, "Towards ethical guidelines for dealing with unsolicited patient emails and giving
teleadvice in the absence of a pre-existing patient-physician relationship systematic review and
expert survey," J Med Internet Res 2000, 2(1): E1.
4. Gorrindo T, Groves JE, “Web searching for information about physicians,” JAMA 2008, 300(2):213-5.
5. Guseh JS, Brendel RW, Brendel DH, "Medical professionalism in the age of online social networking,"
J Med Ethics 2009, 35(9): 584-6.
6. Jain SH, “Practicing medicine in the age of Facebook,” NEJM 2009, 361(7):649-51.
7. Kane B, Sands DZ, "Guidelines for the clinical use of electronic mail with patients. The AMIA Internet
Working Group, Task Force on Guidelines for the Use of Clinic-Patient Electronic Mail," J Am Med
Inform Assoc 1998, 5(1): 104-11.
8. Shapiro DE, Schulman CE, "Ethical and legal issues in e-mail therapy," Ethics Behav 1996, 6(2): 107-24.
9. Silk KR, Yager J, "Suggested guidelines for e-mail communication in psychiatric practice," J Clin
Psychiatry 2003, 64(7): 799-806.
10. Spielberg AR, "Online without a net: physician-patient communication by electronic mail," Am J Law
Med 1999, 25(2-3): 267-95.
11. Thompson LA, Dawson K, et al., “The intersection of online social networking with medical
professionalism,” J Gen Intern Med 2008, 23(7): 954-7.
The GAP Fellows would like to acknowledge Larry Gross, MD, David Baron, DO, and the GAP membership
for their help and support during the tenure of our fellowship and preparation of this presentation.