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21 November 2019
The RACGP recognises that GPs and general practice staff have embraced social media at a rapid rate, and guidance around safe and professional usage within general practice is necessary. Similarly, there are many health apps that have the potential to encourage better health but there are concerns about the accuracy and appropriateness of information in some apps and their privacy and security settings.
This webinar is designed to assist general practices in their adoption and use of social media and apps. In particular, it will provide an overview of social media advantages and disadvantages, associated risks and benefits, key considerations when discussing health apps with patients, appropriate online conduct, security and privacy requirements, legislation regarding advertising and testimonials, and the use of disclaimers.
Dr Tim Senior
Ms Mahala Boughton
MAHALA: Welcome to today's webinar - Social media and the use of apps in general practice, as part of our ehealth webinar series. My name is Mahala Boughton, I’m the Project and Events Officer for the RACGP Practice Technology and Management team, and I'll be your host for today.
I'm joined by Dr Tim senior, a GP based in Sydney. He will deliver the presentation for you today. Tim senior works as a GP at an Aboriginal Community Controlled Health Service in Southwest Sydney and is involved in teaching medical students and GP registrars, and is active in policy development and advocacy in Aboriginal and Torres Strait Islander Health. He is an award winning writer on General Practice and Public Health, and is a contributing editor and member of Croakey Health Media. He is active on social media, and was named as one of the top 10 health users of Twitter in Australia.
Tim, welcome to the webinar.
TIM: Thank you very much, have to remember to unmute myself before I talk to you. Good evening everyone.
MAHALA: Thanks Tim. So Tim, myself and the RACGP would like to thank everyone today for taking time out of your busy schedules tonight to participate in the webinar. We look forward to engaging you in this RACGP webinar and you are joined online by number of your peers as well as other key health experts that will be available at the end of the webinar to assist him in answering your questions. So before we begin I'd like to make an acknowledgement of country.
I would like to acknowledge the Traditional Owners of the respective lands on which we are meeting today, and pay my respects to Elders past and present. I would also like to acknowledge any Aboriginal and Torres Strait Islander people present.
TIM: These are our learning outcomes, and that's essentially educational speak for what we hope to get out of the evening tonight.
So we hope that by the end of this session we’ll all be able to describe the advantages and disadvantages of using social media and apps in general practice.
We’ll be able to implement a social media policy in our own practices.
We’ll be able to identify scenarios in which a general practice’s use of Health apps might assist in patient assessment and management
We’ll look at managing online testimonials so that we stay in accordance with the AHPRA Guidelines for advertising regulated health services, and we'll look at the privacy requirements that we need to think about when we're using social media in practice.
So these are the sort of things we're going to cover to achieve those learning objectives. We’re going to look at different platforms for social media in general practice. Not all of them, because there are a lot, but most popular ones that you'll most likely be familiar with.
We’re going to look at the AHPRA Guidelines for advertising regulated health services and online conduct, and what that means for our use of social media.
We’re going to look at the privacy and security requirements of us particularly in the use social media.
We're going to look at the way our practice teams, and the roles and responsibilities in our teams, are important in the way that we use social media in our practices.
We’re going to look at how we can recommend different health apps to patients, and we're going to look at some of the College Practice Technology and Management resources that are available to help with that. And then hopefully having done all of that, we're going to find some time for Q&A.
So social media, we’ll start off with some of the most commonly used social media platforms and some tips about how we can use them safely. There's lots of different social media platforms with different purposes and different audiences and there's new apps being developed all the time.
We're just going to focus on some of the more prominent platforms LinkedIn, Facebook, Twitter, and blogs in general. Someone was pointing out to me the other day about ‘Tik-Tok’ and how much fun they had looking at that. We're not going to look at that. But if you want to know more ask your teenage children.
With each of these platforms there really needs to be some parameters set around the use in general practice and particularly the importance of having a social media policy in the practice so that it's clear to all the staff, that covers their roles and responsibilities for themselves, and for the practice. And we’re going to look at the considerations of the best security measures in place to cover our legal requirements.
