“You’re a boring whore! Fix it.” The barked criticism came like a slap in the face. The director of Les Miserables was right, though. I was a boring whore.
Actors need to immerse themselves in their roles, shed inhibitions and squelch embarrassment. I was not managing to do this while rehearsing the Lovely Ladies prostitute scene. My performance was overly self-conscious and restrained.
Three days later I found myself at a medical education conference, attending a session discussing learning plans. A popular tool in adult education generally, and a training requirement for all GP registrars, learning plans are actively disliked by many. Done purposely and thoughtfully, they can be of great benefit; completed hastily or reluctantly because they are compulsory, they are next to useless.
I have to confess that, as a registrar, my own learning plans were dashed off with little thought, submitted and then promptly forgotten. I’d never thought this technique would work for me.
At the conference, the attending educators were instructed to each write a learning plan that addressed an aspect of their non-medical lives. We were asked to choose something that we genuinely wanted to improve. I instantly knew what I’d write about, and completed the task with seriousness and sincerity.
The facilitator randomly picked a few participants to read out their learning plans. The topics were predictable: “I want to exercise each morning”, “I want to get at least seven hours of sleep a night” and the like. Yes, you can see where this is leading ...
I should have anticipated being called upon, but when the “We have time for one more, how about you?” came, along with direct eye contact and a kindly smile, I momentarily panicked.
Surveying the room of mostly middle-aged, male faces, many of whom I didn’t know, I considered making something up on the spot. Instead, I stood up, took a deep breath and read out: “I want to be a more exciting whore.”
I then outlined my proposed methods for achieving this objective and how I intended to measure my progress. Without explanation, I then sat down.
Silence. Not a sound. Most eyes were glued to me, the others looking anywhere but. The atmosphere was thick with shock, amusement, confusion, suspense and fascination.
I didn’t leave them hanging for too long. After my disclosure as to why I chose the topic and the context in which I was “whoring”, there were audible sighs of relief and a sprinkling of laughter throughout the room.
It was memorable for those present. Four years later, I still get the occasional question about my “whoring” when I run into certain educators at conferences.
I am pleased to report that my learning plan well and truly achieved its aim. I enacted my plan exactly as written and practised diligently. I knew I had been successful when the director instructed me to “Tone it down a bit. This is a family show, you know!”
I now feel a lot more comfortable extolling the benefits of learning plans to unconvinced registrars. I tell them: “I used to think that I wasn’t a learning plan-type person either but I’ve discovered that if you choose a relevant and important objective and spend time and effort working out how to achieve it, the technique can really work.”
I tend to leave out: “It didn’t do much for my medicine, but it turned me into a fabulous whore.”
This blog post has been adapted from a column first published in Australian Doctor.
Dr Genevieve Yates is an Australian GP, medical educator, medico-legal presenter and writer. You can read more of her work at http://genevieveyates.com/
Many know that engaging in regular physical activity and exercise will tremendously improve one’s health and overall well-being. This goes the same, if not tenfold, for individuals suffering with diabetes. However, before rushing in a high intensity or physically straining physical régime, consult with your diabetes care provider. Make sure to discuss your plans take note of any precautions that may be needed to be made prior or during these activities.
It will be interesting to know that individuals with type 2 diabetes who do participate in some exercise (even at work) reduce their risk for heart disease. Remember that a physical examination that focuses on the signs and symptoms of diseases affecting the heart and blood vessels, eyes, feet, nervous system, and kidneys must be made in advance before any extensive work out plan takes into action. Any strenuous strength training or high-impact exercise is generally not recommended for people with uncontrolled diabetes. Such strain caused by these exercises can weaken blood vessels in the eyes of patients who suffer from the common diabetic complication known as retinopathy. High-impact exercise can also injure blood vessels in the feet. In fact, diabetes can contribute to foot problems in several ways: diabetic neuropathy; which is a nerve disorder that causes numbing and pain in the hands, legs and feet as well as damage to internal organs; also poor circulation to the feet is another problem that can be associated due to diabetes. Keeping this in mind it is imperative to keeping your feet healthy, investing in some great therapeutic footwear like these can be a great step in moving toward healthy feet!
