Saturday, September 8, 2012

Fixing AHPRA's draft Social Media Policy

There has been a lot of comment among Australian health professionals on social media about the Australian Health Practicioner Regulation Agency's (which I'm going to call AHPRA from now on!) preliminary consultation document on social media policy. (The policy is available here.) For a flavour of the debate, have a look at the posts on Croakey and read the comments, too. The only positive comments I've seen are that AHPRA are venturing nto this area and inviting feedback. The preliminary consultation document itself reads like it was written by someone who's not used the internet for the last decade!

There seems to me to be an obvious way forward for them, though. It is a related to the Medical Board, but would be appropriate for all the other health practitioner boards, too I would imagine. Ironically, the whole policy could be written ina single tweet with room to spare!

Practitioners engaging with social media are reminded of their obligations under Good Medical Practice.

As doctors, we have already been given guidance in a document called "Good Medical Practice" (Opens PDF document). The principles in here would be good guidance for the way we engage with social media. Most of the document relates directly to patient care and would only be tangentially relevant, but the initial principles and some of the later sections are highly relevant, and would produce some very different recommendations.

To quote:
"Doctors have a responsibility to protect and promote the
health of individuals and the community."
  The way we use social media can be measured against this statement.

"Good medicine is Patient Centred"
It seems to me, it is impossible to be patient centred if we are not willing to listen to what our patients say, both as individuals and as groups. There are many people who would find it easier and more natural to comment on the services they recive through social media, rather than face to face. There are already websites dedicated to hearing patient views - Patient Opinion is probably doing this best, based on some good outcomes from the UK. I have had interesting discussions with mental health advocates from around Australia, and heard the opinions of many Aboriginal people about their experfiences, which is essential in my role as a GP working with Aboriginal people. Restricting who I might connect with or how I might engage in discussion would seem to be counter-intuiitive towards achieving patient centredness. The potential that social media has for hearing the perspective of our patients has enormous potential to improve our practice, and it would be a shame to miss out on this because of fear of making a wrong step. There are boundary issues, and the vast majority of health care providers are aware of these, and reflect all the time on how their social media activity impacts on this. I have seen very thoughtful online discussions about whether o follow patients or not, which have used both professional guidance and other people's perspectives. Patient advocates often contribute to these iscussions, which give them a richness often missing elsewhere. It's worth pointing out that the same boundary issues often come up for practitoiners working in a small rural town, and are certainly taught about in GP training.
"Professionalism embodies all the qualities described
here, and includes self-awareness and self-reflection.
Doctors are expected to reflect regularly on whether they
are practising effectively, on what is happening in their
relationships with patients and colleagues, and on their
own health and wellbeing. They have a duty to keep their
skills and knowledge up to date, refine and develop their
clinical judgment as they gain experience, and contribute
to their profession."
I would argue that our use of social media is entiely underpinned by professionalism, self awareness and self reflection, and that those practitioners who do this regularly in their professioanl life are also doing this for their social media use. Those who struggle  with this in their day to day practice are also likely to struggle in social media. However, I wouldn't be surprised of they also had practitioners and non-practitioners telling them clearly when they thought a boundary had been crossed. Our use of social medis reflects our personality after all. (And here is a good example of a medical student learning the hard way! But this is a brave exmple of reflective practice after a mistake.)

"For the doctors
who undertake roles that have little or no patient contact,
not all of this code may be relevant, but the principles
underpinning it will still apply."
And his would be the same for social media use.

"Doctors have a responsibility to contribute to the
effectiveness and efficiency of the health care system."
Social media has been a very effective platform for doing this, and disseminating messages about this. Again, social media is not the only way of doing this, but is one of the many tools. From the wording of this, it could be argued that doctors on social media should be encouraging this!

 "There are significant disparities in the health status of
different groups in the Australian community. These
disparities result from social, cultural, geographic, healthrelated
and other factors....Good medical practice involves using
your expertise and influence to protect and advance the
health and wellbeing of individual patients, communities
and populations."
This has been one of the main reasons I have been using social media. I work in Aboriginal health, and have used my social media presence to engage internationally, and advocate for improved services, as have many people all over the world. Again, the prionciples of Good Medical Practice would seem to indicate that an active social media presence to engage on issues like this would be part of our duties, rather than something to be discouraged.

 "Doctors have a responsibility to promote the health of
the community through disease prevention and control,
education and screening"
One of my most re-tweeted tweets was about the measles outbreak in South West Sydney. I encouraged people to ensure they were fully vaccinated. I would hope that many people saw this message, and that I was doing ym duty under Good Medical Practice.

"In professional life, doctors must display a standard
of behaviour that warrants the trust and respect of the
community. This includes observing and practising the
principles of ethical conduct."
This section, which includes a parts on professional boundaries and advertising, would be highly relevant for our use of social media - are we behaving in a way that warrants the trust of the community - I don't think this means having no opinions at all, but might go to how we express them. The principles behind these would be (and probably have been) useful starting points. There is an issue for clarity, though, about advertising in social media, where the interactive nature can blur the line between patient engagement and advertising - mainly because big corporations want to "engage" with their customers, and the wording and tools look the same, even if the intent is different.

"Conflicts of interest"
This hasn't been explored much, but would be relevant. It is being discussed a little in the journalism world, and in the medical world in the context of drug companies and publication in journals, but there would be room for declarations somewhere, I would imagine.

I am sure these are not the only sections of  Good Medical Practice that would be relevant, but this would seem to be the obvious place to start.

There is much discussion in the #hcsmanz community at the moment, so do please put your in your two-pennies here, at Croakey or on twitter.