The RACGP technology team did a technology survey asking members their views and relationship with technology in general practice. And in that survey they asked if people use social media for work purposes. And one in four GPs that completed the survey said they use social media, and those that don't said it was mainly due to security concerns and confidentiality breaches that could result in liability for them.
Some doctors also mentioned that monitoring social media and online presence can be really time consuming and requires expertise that they don't feel they have, and again that can be really important in terms of developing practice policies.
If some of you know me, you'll know that I do use social media, particularly Twitter, but I’ve also been on Facebook. So I do focus a bit on the benefits in the ways of incorporating those benefits into our practice, and we'll look at some examples that have worked including some recommendations from the College.
It's so widely used these days, including by our patients, that we probably can't ignore it because that's where our patients are. So I tend to be a cautious advocate for social media use.
The next slide this shows us some of the advantages and disadvantages of social media.
As you can see it's a really low cost way, certainly in terms of financial cost (can be a cost in time), and there are concerns about privacy of our data when we using social media which is how social media companies make a profit. It can be a really good way of expanding our professional networks and getting information and expertise that we wouldn't normally have and collaborating across professions.
Different platforms can be used to cross-promote content and broaden our reach. So we'll see that different platforms actually have different audiences that we can reach out to. And for many GPs now, particularly important in rural and remote areas, it's a great source of education for GPs and for patients and for cross-professional education as well.
We'll talk about some of the risks about security and confidentiality and managing our professional reputation, which is important because people do listen to what we say because we're a trusted profession.
It's important to understand that information you put out. It is just about impossible to permanently delete, and if we really get into it, it can be time-consuming.
So if we start off with LinkedIn… many of you will be on there. LinkedIn actually is the world's largest professional network on the internet and apparently they have over 600 million members and half of those are active users. That's a professional directory of individuals and companies. And it's a way of networking with people in the same industry or in other complimentary industries.
Certainly I've got a LinkedIn profile and I'm a user, but I'm not a particularly active user, but it has allowed me to link in with people that I wouldn't normally have met including internationally and across Australia. And I have formed contacts and have been able to ask questions of people, and they've been able to ask questions of me about particular work that they're doing. Someone approached me on LinkedIn recently to ask for some particular advice about locum work they were doing in a remote part of Australia, it was very interesting.
There are a lot of recruiters on there, and people certainly use LinkedIn to find people for locum work, and GPs use LinkedIn to find locum work and local agencies for job changes. It could also be a good way of researching companies on LinkedIn, and actually linking with individuals within a particular company.
So apparently, there are nine million users just in Australia. So it's a huge network of people that can be really useful.
And on the next slide, these are some of the tips. I think one of the most important things is choosing an appropriate profile picture that creates an impression that you want to show. It doesn't take too long to look on LinkedIn to find profile pictures who have obviously have a wine glass in hand at a party and are using that for their LinkedIn profile, which may not be the image you are wanting to get out to your next employer.
You do get to choose those who you connect with, you don’t have to accept all the connections. So certainly use that to your benefit, think about the sort of people that you want to connect with and how interesting that seems or how beneficial that seems. Probably don't connect with patients… current, former or prospective. That may sometimes be difficult to tell and it may be difficult in an area, say in a rural area, and you have professional interests with people who are also patients. But those boundaries need to be actively managed.
If you have a practice page or your own profile, it's worth keeping that current so that if people are seeking you out on LinkedIn, it's not really outdated information that's on there.
Next up we talk about a social media page that you may well have heard of called Facebook. It was founded in 2004 originally as ‘The Facebook’ by Mark Zuckerberg who's become famous. And apparently there are 2.41 billion monthly active users on Facebook, which is massive.
