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Social media in general practice webinars

To help GPs navigate the world of social media safely, the RACGP has presented webinars on social media in general practice that explored the benefits and risks, particularly regarding privacy issues, the use of disclaimers, advertising and testimonials. The webinar follows a case study that demonstrates how different social media platforms can be used in general practice. A recording of the webinar is available below.

Social media in general practice webinar

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16 September 2015

 [Slide – Introduction]

Betty Petkovski: Welcome to the social media webinar. My name is Betty Petkovski and I will be your host today. Angela Whitworth, an RACGP, who will be assisting with answering your questions for this evening, and Dr Tim Senior, a GP based in Sydney who will be delivering the presentation for this evening.

Tim Senior: Hello

[Next Slide – About your GP presenter]

Betty: And there’s Tim on our screen, hi Tim thanks for joining us.

Tim: I’ve activated my camera but I won’t leave it on all the time because it chews up bandwidth but it’s sometimes nice to put a face to the name.

Betty: Definitely. Thanks Tim. Dr Tim Senior works as a GP at Tharawal Aboriginal Corporation in South West Sydney and as the Medical Advisor in the RACGP National Faculty of Aboriginal and Torres Strait Islander Health. Tim has previously worked as a Medical Educator and has practiced in the Northern Territory and Thursday Island, and in the UK. He is active on social media and was named in the top 100 Twitter health and change care leaders by ‘The Edge’ NHS, and he is also in the Top 10 most followed health Twitter accounts in Australia. In his spare time Tim likes to grow some vegetables, brew some beer and play some music. So thanks for joining us tonight Tim.

Tim Senior: It’s my pleasure. It’s fantastic that people have taken some time out to join us, I think it’s going to be an increasingly important topic in medicine. The other thing I’m aware of is that there is a lot of wisdom around in the webinar, in the room, so I hope that we’re able to have a bit of discussion and a lot of people participating.

Betty: As you just said, myself, Tim and the RACGP would like to thank everyone for taking their time to join the webinar this evening.

[Next slide - Acknowledgement to Country]

Before we begin, we would like to make an acknowledgement to country. We would like to acknowledge the traditional owners of the land on which this event is being broadcast. Thank you for providing access to this part of your country.

[Next slide – Tips and tricks for you]

As some of you may be new to webinars, I would just like to talk about your control panel. We will refer to your control panel throughout the webinar, and your control panel looks like a blue-grey box like the one on the PowerPoint slide there. And it enables you to pick your audio controls and also to send us questions throughout the webinar. If you can’t see this box just click on the red arrow in the top corner, not sure if you can see my curser there, it’s just circling that red arrow. If you click on that it should expand your control panel.

[Next slide – Tips and tricks for you]

During the webinar we have set all attendees on ‘mute’, this is to eliminate any background noise. If you do have any questions throughout the webinar, like I mentioned, we do have the question box. Angela is monitoring that, and myself and Tim can see that throughout the webinar as well. So you can send any of your questions through there. I’d also like to highlight that at the bottom of each slide there is a number that you can call if you are experiencing any technical issues, in the meantime you could send them through the question box, but it would be best to give that number a call and someone should be able to help you on the line.

[Next slide: Do you currently use social media?]

Betty: Now first thing we would like to do is to practice using that question box, so what we would like to ask our participants online is, do you currently use social media. In your answer could you either put ‘Yes’ and ‘Personal’ if it’s for personal use, or ‘Yes’ and ‘Practice‘ if you use it for your general practice, or the other option of an answer is ‘No’. 

Tim you should probably be able to see as well, we have all those answers flooding through there. It seems like a bit of 50/50 for the moment, and a lot of people using it for personal use.

Tim Senior: So a lot of people using it for personal use there and a few using it in the surgery, in their practice. It will be really interesting to hear their perspectives of how they’ve been using it. Someone is mentioning ‘GPs Down Under’ on Facebook, which is one of the largest closed Facebook groups that people are finding quite useful for education now, so that’s good to see some other members there. I’ll give you a wave on Facebook when I’m next there. A lot of people on Facebook, probably fewer in Twitter and a comment there that’s an important thing to discuss: “patients try to track me on Facebook”, which I suspect a lot of doctors have had happen and having a way of dealing that can be quite important.

Betty: I’m sure that’s something that we’ll cover as well later on in the webinar.

Tim Senior: and hearing how people deal with that can be important. I think one of the important things that everyone will find with social media is that sharing of information, that collegiate peer support is one of the things that GPs find most useful about it.

Betty: Definitely. I’d also like to mention to our participants that we have a very large number of registrants this evening. We’ve got over 200 people registered for this webinar. So please send any questions throughout the webinar and we will have quite a big session at the end where there will be more of a Q&A session. If we can’t get to any of your questions throughout the webinar, they are all recorded through GoToWebinar, so we will get to them in the next couple of days and ensure that we answer them as well.

[Next slide: Polling questions]

Betty: Now the last feature of GoToWebinar that I would like to talk about is ‘Polling Questions’. Our polling questions will basically help Tim to be able to tailor the presentation to the audience. So I would like to launch the first polling question. The first question should come up on your screen, and that is ‘what is your role in your general practice?’ You’ve got the options of ‘GP’, ‘Practice nurse’, ‘Practice manager’ or ‘Other’. Now if you are selecting ‘Other’, it would be great if you could please send through which organization you’re representing or what your role is through the question box and just so we can get an understand of where everyone is from. If you are using a smart phone or an iPad or tablet to join us this evening, you won’t be able to answer these polling questions through the feature but you can send it through in the question box, so that would be great as well.

