Email, apps and SoMe for psychiatrists

Emails, Apps and Social
Media for Psychiatrists
Dr Christopher Pell
Consultant Psychiatrist
NHS Tayside
chris.pell@nhs.net
@egosyntonically 15th Dec 2014

Overview
❖ The technologies - what are we using?
❖ The techniques - inbox zero, getting started on Twitter
❖ The benefits - positive potential uses for Psychiatrists
❖ The pitfalls - and how to avoid them
❖ The guidance - further reading and regulations
http://www.internetlivestats.com

Rise of the Cyborgs
❖ Web 2.0 allows for rapid and easy creation of online content - the read/write
web
❖ “Moore’s Law” puts mobile computing on a par with traditional desktop
devices
❖ 3G and 4G rollout allows instant and continuous access
❖
Do you know your partner’s telephone number?
❖ Phantom Leg Vibration Syndrome, FOMO

Rise of the Cyborgs
❖ Web 2.0 allows for rapid and easy creation of online content - the read/write
web
❖ “Moore’s Law” puts mobile computing on a par with traditional desktop
devices
❖ 3G and 4G rollout allows instant and continuous access
❖
What is your partner’s telephone number?
❖ Phantom Leg Vibration Syndrome, FOMO

Why Doctors should care
✤ You are already on-line.

Why Doctors should care
✤ You are already on-line. ❖ Your patients are on line
❖ Your relatives and friends are online
❖ You are increasingly searchable and linkable to
personal profiles
❖ Google yourself to see what others might
❖ Curate, block, report
❖ Can set up an RSS feed to alert you to new content

Email
❖ Asynchronous electronic communication
❖ Allows attachments, creation of folders, storage
❖ Mobile connectivity ………. always on
❖ Confidentiality - NHS.net, but conflict with Trust Policies?
❖ Volume, deluge and email bankruptcy
❖ Spamming/spoofing - use of block lists
❖ unroll.me - rolls up all of your regular emails into a daily newsletter

Inbox Zero
❖ 5 actions for emails - Delete, Delegate, Respond, Defer, Do
❖ Open and close email client at set times, not in between.
❖ First delete or archive as many emails as possible
❖ Identify those that others should do and forward on (then delete original)
❖ Sort the remainer into ones that can be done in 2 mins or less and do
them
❖ Move ones taking longer to a “response required folder”
❖ Set aside a fixed period in the day to work on these

Applications and Widgets
❖ "Do one thing well"
❖ Small programmes specialising in a few tasks,
downloadable, often optimised for mobile devices
❖ Apple App Store, Google Play, Amazon App Store
❖ Considerations: free/paid for, in-app purchases,
accessible off line?
❖ Easy to use
❖ Easy to create…?

Applications and Widgets
❖ "Do one thing well"
❖ Small programmes specialising in a few tasks,
downloadable, often optimised for mobile devices
❖ Apple App Store, Google Play, Amazon App Store
❖ Considerations: free/paid for, in-app purchases,
accessible off line?
❖ Easy to use
❖ Easy to create…?
Cumulative downloads from Apple App Store
http://www.statista.com/statistics/263794/number-of-downloads-from-the-apple-app-store/

Types of useful app
❖ Reference
❖ Organisation
❖ Storage
❖ Education
❖ Patient data
❖ Self-help

Social Media
❖ The BIG 4: Facebook, Twitter, YouTube/Google+, LinkedIn

1200
900
600
300
0
facebook twitter google+ pinterest instagram
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Year
Users (millions)

1200
900
600
300
0
1 5.5 12
50
150
350
608
845
1,060
1,150
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Year
Users (millions)

1200
900
600
300
0
150
350
608
6 8 26
845
150
1,060
500
1,150
555
1 5.5 12
50
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Year
Users (millions)

1200
900
600
300
0
845
400
1,060
500
1,150
1,000
150
350
608
6 8 26
150
555
1 5.5 12
50
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Year
Users (millions)

1200
900
600
300
0
845
400
150
350
608
6 8 26
150
1 10
1,060
500
50
1,150
1,000
555
150
1 5.5 12
50
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Year
Users (millions)