And I think that's one of the reasons that despite people's reservations, people are still there because all the people they tend to want to connect with – family, friends, professionally, are also on Facebook. It's increasingly become a place where people go to get news and a place where people discuss things. Many of you will be aware of the network ‘GPs Down Under’ for Australian and New Zealand GPs, which is not affiliated with the college. It does have college people in there, but is a networking site where people share information, ask clinical queries ask medico-legal or political queries, even the odd joke gets in and there's quite a lot of members on there. Many of you will already know it. You do need your AHPRA credentials to join them and have discussions.
Many of us will also have a personal Facebook account, but businesses including practices can create their own Facebook page. It’s become increasingly popular to do so.
You might feel confident in managing your own Facebook account, but it's always worth going in and learning exactly how the security and privacy settings work. So, go into the settings and actively look at those. But it's particularly important to know how managing a work or professional page is done that can be different to you individual personal account.
So using Facebook to promote your practice - because all our patients are there, it's a really useful way of engaging with patients and community and make our practice have an online presence that’s not anonymous.
Patients look for information about businesses, including practices, to find out when they're open, where they are, even asking them questions, and in certain circumstances to look for health information as well. If you have practice website - because Facebook is often the first place that people go, then you can use [Facebook] to drive traffic to your practice page.
It's worth all the staff knowing how the staff manage their own social media privacy settings, because often that they'll be identifiable if they like or comment on the practice Facebook page. And it's important that at least one staff member is assigned to the task of updating and maintaining information, and that this is documented in in a policy so that all staff know what it is they should do and how that they can engage with that.
So business pages… the Medical Board of Australia (MBA) Guidelines for advertising regulated health services now say that practitioners are not responsible for removing or trying to have removed, unsolicited testimonials published on a website or in social media that they don't have control over. The original guidance actually did say we should remove those comments and they changed that due to feedback from the profession.
As soon as you put an address to go with your Facebook business page (which you do need for people to be able to find you) that enables the ‘star rating’ function of a page to appear. So you can see on here, just circled, the star rating function and it gives people a way to rate your business and it leaves the page open for comments, which could be good or bad.
But one of the things about that is that if people ‘check-in’ at your business, it can actually create a business page for you that you may not be aware of, so that's worth looking in to. So if you do have a practice page, or if you discover that you've had a practice page created for you, then do claim that. And you're able to go into the reviews page in settings and actually disable the ability to give reviews.
So that's the settings page, and under ‘reviews’ you can disable reviews if you click that button there. And that can be important, and the college does recommend disabling reviews for your practice because that disables the star rating as well. And so that means you don't need to monitor and moderate comments, look for reviews and worry about any testimonials or anything.
So while we're on the topic of reviews, it's important to note that even with reviews disabled on Facebook the practice can, and you individually as doctors, can find that you get reviews online outside of your control on other websites.
So there's specific websites, like ‘rate your doctor’ and ‘MD rating’ where people can leave reviews - and Google reviews which allows reviews to happen too. So the College has a fact sheet called Responding to online reviews, which gives guidance about how to deal with those. Most of the reviews you get it are actually positive, but if you do get an unfavourable one that can be quite upsetting and everyone's always tempted to respond to those. It wouldn't be the first time that someone had been wrong on the internet.
And so sometimes the best response to those can just be actually ignoring it and not drawing any attention to it. But that policy, which has just been sent out to you, that will give some more information on that.
It's worth saying a little bit about Facebook Instant Messaging. Again, because so many of our patients are there they often use Messenger to contact other people and practice staff. The problem with instant messaging is it's very easy to have a breach of patient privacy and confidentiality. Unless your patients have provided consent to being contacted in that way, and even then we need to be really cautious.
First of all, it's not secure. So the information being sent isn't encrypted. There is a method - so Facebook Messenger does have a secure channel that will encrypt the messages. But even then, even if you're using that, you don't know who's got the phone on the other end or who has access to the phone to read those. So you don't actually know that the person you think you’re communicating with is the right person. So we need to be really cautious about giving out any information and it's just it's recommended not to use the messaging feature to provide or discuss any health information because of that.