I’ll just close off those polls and share those results Tim. 88% of our attendees this evening are GPs. We’ve got 5% Practice managers and 6% have selected ‘Other’.

Tim Senior: excellent, that’s fantastic. Lovely to see so many GPs and I think the profession is throwing itself into social media. But I would like to give a special shout out to practice managers and other people as well, general practice and primary care is such a team sport now that it’s fantastic to have other professions joining us as well. You are very much most welcome.

Betty: Definitely, thanks Tim. That concludes the little tutorial on how to use GoToWebinar. Tim I’d like to hand over to yourself to start the educational part of the session.

[Next slide: What is your definition of social media?]

Tim Senior: Essentially, I just wanted to start off again with a question really, and you can put the answers into the question box, what your definition of social media is. I think it’s one of those phrases that everyone uses at the moment. But often it’s one of those phrases that to everyone means something slightly different. I’m just curious to see how you define social media, what you think it is. So put your answers in the question box now.

Betty: So we’ve got ‘interactive online sites for example Facebook, Twitter and Instagram’.

Tim Senior: ‘Not talking face-to-face’ and that’s an important aspect actually, talking face to face is probably social, though we don’t think of it as media. And it’s important that we shouldn’t actually lose that ability.

And a lot of people mentioning different tools, Facebook, Twitter, and Instagram. Media like that. ‘Anything online’. Some people are talking about ‘blogging’, some people talking about sources of news and sources of sharing clinical resources. Some people are talking about any form of contact really, where it’s not direct. And interestingly, it can be real-time. Twitter is real-time contact and blogging is very synchronous, so it can work in both ways.

[Next slide: What is social media?]

Tim Senior: Thank you very much for those responses. I think it shows that it’s something that we’re all feeling out way with. The Macquarie Dictionary defines social media as ‘online social networks used to disseminate information through online social interaction’, which I think is the sort of essence of what everyone was saying, when people were describing some of the tools available. And we’ll go through the use of some of those tools in practice as well. But essentially it’s used for a range of interactive things and I do think the key word is ‘social’ rather than ‘media’.

And to some extent, its use is only limited by our imagination to how we think it might be used.  

[Next slide: What will you get out of today’s webinar?]

We’ll be looking particularly at some of the most common uses, commonly understood as ‘social media’: Facebook, Twitter, LinkedIn and blogging. There are others, people have mentioned Instagram. I used Periscope for the first time today which is a live video app. YouTube is social partly because of the commenting, so there is a lot of other social media tools out there.

[Next slide: What will you get out of today’s webinar?]

We’re going to look at how to use it in practice, particularly it’s slightly different using in practice to using it just personally, and think about the importance of having a social media policy. Thinking about security and privacy and our legal obligations and staff roles and responsibilities. For the final section we’re going to have a chat with Dr Tim Koh who is a Western Australian GP, well hear more about him as to how he uses social media as well.   

[Next slide: Setting the scene]

Betty: Thank you Tim. Now we will be running through a case study as well to sort of set the scene so you can see how social media could be used in a general practice. Basically we’ll be starting with Dr Singh who is a GP in Melbourne and owner of The Good GP’ family practice. His receptionist Dorothy has just resigned. Dorothy had been working in the clinic for a long time and is now finishing up in the practice and heading into retirement. Although he is sad to see her go, Dr Singh needs to recruit someone ASAP to take care of the front desk and appointments for his busy four GP practice.

[Next slide: What is LinkedIn?]

Dr Singh is a little bit social media savvy. He has a personal LinkedIn page where he is linked with colleagues and his peers. He discovered that having a LinkedIn page for the general practice would be great way to connect with other professionals and to find a replacement for Dorothy.

Tim Senior:  Many of you probably have a LinkedIn network, and it’s a bit like Facebook for professionals. It very much focuses on your professional life and it’s a directory for individuals and companies that you can form mutual links with. You connect with someone and they connect to you. It’s the largest professional network worldwide. Apparently with 300 million members around the world, it’s a huge number. People use linked in for professional networking, connecting and particularly job searching. So those of you who are on LinkedIn may find some useful professional connections there and also some connections for people who are keen to advertise job opportunities to you. Interestingly, in the scenario, it’s probably a pretty savvy idea to ask your practice manager to use LinkedIn to find someone who is social media savvy. So we’ll have a look at LinkedIn and how to use this.

[Next slide: Advantages of using LinkedIn in general practice]

So there’s the sorts of things that LinkedIn can do for you. It allows you to search companies and look at people’s CVs, essentially online.  There are also discussion groups on there where people discuss everything form sort of leadership to healthcare and medical practice. The College does have some LinkedIn groups linked into the National Faculty of Specific Interests. It allows you to build a curriculum vitae for yourself online that other people can easily look at if you are in the job market, and also has the social advantage of being able to share articles with comments to others in your professional network and for them to share things with you. That’s often one of the most useful things. There’s a free membership and you can pay extra for a premium membership. I’ve not done that, so I’m not quite sure what’s involved in that but you get more job search and search requirements, but it’s pretty good for looking up companies and for connecting professionals. There’s some apps now that allow you to use LinkedIn at conferences and connect through Evernote and Business Cards and finding people on LinkedIn.