Facebook
❖ Total no. of Facebook users: 1.38 billion
❖ Percentage of online adults using FB: 72%
❖ Global daily active FB users: 864 million
❖ UK daily active users: 24 million
❖ Average no. of monthly posts/page: 36
❖ No. of friend connections: 150 billion
❖ Average no. of friends per FB user: 141.5
❖ Average daily FB likes: 2.7 billion
http://expandedramblings.com/index.php/resource-how-many-people-use-the-top-social-media/

Twitter
❖ Total number of Twitter users: ~1 billion
❖ Total number of Tweets sent:
❖ Monthly active Twitter users: 284 million
❖ Average no. of Tweets sent per day: 500
million
❖ Average no. of tweets per Twitter user: 208
❖ Average time spent per month: 170 mins
❖ Percentage of Twitter users on a mobile: 60%
❖ Most followed celebrity on Twitter: Justin
Bieber

LinkedIn
❖ Link skills and endorsements
❖ Share C.V. - professional networking
❖ Total number of users: 332 million
❖ 40% of its users check LinkedIn daily
❖ Your LinkedIn profile is 11x more likely
to be viewed if you include a photo
❖ Most used profile buzzword in 2013:
Responsible
❖ 41% of millennials use LinkedIn

YouTube
❖ One billion unique views per month
❖ 4 billion views per day
❖ 100 hours of video uploaded per minute
❖ Nearly 9 out of 10 (87%) of UK internet
users have used YouTube
❖ Incorporated into Google 2006/7 leading to
monetisation, music vids and adverts
❖ Most watched video?

Positive Uses of Social Media
❖ Keep up to date
❖ Inform others and share interesting
articles
❖ Networking particularly for conferences -
#RCPsychIC14
❖ Journal clubs and specific discussion
groups - #meded #TwitJC
❖ Track jobs and other opportunities
❖ Public health - track disease outbreaks,
emergencies - #UKsnow
❖ Crowd sourcing platform - ask your
followers
❖ Communicate with colleagues (and
patients?)
❖ Present a professional image
❖ Create a “fan page” for your organisation
- e.g. RCPsych
❖ Use to disseminate information
❖ Generate discussion amongst friends or
fans

Getting Started on Twitter
❖ Find a username, ideally that reflects your main content
❖ Consider guidance on anonymity - GMC
❖ Work on the basis that all material is public domain and
can be reused without permission
❖ Join the conversation - @ and #
❖ Build a following - be interesting, be focussed, be
helpful and be polite
❖ DFTT, or start flamewars - remember Godwin's Law!
“If you don’t learn something new
each day on Twitter, then you are
following the wrong people.”
-via @TweetSmarter

http://jbmccrea.com/wordpress/wp-content/uploads/2014/12/State-of-Social-Media-in-the-NHS.pdf

http://jbmccrea.com/wordpress/wp-content/uploads/2014/12/State-of-Social-Media-in-the-NHS.pdf
❖ @PsychiatrySHO
❖ @Mental_Elf
❖ @MentalHealthCop
❖ @DrG_NHS
❖ @ProfLAppleby
❖ @ffolliet
❖ @DeeeDoc

Netiquette
❖ Contextless text - use emoticons? :)
❖ Flaming and trolling - just don’t.
❖ Know your abbreviations - LOL, IMHO,
AFAIK, KTB, FFS…
❖ Always proofread - spelling and
grammar
❖ Are you communicating with the right
media for the task in hand?

Security
http://amitay.us/blog/files/most_common_iphone_passcodes.php
http://www.nytimes.com/2010/01/21/technology/21password.html

Personal vs Professional Personas
❖ Article 8 of the Human Rights Act states:
“Everyone has the right to respect for his
private and family life, his home and his
correspondence.”
❖ Care needed to ensure policy does not
infringe our rights to freedom of speech,
and to a private life
❖ Would we accept policies that monitor and
limit what we say in public? Are tweets
and posts any different?
❖ Is it possible to separate who we are?
A Helpful Venn Diagram
The
Internet
Privacy
http://www.flickr.com/photos/buriednexttoyou/5095255302/