One thing is for sure, physical activity can increase the health in anyone’s life. Always make sure to take care of your body and take the extra precautions needed in order to maintain proper health.
A brief overview of some of the common colorectal operations and complications arising from them. An introduction to stomas and a comparision of the differences between colostomies and ileostomies as well as a few of their potential complications.
GPs for a little while have been asked to compare each other’s outpatient referrals rates. The idea is that this peer to peer open review will help us understand each others referral patterns. For some reason and due to a natural competitive nature of human behaviour, I think we have these peer to peer figures put to us to try to get us to refer less into hospital outpatients.
It’s always hard to benchmark GP surgeries but outpatient referral benchmarking is particularly poor for several reasons
It's Very Difficult to Normalise Surgeries
Surgeries have different mortalities morbidities ages and other confounding factors that it becomes very hard to create an algorithm to create a weighting factor to properly compare one surgery against another.
There Are Several Reasons For The Referral
I’ll go into more detail on this point later but there are several reasons why doctors refer patients into hospital which can range from: doctors knowing a lot about the condition and picking up subtle symptoms and signs lesser experienced doctors would have ignored; all the way to not knowing about the condition and needing some advice from an expert in the condition.
We Need To Look At The Bigger Picture
The biggest killer to our budget is non-elective admissions and it’s the one area where patient, commissioner and doctor converge. Patients want to keep out of hospital, it’s cheaper for the NHS and Doctors don’t like the lack of continuity when patients go in. For me I see every admission to hospital as a fail. Of course it’s more complex than this and it might be totally appropriate but if we work on this concept backwards, it will help us more. Likewise if we try to reduce outpatient referrals because we are pressurised to, they may end up in hospitalisation and cost the NHS £10,000s rather than £100s as an outpatient. We need to look at the bigger picture and refer especially if we believe that referrals will lead to less hospitalisation of patients further down the line. To put things into perspective 2 symptoms patients present which I take very seriously are palpitations in the elderly and breathlessness. Both symptoms are very real and normally lead to undiagnosed conditions which if we don’t tackle and diagnose early enough will cause patients to deteriorate and end up in hospital.
Education, Education, Education
When I first went into commissioning as a lead in 2006 I had this idea of getting to the bottom of why GPs refer patients to outpatients. The idea being if we knew why, we would know how to best tackle specialities. I asked my GPs to record which speciality to refer to and why they referred over a 7 month period. The reason for admission was complex but we divided them up into these categories:
2nd care input required for management of the condition. We know about the condition but have drawn the line with what we can do in primary care. An example of this is when we’ve done a 24 hour tape and found a patient has 2sec pauses and needs a pace maker.
2nd care input required for diagnosis. We think this patient has these symptoms which are related to this condition but don’t really know about the diagnosis and need help with this. An example of this is when a patient presents with diarrhoea to a gastroenterologist There could be several reasons for this and we need help from the gastroenterologist to confirm the diagnosis via a colonscopy and ogd etc.
Management Advice. We know what the patient has but need help with managing the condition. For example uncontrolled heart failure or recurrent sinusitis.
Consultant to Consultant Referral. As advised between consultants.
Patient Choice. Sometimes the patient just wants to see the hospital doctor.
The results are enclosed here in Excel and displayed below. Please click on the graph thumbnail below.
Reasons For Referrals
Firstly a few disclaimers and thoughts.
These figures were before any GPSI ENT, Dermatology or Musculosketal services which probably would have made an impact on the figures.
There are a few anomalies which may need further thought eg I’m surprised Rheumatology for 2nd input for diagnosis is so low, as frequently I have patients with high ESRs and CRPs which I need advise on diagnoses. Also audiology medicine doesn’t quite look right.
The cardiology referral is probably high for management advise due to help on ECG interpretation although this is an assumption.
This is just a 7 month period from a subset of 8-9 GPs. Although we were careful to explain each category and it’s meaning, more work might need to be done to clarify the findings further.
In my opinion the one area where GPs need to get grips with is management advice as it’s an admission that I know what the patient has and need help on how to treat them. This graph is listed in order of management advice for this reason.