[Next slide: LinkedIn]

Betty: Dr Singh decided to advertise the receptionist position on LinkedIn. He is looking for a candidate that has experience as a medical receptionist and also someone who is social media savvy to manage the practices’ social media pages. And Tim let’s go one with some tips for using LinkedIn.

[Next slide: Tips for using LinkedIn]

Tim Senior: it’s always been entertaining to look around on LinkedIn and look at what people choose to use as their profile picture but I think because it is professional it’s often quite important to use a sort of professional looking picture rather than of the one of the party on the beach with you half-dressed. You can choose who you’d like to connect with, there’s no necessity to accept all connections. LinkedIn themselves recommend just connecting with people that you know, but I’m sure that’s not what most people use it for. But there’s no obligation on you to accept people’s connections or for them to accept yours.

You’re able to, as part of your CV, use the Projects function to add current and past projects that you’ve developed and worked on throughout your career. You’ll see some GPs using this for presentations that they’ve done at conferences or for work that they’ve done for example through Medicare Locals and Primary Health Networks or through academic work and teaching things. It can be helpful to highlight the sorts of skills that you have. Because LinkedIn is a professional networking site, certainly it’s not recommended to connect with patients on LinkedIn. I think the reasons for that are reasonably obvious. There may be exceptions in particular circumstances but as a general rule I think that’s what I would recommend.

[Next slide: Hello My Name is Maria]

Betty: Dr Singh hires Maria as his receptionist. Maria is very competent in using different social media platforms both professionally and personally. Using the RACGP ‘Guide for the use of social media in general practice’, Maria reads about the security aspects of social media and what should be considered before they develop the practice’s social media pages.

[Next slide: Security in social media]

What Maria found in terms of social media security in general practice includes the following and I’ll hand over to yourself Tim…

Tim Senior: So the College has some computer and information security standards which are now in the second edition, and that’s worth visiting. Many of you already know about that. Because social media is so easy and getting online is so easy, it can be easy to forget about the security, particularly when you’re using it for your practice. So that talks about security about particular computers, security around digital technologies, and there’s been a lot about that in the press over the last few years. But also the security of your actual internet and Wi-Fi connections themselves, so people can’t get into your system and hack your system that way and there are some stories of that sort of thing happening. It’s important, because there’s so much confidential information in your system, and that social media is by definition connected to the external world, it’s really important that your practice is protected against exposure to unauthorised access and theft or loss of personal information. So do check out the Computer and information security standards from the College with contains more detailed information on that. I think it’s worth doing just because social media is so easy.

[Next slide: Roles and responsibilities]

Betty: Definitely, and Angela has also sent the link to that resource through the question box. You can access that there. The Computer and information security standards also have an accompanying document that has templates in there, and you can use those templates to develop your own asset register and your practice policies around this as well.

Now Maria does use the RACGP Computer and information Security Standards, to check their hardware and software security prior to engaging in social media. She also developed a practice policy with the provided templates.

Tim Senior: So one of the important things, social media can be so busy and it’s important that if you’re using social media for your practice that you assign a staff member or several staff members with clear responsibilities to actually manage the social media. So keeping the information maintained so it’s accurate, because people, patients and the community will use that, and to keep it updated. There’s nothing like a site that it’s not updated to make sure that people don’t visit it. Those roles and responsibilities of your staff members should be documented and clearly defined in the social media policy. So that it’s clear what’s expected of them and the sorts of things to be posting. It can be quite quick interaction back and forward clearly on social media and so it’s very difficult to say ‘right, check every post on Twitter’, so a degree of trust may be required but if it’s documented in a social media policy for the practice then that will give real clear guidelines for everyone concerned.

Betty: In this case, Maria is the staff member who has been assigned to monitoring the practices social media. She uses the RACGP social media policy template within the social media guide to customise the policy to their practice. That’s something that you can do as well if you’re looking at implementing social media into your practice.

[Next slide: Social media policy]

Tim Senior: So there’s a template in the social media guide from the College and I think we’ve just sent that link out in the chat box too. So you can adapt that for your own practice as well as having a social media policy so everyone knows how it’s going to operate and who is going to operate it and what their roles and responsibilities are. It’s also important to have a Code of Conduct, so that staff members running it know what’s expected of them in terms of their interaction with people using social media. So they’re not posting in haste and it doesn’t become at all abusive, and they know how to deal with posts that might be controversial. The other thing that’s probably important for that as well, which we’ll talk about later, is knowing how to deal with posts that might be considered testimonials by patients. Because that is something that AHPRA have put out some specific guidelines on, that’s important for us and any staff acting for the practice on its behalf, to know about.

[Next slide: Facebook business page – star rating]

Betty: Thanks Tim. And actually on the next slide we go on to see that Maria does set up a business page on Facebook for the general practice and she will be the one that will update and manage the page. The practice will use the page to keep patients informed of what’s happening in the practice.

When Maria sets the page up as a business and enters the address of the practice, Facebook instantly gives the page a ‘star review’ rating option. This is for people to leave a review of the business. Maria is unable to remove this feature once the practice’s address has been entered. She is concerned that this might be viewed as a testimonial for the practice.

[Next slide: Chandlers Hill Surgery]

On the next slide we’ve got an example of Chandlers Hill Surgery and they have found a way to get rid of that star rating. If you wanted to chat about that one Tim.

