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Medical professionalism 10 20
1. The Evolving Role of
Healthcare Professionals
Matthew Katz, MD
October 20, 2011
2. Disclosures
• Doctor at Radiation Oncology Associates, PA
- Practice in MA, NH
• Volunteer for
- American Society of Radiation Oncology
- Massachusetts Medical Society
- Mayo Clinic Center for Social Media
•Financial disclosures: none
- No speakership, consulting, ownership stakes
4. What is a professional?
• Professional:
– “conforming to the technical or ethical standards
of a profession”
– “participating for gain or livelihood in an activity
or field of endeavor often engaged in by
amateurs”
Merriam-Webster.com, accessed 9/19/11
5. Social Media are
Communication Tools
• Global reach
• Easy access
• Little technical expertise needed to use
• Immediate impact
• Dynamic content
Wikipedia, http://bit.ly/mZcwaH
6. Social Media
• Presents perplexing challenge
• Transforming the way we interact
• Patients online for healthcare beyond the exam
room
• Unclear how best to get involved without harm
7. What data do we have on medical
professionalism online?
• Survey of U.S. medical school deans
– 60% of respondents confirmed medical students posted
unprofessional online content
• Profanity/discriminatory ~50%
• Sexually suggestive/intoxication ~40%
– Only 38% had social media policy in place
• Study of U Florida medical students/residents
– 44% had Facebook account
– 83% posted personal information, 70% had photos with
alcohol
Chretien et al, JAMA 2009
Thompson et al, J Gen Intern Med 2008
9. Risks of Social Media
• Reputation
– Expertise
– Patient satisfaction
• Career
– Medicolegal
• Patient harm
– Privacy violation
– Damage to doctor-patient relationship
• Boundaries
• Blurring of personal and professional spheres
10. Medicolegal Risks
• Disclosure of patient information
– Statutory risk
– Common law risk
• “Friending” patients
– Established
– Non-established
• Surfing social media sites of established patients
• Physician as employer: social media risks
• Malpractice & risk management
Terry Wall, ASTRO Annual Meeting 2011
11. Benefits of Social Media
• Collaboration
– Conducting research
– Clinical guidelines
– Donations for cancer care
• Connect with patients, others
– Marketing your practice or organization
– Enhance therapeutic relationship
– Share your research
• Education
– Patients
– Colleagues, CME
• Reputation Management
12. “Gamers produced an accurate model of the
enzyme in just three weeks”
Yahoo!News, 9/18/2011
13. AMA Guidelines
• Patient privacy and confidentiality must be maintained in all
environments, including online
• Monitor own Internet presence to ensure personal and
professional information is accurate and appropriate
• Maintain appropriate boundaries of the patient-physician
relationship in accordance with professional ethical
guidelines
• Confront medical colleagues that post unprofessional
content
• Actions online and content posted may negatively affect
their reputations among patients and colleagues and can
undermine public trust in the medical profession
Adopted 11/2010
17. We are public figures
• UK survey of 953 respondents in general public
• Professionalism based upon
– clinician
– workmanship
– citizen
• Respondents expected doctors to be:
–
–
–
–
–
confident
reliable
composed
accountable
dedicated
Chandratilake et al, Clin Med 2010
18.
19. Oath of Maimonides
“May the love for my art actuate me at all
times…
Grant me the strength, time and
opportunity always to correct what I have
acquired, always to extend its domain; for
knowledge is immense and the spirit of
man can extend indefinitely to enrich itself
daily with new requirements. “
20. Social media can extend our domain
• Doctors are healers and teachers
• Opportunity to learn
• Lead by example
• Re-embrace millennia tradition of caring
22. Evolution of Healers
v.
Era
Example
Divine
Healer/W Knowledge Scientific
ounded
Method
Dyad
1.0
Prehistoric Shaman
+
+
2.0
400 B.C.
Galen
+
+
+
3.0
18th-19th c.
Virchow
+
+
+
4.0
20th c.
Osler
+
+
In 2011, v4.0 is a century old
23. Medicine in 19th century
1846
Ether for anesthesia for H&N surgery
1858
Virchow’s Cellular Pathology
1859
Darwin’s On the Origin of Species
1860s
Claude Bernard Experimental medicine
1870s
Pasteur Germ theory, anthrax vaccine
1895
Roentgen’s discovery of x-ray
1899
Aspirin
24. Flexner Report (1911)
• Medical school education
– 4 years
– Merged into university
– Standardized quality
• Implications for professionalism
– Scientific method and knowledge trump caring
– Higher cost of training limits access to upper class
– Decreased access to poor, rural, people of color
– Marginalized other approaches
25.
26. M.D. = Master Dilettante
• Talented at absorbing salient information
• Integrating practical information and applying it
• Free from need for ‘complete’ knowledge
– Able to take diverse data, synthesize it
• Focus on education,care for patient and caregivers
– Values
– Understanding = listening to each other
27. Evolution of Professionals
Professional
Origin
Example
Doctor
5th cent. BC
Hippocrates
Nurse
1850s
Crimean War
Epidemiologist/Public
Health
Physical therapist
1840s
London trash
1813
Swedish Gymnastics
Paramedic
1860
American Civil War
Dietician
18th-19th c.
Social worker
1915
Flexner
Medical researcher
19th c.
Claude Bernard
Hospital administrator
1906
AHA
28. Social media:
with influence comes responsibility
Person/Entity
Rationale
Advertisers/Marketers
Split test = randomized trial
Mobile health app developers Influence health decisions
Social Networks
Ecosphere for interactions
Patient advocacy groups
Organizational advocates
Peers
Peers = trusted source of
information
Patients (all of us)
Ultimate judge of quality but
biased by experience
29. Ethos of Medical Professionalism
• Traditional
– Autonomy
– Beneficence
– Justice
• New
– Integrity
– Connectedness
30. Integrity & Connectedness
• Integrity
Being ‘whole’
Honesty
Transparency of intent
Willingness to change
• Connectedness
Centered on relationships
Links professionalism to how we interact
De-emphasizes knowledge, expertise
Repudiates notion of pure objectivity
31. Medicine 5.0
v.
Era
Example Divine Healer/W Knowledge Scientific
ounded
Method
Dyad
1.0 Prehistoric Shaman
+
+
2.0 400 B.C.
Galen
+
+
+
3.0 18th-19th c.
Virchow
+
+
+
4.0 20th
Osler
+
+
5.0 21st
?
+
+
+
Define professional Social media as challenge – risks and benefits Guidelines
-- Social media challenges our approach to interactions in healthcare -- Partly because we do not always provide information that patients are looking for, they’re going online to find it -- As professionals, not easy to just jump in when we’re obligated to “first, do no harm”
Developed in 2008 at U Washington “ fun-for-purpose video game in which gamers…compete to unfold chains of amino acids”
- Half of 50-64 year olds, ¼ of 65+ ysing social networking sites - 58% of all adults have looked for health information online
To know how to improve in the social media era, we have to look at where we’ve been
-- We are healers, not scientists - Our value is in what we do for our patients, not what we can do to them - To learn how to use these tools well, we need to start using them
- Not the first time medicine has faced challenges - Similar period of rapid change occurred about 150 years ago -- Medical advances during Industrial Revolution and social change -- Flexner Report culminated in defining basis for how we define medical professionalism – MD as scientist -- Focus on what we know and can do, not how much we care -- More objective, less willing to engage