Sharing of Information
❖ 2008 USA survey showed 2/3 medical students use Facebook
❖ Only 37.5% of these made their profiles private
❖ University of Otago NZ - class of 2006
❖ N=338 - 65% had Facebook accounts
❖ Only 63% had activated their privacy settings
❖ University of Rouen 2010
Guseh JS (2009)
MacDonald J (2010)
❖ N=202 - 73% had Facebook profiles, 61% changed privacy
Moubarak G (2011)

Friending and Patients
❖ 76% of doctors in the Rouen survey felt that the doctor-patient relationship
would be altered if patients had viewed their FB profile
❖ Don’t accept requests if you are not absolutely certain who they are
❖ Ignore friend requests from patient
❖ Discuss the issue with them face to face if they persist
❖ Respect patients’ rights to on-line privacy and do not enter information
gathered from the internet into their case file without their consent

Developing Legal Trends
❖ #twitterjoketrial
❖ Unnamed footballer saga
❖ Ongoing case in respect of Twitter users who
wrongly identified Lord MacAlpine
❖ Upshot in UK as far back as 2011 - all tweets
are considered public domain material
❖ Material posted is permanent attributable and
searchable

Specific Problem Areas for Clinicians
❖ Boundaries
❖ Personal views
❖ Privacy
❖ Confidentiality
❖ Professionalism
❖ Harassment
❖ Anonymity
CC: Takomabibelot

GMC Cases to date
❖ Dr Kavasogullari
❖ In or around October 2010 and thereafter you stored
photographs of patients on an online storage site
without patient consent; Admitted and found proved
❖ In or around April 2012 and thereafter you posted 3
photographs of your patients on Instagram (“the
Patient Images”) without patient consent; Admitted
and found proved
❖ In or around April 2012 and thereafter you permitted
links to appear on your Twitter account to a) The
Patient Images, and b) The Third Party Comments
CC: Takomabibelot

GMC Cases to date
❖ Comments made:
❖ In relation to a photograph of a misshapen ear,
you commented: ‘I can’t hear you!’
❖ In relation to photograph of an avulsion injury
to a finger, you commented: ‘I said: “DO NOT
point your finger ever again” But he did...’
❖ In relation to a photograph of a cut forehead,
you commented: ‘the real Harry Potter!’
❖ In relation to a photograph of a cut wrist, you
commented: the ‘NHS should provide “How to
commit suicide effectively!” courses’.
CC: Takomabibelot

GMC Cases to date
❖ Dr Stamatov
❖ […] pursued two female colleagues in order to achieve a
personal relationship with them, despite them each
having categorically rejected his advances and made
clear that his attentions were unwelcome. His advances,
which included text messages, emails and Facebook
messages, were persistent, […] were sexually motivated
and extended to sexually suggestive physical contact.
❖ You admitted that on the day you were dismissed from
the Trust you posted a comment on Facebook relating to
your dismissal knowing that it would be seen by the
various Trust employees […] You accepted that the
language used was intemperate and inappropriate.
CC: Takomabibelot

GMC Guidance
❖ Part of process to update Good Medical Practice
❖ Came into effect as of 22nd April 2013
❖ To maintain your license to practice, you must demonstrate, through the revalidation process, that you work
in line with […] this guidance. […] Serious or persistent failure to follow this guidance will put your
registration at risk
❖ 8 additional areas consulted on to provide explanatory guidance on the GMCs
views on what is expected of doctors in the following areas:
❖ Acting as a witness in legal
proceedings
❖ Delegation and referral
❖ Doctors' use of social media
(new guidance)
❖ Ending your professional
relationship with a patient
❖ Financial and commercial
arrangements and conflicts of
interest

General
❖ The standards expected of doctors do not change because they are
communicating through social media rather than face to face
or through other traditional media. However, using social media creates new
circumstances in which the established principles apply.
❖ As well as this guidance, you should keep up to date with and follow your
organisation’s policy on social media.