Tim Senior: Yes, so Chandlers Hill Surgery entered the page settings via Facebook on a mobile phone. I think the settings on a mobile phone are slightly different to a PC or a laptop, and there’s more functionality there. I think they manage to get around that setting. Apparently the college are writing to Facebook to request that the feature be customisable, and the College will keep people updated on that. Because it is a difficulty, if you put your address in, and clearly the address of your practice is an important thing to have there so people can actually get there and find it on a map, but Facebook automatically put star-ratings in to allow people to write reviews. Now if those are at all reviews of your clinical services, then AHPRA considers those to be testimonials and we’re supposed to do what we can to remove those from sites which we have control over,  which would be our own Facebook page. Some practices are saying until that’s more customisable I’m not going to put the address of our surgery in there. That’s a difficult area for GPs, I think given Facebook’s settings and the AHPRA profile. There may be some of you out there who’ve already done this for your practice and tacked it, I think Tim Koh has also may well have done this. I’m not sure too. But that’s a difficult that each practice will have to think about.

[Next slide: Disclaimers]

Betty: Maria also includes the following disclaimer on the practice Facebook page: ‘This account reflects the general practice views and not that of any businesses/committees/boards that staff are involved in.’

Tim Senior: And underneath that is the disclaimer I’ve put on my Twitter profile: “ Opinions could be mine, aren’t employers”, because I’m employed by a few people and I do want to make it clear that what I say is not necessarily going to be endorsed by any of the organisations I work for. So it’s worth inserting a disclaimer on sites that you’re on, particularly personal ones. I’m never quite sure how practical they are, in terms of getting into trouble and I think that’s probably untested, and I think it is important to stress that, so there’s no confusion, that people feel you’re speaking on behalf of someone else.

[Next slide: Advantages of using Facebook]

So the advantages of using Facebook, everyone knows about Facebook and pretty much everyone is there when it comes to social media. So it’s a fantastic way of engaging and communicating directly both with patients and with colleagues. It proves an avenue for patients to find you and one that they will use and increasingly use. But it can also drive traffic to a website off, like a blog or practice website, outside of Facebook. Where people find you there and click on a link that way.  It can be a good way of building a network with other professionals. We’ve already mentioned GPs Down Under being a closed Facebook group for GPs, where people have started to do that very successfully. And there are other groups for pretty much any topics that you could imagine around medical fields and hobbies, or around political interests or reading interests. So you can join and create groups for anything that takes your fancy.

[Next slide: Tips for using Facebook]

Betty:  At the practice they started to see some unsavoury comments on their Facebook page so Maria considered looking at the following tips.

Tim Senior: Yes so it’s important to know about your privacy settings on Facebook. Facebook has been criticised in the past for some of their privacy settings. I went in to check mine today and it’s actually easier that it used to be, but it’s worth spending some time doing that. And it’s worth spending some time talking about hat with staff in the practice as well because it’s quite likely that if people can find your practice and know locally who’s working there, then they can find your practice’s staff profiles as well. So they would want to think about what they’re posting and who can see it, and so encouraging them to think about who they’re sharing their information with as well. Facebook also has an instant messaging feature which patients may well be quite familiar with and there is certainly risks in using this to communicate directly with patients, either via instant messaging or via other sue of social media. In general, don’t. View it as public. There are some instances where I’m aware it’s been used as a last resort. I think in general it’s worth not using. Again, clearly defining the role of the staff member who’s updating your Facebook profile and in accordance with the practice’s social media policy is going to be really important.    

[Next slide: Instant messaging]

Betty: Dr Singh has been trying to recall a patient regarding their test results and has had no luck. He is concerned, so he considers contacting them via Facebook instant messenger as the patient has ‘liked’ the practice Facebook page. Dr Singh was reluctant to do this and luckily Maria got in touch with the patient over the phone.

Now Tim what are your thoughts on this?

Tim Senior: Yes, I would be curious to see if any people in the audience have used this or what their thoughts are. It certainly makes me very nervous using instant messaging to contact a patient, because I’m not certain about how private it is or we don’t know whether the patient has consented to be contacted in that way. How secure it is. Whether the patients get access to their own phone to look at it, or computer, or if it’s shared or not. So I think there’s a lot out of our control that makes using instant messaging quite risky in terms of privacy.

Betty: I’d like to launch a polling question while we’re on this. And we’d like to know from our audience ‘Have you ever used Facebook Messenger to contact patient?’ The answers are Yes, No and Don’t Know. I’ll share those results with the audience as well. 7% have contacted a patient on Facebook instant messenger, 91% say no and 2% are unsure.

Tim Senior: It’s interesting, I suspect people who’ve done that have thought there are circumstances where they’d do that. I’m not surprised at the vast majority of people who say they wouldn’t do it. We’re still a profession that uses faxes so we’re a bit slow to use that.

Betty: Dr Singh has enjoyed providing frequent updates on the Facebook page. Maria suggested that he start a Twitter account of his own to engage with other medical practitioners and people in the profession. He sets up a Twitter account and tweets daily. His followers quickly grew and he was inundated with queries on his favourite topic to tweet about: eHealth.

[Next slide: Twitter]

Tim Senior: Twitter is an online social network and it’s called micro-blogging and it has a limit of 140 characters, which is from the old text message days where people could post to Twitter via text message. Actually that limit makes it a very fast moving, interactive service. Tweets are available for everyone in the internet to read, but only registered users can also post Tweets as well. It allows you to have conversations and you can put in links, you can put in photos. It’s actually a good way of finding and sharing with other people, links to articles, resources, websites and news. It has become quite popular for that.