So what do you do to respond to this? The most logical step is to education GPs on the left hand side of this graph and invest in your work force but more and more I see intermediary GPSI services which are the provider arm of a commissioning group led to help intercept referrals to hospital. In favour of the data most of the left hand side of the graph have been converted into a GPSI service at one point. In my area what has happened is that referrals rates have actually gone up into these services with no decline in the outgoing speciality as GPs become dis-empowered and just off load any symptoms which patients have which they would have probably had a higher threshold to refer on if these GPSI services were not available. Having said that GPSI services can have a role in the pathway and I’m not averse to their implementation, we just have to find a better way to use their services.
3 Step Plan
As I’m not one to just give problems here are my 3 suggestions to help referrals.
To have a more responsive Layered Outpatient Service.
Setting up an 18 week target for all outpatients is strange, as symptoms and specialities need to be prioritised. For example I don’t mind waiting 20 weeks for a ENT referral on a condition which is bothering me but not life threatening but need to only have a 3 week turn over if I’m breathless with a sudden reduction in my exercise tolerance. This adds an extra layer of complexity but always in the back of my mind it’s about getting them seen sooner to prevent hospitalisation.
Education, education, education
It’s ironic that the first budget to be slashed in my area was education. We need to education our GPs to empower them to bring the management advice category down as this is the category which will make the biggest impact to improving health care. In essence we need to focus on working on the left hand side of this graph first.
Diagnose Earlier and Refer Appropriately
The worst case scenario is when GPs refer patients to the wrong speciality and it can happen frequently as symptoms blur between conditions. This leads to delayed diagnosis, delayed management and you guessed it, increased hospitalisation. The obvious example is whether patients with breathlessness is caused by heart or lung or is psychogenic. As GPs we need to work up patients appropriately and make a best choice based on the evidence in front of us. Peer to peer GP delayed referral letter analysis groups have a place in this process.
At the end of the day it's about appropriate referrals always, not just a reduction.
Indeed for us to get a grip on the NHS Budgets as future Clinical Commissioners, I would expect outpatient referrals to go up at the expense of non-elective, as then you are looking at patients being seen and diagnosed earlier and kept out of hospital.
This is a vasculitis that most commonly occurs in children. It tends to only affect the small vessels, and typically presents with: Palpable purpura – red/purple discolorations in the skin, often on the extensor surfaces of the feet, legs, arms, or sometimes on the buttocks. The rash may initially resemble urtricaria, but later becomes palpable. GI disturbance – may include colicky abdominal pain, abdominal tenderness, melena – occurs in 50% of patients
Last week in my personal blog I reflected on humility as defined by James Ryle:
God given self-assurance that eliminates the need to prove to others the worth of who you are and the rightness of what you do.
Ryle suggests, from 1 Peter 5:5-7, that central to humbling ourselves is throwing our cares on to God. Every concern, care and fear being hurled on to God who is faithful and powerful enough to handle them. When we know that we are loved by Him no matter what and that He is in control no matter what, then we remove the need to prove ourselves or protect ourselves. We become humble – secure enough to allow God to be in control and to serve others. Once our eyes are lifted from ourselves we are able to see others to love and serve them.
Just before writing the last post I was reading an article about the report by Robert Francis QC on the appalling treatment of patients at Stafford Hospital. One of the recurring comments made by many different people is that the pressure of targets and incentives increasingly displaces focus on compassion and patient care. When doctors, nurses and managers alike are bombarded with ever increasing and regularly changes hoops to jump through and targets to meet, no wonder their attention and efforts are dragged from patient care.
I’ve seen something of the effects of this in a family member who for many years worked as a Health Visitor. In their decades of service they saw an ever increasing and ever changing string of targets and goals alongside cost cutting moves that stripped resources and personnel. Their desire to be compassionate and offer the best care possible became more and more stressful until it finally proved too much. She recently changed jobs.