There have been times where there’s been other methods of trying to track down a patient, say for an urgent result that patient hasn't responded to, and Facebook Messenger has been used as a last resort. But again, use that to say “contact us” rather than anything that might breach patient confidentiality.
Moving on to Twitter. This is a different social media and it's known as a microblogging service, we’ll come to what blogs are shortly, but Twitter is designed for sending tiny, brief updates over the internet. And it was originally designed to be used as text messages, so that's why the limit was initially a hundred and forty characters.
They've doubled that limit to 280 characters, but actually most tweets are still pretty short and the most common length of a tweet is 33 characters across all users. Twitter is available for everyone to read but only registered users can post tweets as well. It's a really good way of staying in touch with what's happening now, so it’s a good way of staying in touch with news and particularly breaking news.
It's a good way of staying in touch with what's happening at conferences, because people tweet out from conferences about what the speaker is saying and often commentary about that. And for that reason, I think it's very popular with GPs.
There's a good GP cohort on Twitter, and a broader medical cohort, that engage in a lot of conversation and discuss patient care and evidence and things. You can follow people, there's no need to follow back, and you can follow topics that are trending globally so it can be a really good way of keeping up, I’ve found.
So these are the advantages of using Twitter, you get to be part of conversations and start to build a community. Over the years that I've been using it, people will now bring me information that they know I'll be interested in, and I know people will be able to provide comment on things or who have views that I know will be worth hearing.
Tweets originally built for text, but they can include links to other websites and can include photographs. They can include videos, and it's often those tweets with video or photographic content that are often the most shared, which called retweeting or ‘liked’, and that they're particularly engaging. I said you get to choose who you want to follow, so you don't have to follow anyone back if they follow you. People will often follow for a particular length of time while they're interested in something and then un-following later on. Hashtags are really useful because they were developed from Twitter audiences. They started putting hashtags as a way of categorizing tweets containing particular information. So that caught on through the use of Twitter, so now you can click on a hashtag.
To follow all the tweets that contain that hashtag. That's really useful at conferences. The example on slide is GP 19 - that’s actually a mix of general practice and Grand Prix Tweets in that, so that the official conference hashtag is actually a hashtag GP19 Adelaide. You could still go back and see all those old tweets on there. But that’s a good way of finding out what people are saying about a particular subject.
So tips for using Twitter. It’s worth following people who could have a positive impact on your practice. You don't have to follow everyone, you can unfollow if they're not very interesting. It's worth tweeting regularly. So keep your own followers interested in terms of building a community. It's also worth if you're tweeting saying something personal about why you're tweeting what you're tweeting.
So rather than just a headline, but what's important about that to you, what it influences in your practice. It’s worth remembering from the AHPRA guidelines to not re-Tweet testimonials made by others saying how marvellous you were, because AHPRA may take an interest in that sort of thing. Do maintain professionalism when using Twitter and check your spelling, as this would actually be good advice for a certain US president, though he has invented some nice words that have become fun usage.
When you're on Twitter, people will recognize that you're a doctor and anyone can see those tweets. So it’s about being professional and not getting drawn into the sometimes bitter arguments that can occur on Twitter. Being supportive, being engaging, checking spelling - all of those things that design a community well.
And if you use hashtags, then you get to comment on particular topics that are going around at the time and there's a hashtag for pretty much any subject that you would want to be interested in such as women in medicine - that's particularly interesting one given some of the contents of the MGA this week. And for example digital health, if you follow Australian politics ‘AusPol’ can be a place that you may not want to spend too much time there.
Next up is Instagram and this is a site for photo and sharing short videos. There is a real reputation on Instagram for following businesses or brands that are promoted by influences. So people who develop a large following and then they are actually paid to promote brands or products or businesses. And Instagram probably has more of a focus on that than other social.
Users can follow you and you can follow them, and it's a very pictorial method on Instagram, can be quite engaging. It's the third most popular social media platform behind Facebook and YouTube. And also the users of Instagram tend to be younger than users of Facebook. For example, so if you want to reach a younger audience it will be worth having a presence on Instagram and knowing the difference between the different sorts of audience. It can be a really helpful.