[Next slide: What is Twitter?]

[Next slide: Advantages of using Twitter]

Tim Senior: There’s some advantages for using Twitter, it’s very easy way of sharing information with a broad range of people. When you follow someone, they don’t have to follow you back. It’s not mutual in the same way that LinkedIn or Facebook is. Your tweets can contain links, you can choose who you want to follow, it’s fantastic for conversations at conferences. It creates a back-panel of discussion and commentary around the presentations that are happening. So, given that GP15 is happening next week, whether you’re there or not, following the hashtag #GP15Melb will take you to all the tweets with that hashtag in that people from the conference will be using. And a few people outside the conference as well.

[Next slide: Using Twitter at conferences]

Betty: Dr Singh was holidaying in Bali and was keen to get back to Melbourne for the GP15 conference. Unfortunately is flight was delayed and he missed the first day due to the ash cloud. Via Twitter he was still able to follow and contribute to what was going on at the conference.

Luckily he was back in time to attend the last 2 days, especially the social media presentation that he was keen to see at 3:30pm on Wednesday 23rd September.

Tim Senior: Fantastic. I think conferences are one of best places to start, if you’re not using Twitter, to start using it. The conversation is all pretty relevant to what you’re there for. You actually get to meet face-to-face with the people you are tweeting with. There’s a lot more interaction then when you’re just in a room on your own. Always worth remembering that the tweets are public and people outside the conference often enjoy following and seeing what’s going on and what people are saying about the conference and seeing pictures. Last week, I started noticing Periscope used more widely at conferences, which adds a bit of live streaming video. It’s a really great way to dip your toe into using twitter at conferences. Twitter is probably better at conferences than either LinkedIn or Facebook, because it is so fast-flowing. It’s real-time updates.

[Next slide: Tips for using Twitter]

So these are the tips for using Twitter. Use it to reflect the brand of your practice and follow people who can have an impact on your business. People who will share interesting resources or research, or interesting information for you and your patients. You can use it to direct traffic to a website or a blog, Facebook where you can have more than 140 characters. That’s really useful. You see ‘trolls’ on Twitter sometimes who are just very rude, and it’s important as medical professionals and health professionals that we do maintain professionalism when using Twitter, and not be dragged into the sort of abuse or rudeness that we see.

Remember not to re-tweet testimonials made by others about your clinical work.  That can be viewed as self-promotion using testimonials and AHPRA say we can’t do that. If you want to build up a Twitter following, tweet regularly. My own rule on Twitter is try not to be boring. There’s quite a lot of people who are saying things that are a little bit old on Twitter. Saying things new things in a new way always provides value for your audience.

Betty: Dr Singh does suggest to his fellow GPs in the practice that it would be great idea to expand their practice website to link to a blog, to discuss some of the medical issues that people have brought up on Twitter. So Tim, now we can go onto talk about blogging. Prior to getting into our Q&A session.

[Next slide: What is a blog?]

Tim: I’d actually just like to point out that the link to the AHPRA social media policy has gone out in the chat box as well, and that’s important to familiarise yourself with []. Particularly regarding advertising and testimonials. But essentially if you stick to good medical practice you’ll be doing the right thing, and remembering patient confidentiality.

Onto blogging, blog is short for a ‘web log’ and it used to be a sort of a diary type feature, expanded to be people writing about anything that interested them.  Businesses can use it to keep people updated with their products and services, their thinking in their area of expertise and business. Many people use it for personal use on issues that interest them from anything really. There’s quite a few good bloggers around who write about health and medicine.

[Next slide: How to blog?]

Tim Senior: It’s important to use a target audience, who are you writing for? And a topic area to blog about. If you can find an area that not many people are writing about or that you have a new perspective on that’s important. There are many free blog websites around. The two most popular being WordPress and Blogger, but you can also buy a page web domain. That might be worth doing for a practice, you can get your own ‘’ address, which can be paid an then redirected to that. Again, design the website to reflect your practice branding and it’s important to assign a staff member to maintain and update the practice’s blog and defining that. When you establish a blog, you can get recognised as a place where people return o for useful views or knowledge on particular subjects and you can other social media to promote and share your blog. Using Twitter when a new post goes out, using Facebook and sharing that, does expand your network very well.  Again, try not be boring, be engaging. Educate and inspire, that is often what will keep people coming back. It can be used to establish your online identity, what your area of expertise is and how you tackle that.

[Next slide: The benefits of starting a blog]

People will comment on blogs, so it is worth be prepared for complaints and learning how to manage them. Have a protocol and practice policy on managing and monitoring content and feedback. Particularly important if patients write anything that could be viewed as a clinical testimonial. That will need to be removed and it is important that whoever maintaining the blog understands that and is able to act on that. Consider adding a disclaimer as we discussed earlier.

[Next slide: Tips for blogging]

Tim Senior: Social media is public and essentially I think you shouldn’t be saying anything on social media that you wouldn’t be prepared to shout from the roof of your local hospital. So the confidentially is crucial. We can fall into the same traps on social media as we do in lifts in hospitals or front areas in our reception rooms.