Privacy
❖ Using social media has blurred the boundaries between public and private
life, and online information can be easily accessed by others. You should be
aware of the limitations of privacy online and you should regularly review
the privacy settings for each of your social media profiles. Because...
❖ Social media sites cannot guarantee confidentiality
❖ Others may be able to access your personal information
❖ Location information may be shared
❖ Information posted is permanent and distributable

Doctors’ use of Social Media
❖ Risks:
❖ Maintaining boundaries
❖ Follow separate guidance
❖ If approached by a patient you should indicate you cannot mix social and
professional relationships and direct to your professional profile
❖ Maintaining confidentiality
❖ Caution even in private forums
❖ Must not discuss individual patient or their care with those patients or anybody else
❖ Caution that confidentiality may be breached by the sum of info on-line

Confidentiality
❖ Confidentiality is the sum of on-line information

Confidentiality
Today
✤ Phew what a day! Ward understaffed, and annoying tribunal for that patient
with the stroppy relatives.

Confidentiality
Today
✤ Wow, the nerve of some people - admitted a really difficult patient with
stroppy relatives today. People don’t appreciate doctors!
Friday

Confidentiality
Today
Friday
✤ Looking January forward to starting on Ward 20 today!

Confidentiality
Today
Friday
✤ Looking January forward to starting on Ward 20 today!
✤ Nice to see our local NHS Tayside newsletter today, interesting article on
Sunnyside hospital - I’ll be there for my next job!
August

❖ Risks:
❖ Respect for Colleagues
❖ Covers all situations and all forms of interaction and communication
❖ Must not bully, harrass or make gratuitous, unsubstantiated or unsustainable comments
about individuals online
❖ Be aware that online content is subject to same laws of copyright, and defamation (or
libel) as other forms of communication
❖ Conflicts of interest
❖ You should be open about any conflict of interest and declare any financial or commercial
interests in healthcare organisations or pharmaceutical and biomedical companies

❖ Anonymity…
❖ If you are writing in a professional capacity, you should usually identify
yourself. Any material written by authors who represent themselves as
doctors are likely to be taken on trust and/
or to represent the views of the profession more widely.
❖ You should also be aware that content uploaded anonymously can, in many
cases, be traced back to its point of origin.

❖ Anonymity…
❖ 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.
❖ You should also be aware that content uploaded anonymously can, in many
cases, be traced back to its point of origin.

Backlash
❖ Doctors will disappear off Twitter and interaction will be lost
❖ Can doctors be trusted to exercise professionalism online?
❖ Doctor anonymity will help protect identification of patient cases being discussed
❖ Suggestions have been made to run two accounts - If one account is anonymous
and the other under a real name, then the user is bound to get them mixed up
❖ Why, when patient safety is not an issue?
❖ That doctors should have the right to be anonymous in their social media
activities just like any other profession
❖ Doctors will feel unable to comment on medicine and medical politics
❖ There are valid reasons to be anonymous
http://surgicalopinion.blogspot.com.au/2013/03/twitter-wars-on-anonymity-of-doctors-on.html

Further Reading
❖ GMC Doctors’ Use of Social Media - accessed at http://www.gmc-uk.org/
static/documents/content/Doctors_use_of_social_media.pdf
❖ Social Media and the Medical Profession: A guide to online professionalism
for medical practitioners and medical students. AMA, NZMA, NZMSA,
AMSA (2010) : https://ama.com.au/social-media-and-medical-profession
❖ BMJ Social Media Guidelines: Download a copy here
❖ RCGP: Social Media Highway Code: http://www.rcgp.org.uk/social-media

Further Reading
❖ Farnan JM et al (2008) The YouTube generation: implications for medical professionalism.
Perspectives in Biology and Medicine. 51(4):517-24.
❖ Chretien KC et al (2009) Online posting of unprofessional content by medical students. JAMA
302(12): 1309-15.
❖ MacDonald J et al (2010) Privacy, professionalism and Facebook: a dilemma for young doctors.
Medical Education 2010; 44:805-813.
❖ Guseh JS et al (2009) Medical professionalism in the age of online social networking. Journal of
Medical Ethics 2009;35:584-586.
❖ Moubarak G et al (2010) Facebook activity of residents and fellows and its impact on the doctor
patient relationship. Journal of Medical Ethics Online First DOI:10.1136/jme.2010.0362893

Email, apps and SoMe for psychiatrists

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