So the advantages of using Instagram, it's really useful for visual images. And so it can actually be a way of showing (with the consent your practice staff) showing the rooms around, showing interesting things, interesting images in the practice or about healthcare. And again, it's another way of driving traffic to the website and also other social media pages. The picture you see there is the College's Instagram page, and you can see the bottom half of that picture, images that the College has shared, and often that's with a small amount of text as well.
It's worth noticing some of the images are actually text-based images that make it more engaging for people, and infographics are often a really good use of images, particularly on Instagram, but also on side other social media as well.
So again as with all social media, it's worthwhile getting to know the privacy settings and knowing how to operate those. For an Instagram post you can turn comments on or off and you can do that before you share a post or you can do it after you've shared a post as well.
Be careful. So wit all of the social media – we’ve talked about Facebook Messenger earlier - it's become its own messaging platform on mobile phones and tablets. But all the social media have the capacity to do direct messaging. So Instagram has it too, where you can send a message privately to people and Twitter has that through direct messaging as well. Those aren't secure messages. And so the same advice applies with those about being very careful about confidentiality and privacy in using the messaging from that.
Facebook and Instagram actually owned by Facebook now so it's very easy to link your Instagram and Facebook accounts to share posts across both platforms and that can save a lot of time in terms of sharing posts from the practice. And again Instagram has made good use of hashtags as well to group things by different topics.
So blogs. Again, these are blogs that are short for web logs, and they are where you can write and publish longer articles about whatever you're interested in. So they can be for business or personal use and they can focus on a particular topic that you're interested in, or it can focus on across a range of topics. So a practice could have their own blog, or an individual GP, or practice staff and could have their own and write things about their practice or broadly about the health sector, either locally or nationally, or about health issues that might be of particular interest to their patients or that they have a particular expertise in.
So I do have a blog but it's not been updated very regularly because I've been writing for other people's blogs, particularly Croakey which has a broad focus on health promotion health equity and public health issues. So if you're writing a blog it’s a good idea to keep it updated to keep people coming back.
There’s a few examples on the next slide of really good blogs. Edwin Kruys, you may have come across, he has a blog called the Doctor's Bag, which he keeps updated regularly. He's a GP and he writes about interesting health policy issues. And as you'll see that's a picture of the blog there. And then he promotes this blog from his Twitter account, as you see there, he's got a good Twitter account. If you look at this here, you'll see over on the right, it says ‘lists’. Edwin actually keeps a list of GP bloggers, and a list of GPs on Twitter. And so that's a good place to go and find out other people to follow on social media.
And then on the next slide we see this is his Twitter account where he's posted a tweet that links back to his blog, so you can see it's just a headline and then that links back to the longer article on his blog. So it's a great way of driving people back.
So in terms of blogging, they can be hosted on free web sites like Blogger or WordPress, or sometimes you can actually pay to have a domain registered for a suitable name.
If you're doing it as a practice, it's worth having a practice protocol or policy on managing and monitoring the content and the feedback that you get. Especially to develop an audience which post comments on the blog, and how you manage and moderate those comments will be quite important particularly, given that you'll be controlling the content of a blog unlike the content of some other social medias. And it may well be worth adding a disclaimer that your blog isn't a place for people to ask clinical questions because you can't go into it.
This is a little note about disclaimers. This is my Twitter profile there, and it's worth having a disclaimer on your social media pages just to be clear for people that the opinions you're posting, who they represent… So I like to make it clear, because for those of you know me on Twitter, I say some things that may not be endorsed by the College, or by any other organizations that I work for. Those aren't my employer’s opinions and they might not even be my opinions. And it's really important that people understand that. And so another example of a disclaimer on the practice page might be something like “this account reflects the general practices views and not those of any businesses, committees, or boards that staff are involved in” and that sort of thing that just makes it clear to the audience whose views are being represented on the on social media.