[Next slide: Don’t forget privacy because social media is public]

So again, a reminder of the confidentiality and privacy of good medical practice. And that specifically includes our use of social media. There’s more on that in the Handbook for the management of health information in general practice, from the College. The link to that has just gone out as well [/your-practice/ehealth/protecting-information/privacy/]

[Next slide: Meet your guest speaker…]

Betty: Thanks for that Tim. Now I would like to introduce our guest speaker for next part of the session where we’ll be running a Q&A. We’ll be joined by Dr Tim Koh. Tim is a GP in North Metropolitan Perth.  He is Chair of the RACGP WA Faculty.  Tim is a second generation GP, originally hailing from Three Springs WA where his father was a rural GP. He has been involved in teaching with the RACGP WA Faculty and regional training provider WA General Practice education and Training since 2002.  He has served the RACGP WA Faculty as Assessment Panel Chair for 6 years and Education Committee Chair for 4 years.  Tim became WA Faculty Deputy Chair in 2010 and was subsequently nominated WA Faculty Chair in 2014. 

Tim is a co-owner of Currambine and Ocean Keys Family Practices.  He is a GP supervisor at both practices and continues to supervise and mentor GP registrars, Prevocational GP Placement program residents and medical students.  Tim's interests include medical education, immunisation and innovation in practices.

[Next slide: Send your questions and comments via the questions box]

Tim Senior: I’m just going to look through some of the questions, there is a comment here that I think is very important about blogging and it’s important…’Don’t do it half-heartedly’ this person says and I think it’s a good comment. It requires a lot of time if you’re going to do it well, and a blog that’s not nice to look at or not well written will cause more harm than good. I think it’s important to think about the time commitment to keep a quality blog. Particularly if it’s related to your practice but also personally, as it does need updating regularly.

Tim Senior: another comment here from somebody who finds Twitter at conferences distracting and I can’t see why that can be the case. I find it stimulating but tiring and cognitive layer of thinking. I can see why that would be the case.

Tim Koh: Hi, it’s Tim Koh here.

Betty: Hi Tim, welcome to the webinar thank you for joining us. Now if the two of you have the functionality it would be great to share your webcams at this point.

Tim Senior: There you go, I’ve shared mine now, looking a bit end of the day, bedraggled. Tim you look smart.

Tim Koh: thank you Tim, very nice of you.

Betty: Through the question box, just for our presenters, we’ve had a lot of questions come through if you can expand that and you can have a look through some of those questions there. In the meantime if anybody has any questions in this session, please send them through in the question box.

Tim Senior: Can we just start hearing from you Tim about your social media use. How long you’ve been using social media and what you’ve been using it for.

Tim Koh: Thanks Tim, my journey’s been actually very similar to Dr Singh funnily enough. In so far as we’ve started with a practice webpage, which is incredibly busy. Quite frighteningly a lot of our patients use it continuously to get information about that practice, so that’s been a very important thing. I’ve been part of administering that. Subsequently, we’ve gone on to have a practice Facebook page. Being part of the RACGP and on Council, I’ve been sort of using Twitter intermittently to talk about the important political issues affecting general practice.

Tim Senior: There’s a few questions coming through. One of the recurring themes is around tips on managing patient interactions, patient ‘friend requests’ and requests from patients to be friends on social media. Any thoughts on that Tim?

Tim Koh: I’ve got to say, I’m very cautious with this. In fact we started getting problems in the practice with a lot of our junior doctor registrars in particular would often be approached by patients to be friends. I think that perhaps being part of that younger generation, you’re used to getting approached more often. I’ve always encouraged them to be very cautious about ‘friending’ patients and encourage interaction, which is a function, a risk of confidentiality, sending the wrong message. I’ve always sat on the cautious side, I would say Tim.   

Tim Senior: I remember a friend request I had from a patient who is one of my long standing patients through Facebook. And I sent her a direct message back saying don’t take offence but I’m not going to accept because I don’t’ friend my patents. And she was very understanding about it and I think she commented on it once when I saw her after that, and that was the end of the matter. Not every patient will respond like that but I think if we’re honest without patients about that as being a policy then they’re pretty understanding.

In terms of rural practice, where people often know everyone in the local community anyway, are there any issues around that. There’s a specific question to you about that Tim.

Tim Koh: I think it is a really uncomfortable point. I think it’s very easy to be all out, as in you just put the sign up and say that ‘I don’t do that’, or I think the difficult thing is negotiating it once you’re into a policy of interacting or engaging with patients, about what is appropriate and what’s not. I think that can change over time and that’s really really hard to do.

Tim Senior: Absolutely. Another important question and I think it’s worth covering. How has social media improved your practice? Has it helped patient outcomes?

Tim Koh: I think it has firstly, with regard to our Facebook page for the practice, we get ratings on that. I suspect patients actually like being able to rate us which is very interesting. We haven’t’ disabled the rating, we’ve just kept the star-rating thing going which I am not sure is the right thing or the wrong thing to do. But perhaps we’ve perhaps been a little bit slower-acting on that. Beyond that I think it drives people to your website and your website is really your shop front nowadays and I think that’s a really important thing.

Tim Senior: Yes. There is an interesting comment in the AHPRA social media guidelines, or the marketing guidelines. You can use a symbol, like a symbol of an award that you’ve won or something like that and that’s not actually a testimonial, because it doesn’t say anything particularly. They say a testimonial has to have a narrative component to it. I wonder if the star-rating is okay, but not comments associated with that. Certainly not comments on clinical services or clinical skills.  