Now I’m not trying to attack the NHS and I am well aware that so many people receive great care. But this is not a new concern that is being bandied around with fresh vigour in the light of Stafford Hospital. What struck me is that it demonstrates on an institutional level what also seems true at a personal level. Namely, that when we are forced to operate from a place of insecurity we begin to miss the most important things. NHS services have to meet targets to receive funding to simply keep operating – there will be no patient care if there is no hospital. Oftentimes, especially as a leader, we can live with a sense that, unless we meet expectations or make people like us or recognise our worth, then we’ll have no influence to do any of the things we know we are called to do.
The secret of personal humility is to recognise that we are already loved by our Father before we even move our finger; to recognise that He is control and we can throw every care on Him. A person who can live from that place of security finds, free from the need to prove themselves or their actions, can begin to simply do what they are made and called to do. They are no longer pulled in different directions by a multiplicity of cares. What about an institution?
It strikes me that a similar solution is needed for the NHS. Is there a way to give security for doctors, nurses and caring professionals so that they are able to do what they are called to do without constantly watching their back? Obviously there is a need for accountability for the safety of patients and to ensure a good standard of care, but the constant need to prove worth and achievement cannot be helpful for those who are called to compassionate care.
I’m not a healthcare professional. I don’t know exactly what this would look like. But I recognise in the diagnosis of struggles in the NHS, God’s diagnosis of struggles in many people’s lives. The way He designed us to live with Him is often a good basis to begin to imagine a new way for every level of society to function.
So, my question is this: what would a humble NHS look like? To whom could a National Health Service throw it’s concerns and cares?
Inhaled corticosteroids These are used for their anti-inflammatory effects in asthma. They are very effective in asthma, but are of limited use in COPD. Mechanism If you want lots of info on steroids, see the Cushing’s disease notes. In relation to asthma:
Last Saturday on ITV’s The Jonathon Ross Show, TV personality and comedian Rufus Hound announced that his candidacy for the European Parliamentary elections in May, standing for the single issue National Health Action, NHA, party. This is something that I think we (those of us who value the spirit of the NHS) should all be grateful for. The government is changing the NHS, big business is coming and no one seems that angry. Well at least Rufus is...
"David and Jeremy want your kids to die (unless you’re rich)"
A provocative title for his accompanying blog post, which of course has helped to fuel discussion. However, I think Mr Hound was right to use this, let’s face it anything that aggravates Toby Young, I am going to look upon gladly. OK, it is dramatised, but based on the evidence we have, it does seem that Misters Cameron and Hunt want an end to the NHS as we know it (an NHS that does indeed do its utmost to prevent any child from dying). We have had top down organisation and privatisation, from parties that promised the opposite pre-election, with an opposition who seem to accept the changes, and had themselves help start the privatisation of the NHS. You can see why Rufus has turned to NHA party, why hasn't everybody else?
What will Rufus achieve? To be honest I don’t think a lot. If he actually manages to be elected, as a MEP his campaigning will be in Brussels not Westminster. There is one key piece of legislation that the NHA will be looking to stop, the EU/US free trade agreement, which if passed including the NHS will mean that privatisation will not be reversible. The health and social care act opened up contracting opportunities in the NHS for multinationals and the free trade agreement will mean that future governments will be powerless to reverse the private contracting of these overseas companies. The three main parties are broadly supporting this agreement. Good Luck Rufus.
Rufus has already achieved something though. He has brought the issue he feels so strongly about to the public’s attention, in a way that no backbencher, lobbyist or journalist ever could. Since his announcement NHA party has been discussed across national media. People realise the NHS is being changed and are starting to speak up. I hate to think of the NHS going the same way as Britain’s utilities. Shareholders and profit should be nothing to do with the health and well-being of the country.
Apparently not all clowns are evil.
Rufus Hound: Comedian, Radio 4 presenter, argumentalist, and now would be politician.