So this is probably my favourite social media policy. This is from the Mayo Clinic and they wrote a 12 word social media policy, which goes in its entirety: Don't lie. Don't pry. Don't cheat. Can't delete. Don't steal. Don't reveal. And so it's fairly self-explanatory, particularly for health professionals. It's generally good will not to lie. That wrecks the trust that people have in you.
Don't pry. We don't seek out personal health information online. We take care of the health data and the potential for breaching confidentiality.
Don't cheat and can't delete. It's anything that you post that you try to delete. If it's controversial, someone Could have taken a screenshot of it. So in general, I like to think that I don't post anything on social media that I wouldn't be happy shouting from the rooftop of my local hospital or discussing with people in public in the lift.
Don't steal. So where you are using an image or a quote or something, attribute that and give attribution to people, give credit where it's due and acknowledge those people who have helped to develop ideas.
And don't reveal, don't give away information that would be private to you, the organisations that you work for, or for example embargoed research reports, or to speak to some press reports that you may be party to.
And privacy is important because social media takes place in public. And so this is the college resource called Privacy and managing health information in general practice.
And again, they AHPRA social media policy is to be read in conjunction with Medical Board policy for the majority of persons here who are doctors.
Security goes alongside privacy as well. And this is the RACGP Information security in general practice. So we should be using IT that is secure so that our internet and Wi-Fi connections are set up properly and have correct passwords which are difficult to decipher.
We should have a social media policy because that makes sure everyone's clear about what we're doing. And we should have processes in place to ensure that our use of internet at work is appropriate. That doesn't mean not using it for any personal activity, but just that we're not putting ourselves or our practice at risk through inappropriate internet usage, or at risk of security breaches in our practice.
So roles and responsibilities in the practice. As I said, a policy is really important. This makes sure that people are clear about who's doing what and why, so it's worth having a staff member, or perhaps more than one, to update and maintain your online presence and maintain online information. So there’s someone responsible for that and everyone knows who that is.
The that role should be clearly defined in the social media policy, who that person is. And it's worth training staff in best practices around using the internet. So including those protection measures against malicious software for the further security of software. And also about how to use the security settings and privacy settings.
Lets go on quickly to talk about health apps. Apps is short for applications, they used to be called programs when I was young, but now called apps. And that's just a piece of software program that runs on a smartphone, or computer, or another electronic device. So they can be divided into five main categories for health apps - there is Healthy Living, which is the majority of apps. They focus on things like healthy eating, physical activity, smoking prevention, mental well-being.
Some apps are for clinical diagnosis such as symptom checkers, digital imaging lab results review. Some apps are for remote monitoring - so remote heart monitoring, glucose levels, telehealth services and often Fitbits and Fitbit programs would fit into that category.
Personal health records. So they keep a record of health information, and in Australia there are some apps that have actually been designed to work with My Health Record. So there are these are called Health Engine, Healthi, Tyde, and My Child eHealth Record and Health Now. Those haven't been developed by My Health Record, they’re independent companies, apart from My Child eHealth Record.
There's a list of those that has just gone in the chat box now. And finally the final set of apps is apps for reminders, such as those that remind you to take medication on time.
Again, and I think that's probably consistent with the Technology survey again, where the number of GPs recommending health apps is increasing, so in the last one it was 60% who are recommending apps for their patients on a daily or weekly basis and that's gone up from 40 percent in 2017. And GPs who rarely or never recommend apps is 26 percent, which gone down from 47 percent. And again on the left, the most recommended types of apps are mental health, it’s very common, and family planning is an important one there as well.
And the College has developed a fact sheet on apps that'll help you in recommending them. One of the problems we have is that there's very little research on how effective apps are. So if we're recommending apps it's worth us reviewing the app description in the App Store, and the user ratings and reviews to get a feel for what people are saying about it and whether they're finding it useful. It’s worth seeing whether the app is intended for the use that we want it for, and then is it engaging? Is it using simple clear language?