Tim Koh: Yes, it’s shades of grey, Tim, I think. There’s a lot of debate on this. Interestingly we use an online booking service which does a very similar thing. It actually allows patients to book in with your surgery online as an external website, but also includes ratings and that’s another one that we debate back and forth on, you know. Is this acceptable? Does it meet the guidelines or does it not?

Tim Senior: Absolutely. I think one of the other ways that I think it does improve patient outcomes, is allowing us to share resources and share learning between professionals really. Often what the guidelines say isn’t quite nuanced enough in discussing it with peers and colleagues, and indeed patients, is actually, can really improve our practice. Certainly in my field of indigenous health, there’s a very active Aboriginal and Torres Strait Islander population n social media which gives me a whole new perspective into their experiences of health services. Which I’m sure improves the work that we’re able to do.

Tim Koh: Yeah, it’s really affirming, isn’t it Tim, there’s that generosity of knowledge sharing there. I found that a very positive thing. As you’ve probably experienced, you also have to be careful with how much detail you put on when requesting knowledge about very specific things.

Tim Senior: Absolutely. How do you manage that? In terms of the detail about personal life and professional life?

Tim Koh: Probably a bit like yourself, I sit on the very conservative side. I tend to not, I don’t like publishing much detail at all in terms of what I do in my personal life. I think it’s probably just not what I want out there. I am very cautious about any discussion on patient’s privacy in particular. I try to steer my conversations to sort of more theoretical ones, I suppose.

Tim Senior; Yes, I think I am similar. People do use different formats of social media for different things. So Facebook is often more personal and Twitter, less personal detail.

Tim Koh: Absolutely. Tim I was interested in your thoughts on that use of the Facebook messenger in terms of, I know we’ve used it as a messaging service of last resort to get a hold of someone when they were overseas. What were your thoughts on that? There’s no clear guidelines out there. 

Tim Senior: There aren’t clear guidelines and I’d be very nervous about using it because I wouldn’t be confident about where the message was appearing at the other end. If it was a family computer that everyone had access to, or who was holding the phone when the message arrives. You could probably argue that for other things as well, but certainly we’ve not nutted that out. Particularly not if there’s no patient consent for using that. Some participants here have pointed out that often patients use it to contact us, rather than the other way around. I think that’s probably more likely, and having a policy that says ‘this is how we’ll respond to those requests, but can you contact us through these other means’. Partly because the risk in managing contacts through a whole range of different ways. I think it’s probably why we still use faxes is that most practices have a system for managing faxes even though it’s really ancient technology now.

Tim Koh: Yeah, it’s really hard isn’t it? I think the time we have used it was at a point of no other options being available. The message was simply ‘Can you please contact us.’

Tim Senior: Interesting question here, how many people have used a practice Instagram site? We’ve not mentioned that. Are you aware of anyone using Instagram?

Tim Koh: I’ve not ever seen an Instagram site for a practice. It’d actually be very hard to get good shots, you can’t show shots of patients for instance, and you’ve got to be careful of everything you publish in terms of having people’s permission to put it out there. That’s a real difficult one.

Tim Senior: Someone asked can you describe Instagram. Instagram is a photo sharing social media website where people post photos often taken from their phone, and then others get to ‘like’ and comment and share to their networks too. It’s very popular with my teenage daughters and her friends actually. I suspect its main use might be in medical education rather than practice, in terms of sharing visual representation, de-identified photographs of ECGs or chest x-rays or use of medical equipment. I wonder if there’s better use or more use of YouTube and video for medical education as well. Very pictorial and visual like Instagram. I don’t think anyone has used Instagram for their practice, I’ve not come across that.

What about feedback coming through on practice websites and Facebook sites? What’s your practice policy around managing that?

Tim Koh: We get lots of feedback. We have a managed comment box and amazing amount of feedback comes through that Tim. By and large it’s very helpful. I think because it’s a lower threshold for people to use, we’re more likely to get lower level complaints that’s often fairly banal things like ‘I was really annoyed because the doctor was running late and I arrived on time, and this has happened three times in a row’. Perhaps you could say that’s lower level stuff and not that important but we tend to actually follow it up and make a call to people. I think it’s really important in terms of the service you provide to people. It really identifies problems at a low level and allows you to do something about it. If anything it feels good to be able to follow that up.

Tim Senior: Would you say that the way you deal with feedback like that is actually more important than whether you get the feedback in the first place. You can actually turn something that might have been a bad experience into a really good experience by the way you deal with feedback like that?

Tim Koh: Yeah, absolutely. Intuitively you want to get positive feedback but, as you say, often your really positive experiences come from getting and message and then actually, picking up the phone and calling the patient yourself. And say “I’ve got your feedback, its’ really important to us, we acknowledge there’s a problem and we’re going to work on that”. People are quite overwhelmed by that, I’ve got to say. I’ve been really pleasantly surprised.

Tim Senior: Has that been a useful thing, in terms of registrars and teaching them about social media use and practice feedback from patients and things, have you incorporate that into your teaching as well?

Tim Koh: Yeah, absolutely. Pretty much with all our doctors, if we get any significant complaints we sit down and talk through it basically. If there’s repeated low-level complaints we’d do the same. We try to make it as positive as possible. It’s definitely a different era Tim. Once again, there’s a very low threshold for writing something in a comments box. Suddenly we’re getting a lot more feedback than we’d ever got before. Whereas people would’ve gone maybe months or years without getting any complaints. Suddenly you’re actually inundated with a  lot of data about how you’re performing and it’s just trying to acknowledge that we have to get used to that and we have to be able to work with that.