Certainly, there was some research published by Louise Stone in the Australian Journal of General Practice recently showing that actually the technological and literacy levels required to operate mobile mental health apps was actually beyond quite a lot of our patients. So that's really important about whether it uses simple clear language.
Is the information that uses evidence based? And then you can pilot the app, and you can also ask trusted patients to trial it for you and tell you what they think as well. Because one of the problems in terms of reviewing the safety and effectiveness of apps is that there's no regulation. So there's very little evidence around what apps are useful, and so we're relying on reviews from our patients and from reviews in the App Store because there isn't any regulation.
Health apps that claim to diagnose or manage health conditions by analysing clinical data or test results could be considered medical devices and so those would come under regulation with the Therapeutic Goods Administration. Understandably, most app developers don't make those claims so that they get to avoid having to do that.
Vic Health has created a healthy living apps guide where they reviewed over 300 apps. And the NHS also has a health apps library to help guide their patients choice and there's a link coming through to both of those resources now.
These are the resources produced by the College Practice Technology and Management team. And we’ve discussed one or two of these already, but on the left is the Social media in general practice guide, which goes into some of the things in more detail that we've talked about earlier on this evening.
The RACGP Information security in general practice that we've mentioned already tonight and the RACGP mHealth in general practice, which is about effective and secure use of mobile technology which is going to be increasingly used in general practice. And so getting across what that's going to do for us, I think is going to be important. Again, I think links to those have been posted in the chat box for you.
So there are upcoming eHealth webinar topics coming. And the good news is I saw questions coming through in the in the question box and we've actually got time to deal with some of those now.
MAHALA: Yes. Thanks Tim. So that almost brings us to the end of the webinar. Thank you for a great overview of social media in general practice. So as Tim mentioned we do have time for Q&A. So if there's a question you have had from today's presentation, please send them through now.
One question I've got here, Tim, is about messaging colleagues on social media to discuss to discuss a patient.
So someone here says I have a specialist who's a Facebook friend of mine who contacts me to discuss the care of patients or they’ll give a quick update about a patient and they'll send me a report afterwards - I'm assuming that means through the usual channels in a practice - is this okay?
TIM: That's a really good question. I suspect it's done because it's such an easy way of contacting someone. What I’d be wary of doing that is it's not an encrypted channel. So with this, you know it's a specialist who's on the other end. But because it's not encrypted that information can be, in theory, seen by anyone else intercepting the data between them. So the potential for including specific patient information in that even if there's no name or date of birth, particularly with rare conditions it's quite easy to identify patients. And so I think we need to be really careful about that. If you're using either the secure messaging of Facebook Messenger or one of the secure apps such as Telegraph or Signal, which are built for security, you're more likely to be able to protect yourself and be confident that the knowledge is being securely sent between yourself and your and your colleague.
Obviously sending a report afterwards is good, and the main difference between doing that over messenger and doing it by phone is actually that our phone disappears once the words have been said whereas, the message can stick around in text format for a while afterwards. So I think I'd be cautious, particularly if it's not secure, and there's patient information being included in those in those messages.
MAHALA: Thanks, Tim. And the next question here is should we keep our personal Twitter / Instagram under different names? I'm assuming to their real name.
TIM: Yeah, that's a really good question. Actually in the in the UK the GMC which is their equivalent of their AHPRA Medical Board recommended that doctors shouldn't be anonymous on social media if they're identifying themselves as doctors because it made them less accountable for what they were saying in their professional comments. I think it's a personal choice, there’s no particular guidance. I am known by my own name on Twitter and have quite a few followers. Now that was a decision I didn't particularly think about at the start, but think about quite a lot now in that what I post, I make sure is professional.
I think particularly if you're concerned about privacy, it may well be worth doing it and certainly now people on Facebook who have a sort of pseudonym or a clue to their pseudonym as their Facebook name, and certainly for personal use people do have a separate account for personal use and professional use, that again is separate from that practice account. So I think it's worth getting to know the privacy settings and becoming comfortable and familiar with those. And then setting up accounts as you see comfortable and using them as you're as you're comfortable with.