Tim Senior: does that take up a lot of practice staff time? If you’re getting a lot more now than you were then. How do you manage that?

Tim Koh: Yes, it does! And I guess it’s whether that’s a priority to you as a practice. I think we’ve probably tried to make a priority because we’re really trying to grow our practice and grow our reputation of looking after people. But it’s really whether it’s important to you as a practice principle or director, to actually follow up on low level complaints. I think it is, but for other people I can certainly understand why it’s not, because it is time consuming.

Tim Senior: Absolutely it is. There was a comment earlier on, I’m just trying to find it now, about how do people find time to do social media. What are we doing less of? Are we watching less television, or are we spending less time with our families, are we doing less housework or sleeping less? What is it we’re doing less of? I don’t think there’s that much good on television, I won’t’ tweet during doctor who but apart from that…

Tim Koh: The thing I’ve learnt Tim, is to not put my mobile phone on beside my bed at night. As soon as you’re on Twitter it seems to light up all night. Either set the alarms off or take the mobile phone out of the room. I think you’re right. It’s work following us home. Probably good in some ways but it certainly reduces certain elements of quality of life.

Tim senior: Certainly with Twitter, think about it is just dipping a cup in stream every so often. It doesn’t matter if you miss tweets. If there is important enough stuff out there it will find you, because people tweet it to you and it will be tweeted often, so you’ll miss it less. I find that people often accuse me of tweeting a lot. But I don’t feel like I do, I just dip in every so often. Like stood in a queue in a shop, just dip into Twitter for a couple of minutes and then out again. That’s often just using those little bits of time just to see what people are talking about now. It could just be an entertaining way of filling a few minutes.

Tim Koh: I find Twitter fascinating. I suspect I am too boring to actually be really good at Twitter, because I run out of things to say quite quickly. The good thing about Twitter is, it’s there for opinion. I think perhaps people are a bit too cautious in giving their opinion. It’s a tough one to balance out because it’s very public and very social. You really need to give your opinion, basically.

Tim Senior: I think so, and listen to other people’s opinions as well. I think it can become an echo chamber where you only hear from people who agree with you, and I do make a point of following and trying to understand people where I profoundly disagree with them. Because actually you get a lot more out of that. Not trolls usually, they have a lot less interesting stuff to say.

Tim Koh: I agree. I do know that a lot of people re-tweet stuff they don’t necessarily agree with, they just sort of put it out there. I was watching one of your slides from before which was you shouldn’t retweet stuff you don’t necessarily agree with, but it’s a common habit.

Tim Senior: It is, yes you shouldn’t retweet that are positive clinical testimonials from patients. Other stuff is fine to retweet. You’ll notice on Malcolm Turnbull’s Twitter page he says “retweets not ipso facto endorsement”. That got me quite entertained. Who uses ipso facto on their Twitter profile? Interesting question here, could social media commentary be used as part of AGPAL accreditation?

From what Tim’s says this is more valid that the questionnaires being currently used.

Tim Koh: It’s a really good question. I think it’s a very genuine, a very quick sample of what is actually happening in your practice. I think that’s got to be on the agenda of the future of patient sampling.

Tim Senior: I think it’s worth a shout-out to the patient’s opinion organisation as well, which started in the UK and is now an Australian organisation, who use social media to connect patients providing feedback about their experience in the health system, in the health services. To connect that feedback back to the service, with a view to improving health services. It’s not a ‘rate your MD’ it’s a more of a quality improvement tool where patients tell their story to improve  health systems and they’ve got the process in that, but that’s sort of a formalised way of doing the Facebook messaging. I think you can get a widget for your practice profile from them and I think that’s a really interesting space to watch.

Tim Koh: I’ve seen that in action. It looks like a lot of work. I guess it’s not much different from what I’m doing but it can be public.

Tim Senior: It is public. Sometimes the service is identified as well so it can be quite public. I’m just looking at the time it’s 8 o’clock. Any final comments that you’d like to make Tim?

Tim Koh: The interesting thing that I find is the attitude and the culture of social media has changed a lot over time. Even things like, we talk about patient feedback, there was a time not so long ago that the medical profession as aghast at patients commenting on doctors and so forth, in public. And that has changed so quickly and it makes me wonder where things are going to go in the next 5 years Tim, I’d be interested to hear your thoughts on that.

[Next slide: Summary]

Tim Senior: I think that’s right and I think the future is so uncertain, to some extent it’s only limited by what we imagine the use se of social media being. And so some interesting experiments out there. I think to some extent, we need, as a profession, it’s up to us to decide that. I think it’s a really useful tool that can be used for actually including patients in a way we think about our services. Which, in the end, everyone benefits from. It’s an exciting and unknown future out there.

Betty: Fantastic, thank you Tim and Tim. It has been a wonderful session. Very very informative and we’ve had some really positive responses also coming through the question box. So that’s worked really well tonight, thank you.

Tim Senior: It’s a pleasure. Thank you for joining us Tim.

Betty:  We do have a range of resources available on our website, and there’s a link to our website where you can find those resources, coming out in the question box as well.

Tim and Tim thank you very much, it’s been fantastic having you both online.

Tim Senior: Thank you very much everyone, and good night.

Tim Koh: Thank you.