MAHALA: Thanks, Tim. and just going back to the last question about discussing a patient over a social media chat feature. Can we use the identified information to discuss the case and could we use an app like WhatsApp which is encrypted?
TIM: Yeah. So if WhatsApp is encrypted that would be safer and the other secure apps, Telegraph is one and Signal is another… I think it's Telegraph. And journalists are often using those for secure communication as well. The de-identified information - yes in theory. They're actually used de-identified information to show it's relatively easy to re-identify it sometimes, and that'll be more common. So given that the the messages may be tagged with the location, and so the likelihood is that you're talking about a patient in the location near your practice and particularly if there's rare features of an illness that can make someone readily identifiable even without any names or dates of birth used.
So I think it's if it's a common condition then you're less likely to run into into difficulties. Sometimes the way of de-identifying makes the conversation less useful because there's not much information to go on. So again, need to be very careful about de-identifying and it may be that the most appropriate messages are “Hi. Can I have a chat to you about a patient, please?” And then doing it not over the internet, but using voice or other secure messaging.
MAHALA: And the next question here, are there rules around boosting posts or paid advertising of the practice on Facebook or something similar?
TIM: That's a really good question. So the rules around that… so they would be would be governed by the AHPRA guidance on promoting your practice. So there's no specific rule, that I’m aware of, that says you're not allowed to boost the post. I think that's okay. It would it be the content of the post that you are judged on, so you wouldn't be able to put a post that contained patient testimonials about your clinical services and you wouldn't be able to put a post claiming that you are more efficacious than any other particular doctor. So it's the content that you'd be judged on by AHPRA and not the fact of boosting a post.
MAHALA: And this next question - this person just wants to check, so we should not encourage Facebook reviews or turn off the review feature to meet AHPRA and best practice guidelines. Is that correct?
TIM: So AHPRA don't say you have to turn off the reviews, but the College recommendation is doing that. If you don't turn them off, you need to have an active policy about how you're going to manage those reviews and respond to them. I think it opens it up for active monitoring and how you're going to respond to the potential for trolls to say nasty things about a practice, for responses to reviews that accidentally break patient confidentiality. So you're not compelled to do that, but I think if you do leave reviews open, then you need to have an active policy about how you're going to manage the range of responses that come in, which hopefully will all be lovely but there are people who will post nasty comments just for the kicks.
MAHALA: And as a doctor, is it unprofessional to express views? For example on art, music, or movies?
TIM: I hope not because I do that and I actually don't think it is unprofessional. I think people like seeing that doctors are human too and that we have lives outside our clinical care.
That can actually be really engaging seeing that someone, say, has really enjoyed going to a U2 concert this week, or that they are enjoying playing in their in their band, or that they have a particular liking for Bollywood movies. And it moves the doctor from being this sort of clinician to being this human being, who has a broad range of interests.
So the same rules would apply that you don't insult people who don't like the same directors as you do. But actually people really appreciate seeing… it’s one of the advantages of social media, engaging with patients, is that actually people love seeing that their doctors are human and enjoy the whole of life. And I think it makes us better doctors when we do that.
MAHALA: I think that's a really nice place to end the webinar. So thank you for that, Tim. That was a really great presentation, and thank you everyone for joining us tonight and taking the time out of your night to do so. So if you do have any further questions that come to mind after the webinar, please email firstname.lastname@example.org and we will get back to you as soon as we can. So Tim, Thank you.
TIM: Thank you very much everyone. Thank you for your great participation, I really enjoyed it. And I hope all across Australia that you'll stay safe. If you have heat and bushfires near you, I’m thinking of you all.
MAHALA: Yes, certainly. So enjoy the rest of your night, everyone. Thank you and goodbye.
TIM: Thank you very much. Good night.
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