Some further reading:
Trade secrets: will an EU-US treaty enable US big business to gain a foothold? http://www.bmj.com/content/346/bmj.f3574
It’s time to get serious about NHS, says comedian Rufus Hound. http://www.independent.co.uk/news/uk/politics/its-time-to-get-serious-about-nhs-says-comedian-rufus-hound-9086435.html
A Tale of Guilt and Woe
June 2012. It was unseasonably miserable. Having successfully fought the battle of Neuro I was all ready for the next onslaught which manifested itself in the form of reproductive and endocrine medicine (us Bristolians have dubbed it EndoRepro which sounds more like an evil Mexican villain). I was making a trip to the library, which, at the time, was around a 30-minute walk away from my student house. This was to do some extra reading. I had my laptop in my bag along with my bags of Haribo for encouragement and when I’d stomached all I could take I began the walk back. It rained. It rained like I have never seen rain before. For 30 minutes, I walked in a torrential down pour and when I arrived at the local Sainsbury’s, they kicked me out because I was dripping that much I posed a health and safety risk on their tiled floor. It was a very miserable day.
When I had eventually gotten back into my room and put all my clothes to dry I stood there and thought – why. Why was I doing this to myself? It wasn’t even necessary and I’d put myself through a monsoon to go get some books and read ahead. The reason was because I’d have felt guilty if I hadn’t – I planned to do it, so I was doing it. Guilt is a very powerful thing and it’s something we all encounter as students on a regular basis. When I used to revise for my pre-clinical exams, if I stopped for an hour or two that meant I would have to extend my evening revision to cover the time. I should imagine everyone can relate to this (even those macho folk that profess to be invincible!). Stopping was not an option. In that rain-sodden day I learnt one thing – cut yourself some slack.
I never believed it when people used to say to me that “down time” was as important as work time. Down time was wasted time. Down time was a period when I missed that all-important sentence that answered MCQ Q22 on the upcoming exam. At the start of that unit I decided to take things differently. I always timetabled work, but this time I was only doing those timetabled slots if I thought it would be productive. If not, the time was better spent doing other things. If I started and felt like it was too much effort, I didn’t carry on in some marathon-like endurance exercise, I stopped. I refused to let the guilt set in. I turned my ears off to all of the talk in lectures about how much work everyone had or hadn’t done – I refused to let myself be intimidated.
So what was the result? I had much better sleep in that time. My head was a lot clearer and I found it about 100 times easier to get up for lectures in the morning. I spent a lot more time doing the things I enjoy which generally upped my motivation.
More to the point, I achieved the best set of results in two years in those exams.
I only wish I could go back to my fresher self and say:
“Cut yourself some slack. Don’t feel guilty. Do your own thing”.
This is a post about oPortfolio - a project that Meducation and Podmedics are collaborating on. We have a Kickstarter project and would love your support!
The Wrong Question
Lots of people have been asking "will oPortfolio do XYZ?". As an open-source software developer I always find that a strange question, because there is very rarely a yes or no answer - the answer is pretty much always "it could do".
Most people aren't used to having software made for them. Especially in the NHS, people have to live with often outdated systems that are enforced on them. Change involves committees and boards that they have no real access to. The open source world is very very different. You get to choose what features you want in the product - you simply need to ask.
With oPortfolio, we are going to be guided by what doctors and students want. If a feature matters to lots of you, then we're going to work hard to get it in ASAP. If only one person wants it, then it's less likely to get priortised. Right now, the quickest way to get your voice heard is to support us on Kickstarter. When we reach our total, we'll be emailing everyone who's supported us to ask what the most important features are. If you want to make sure you're heard - that's the best way to do it.
The Right Question
In case you're wondering, a better question is "How can I help you get XYZ into oPortfolio?". Open Source is about people collaborating to make something better, expecting nothing in return. We'll write the code, but your input, support and guidance is what will make this happen.
Will oPortfolio do XYZ? Quite simply, yes it probably will, if you drum up some support for the idea and come and talk to us about it.
Please support us today. Thank you.
Just as a bit of an intro, my name is Conrad Hayes, I'm a 4th year medical student studying in Staffordshire. My medical school are quite big on getting us into the habit of writing down reflections. It's something I feel I do subconsciously whilst I'm with patients or in teaching sessions, but frankly I suck at the written bit and I feel on the whole it's probably because there's nobody discussing this with us or telling me I'm an idiot for some of the things I may think/say!
So I think if I'm going to attempt to complete a blog then I am going to do it in a reflective style and I do look forward to peoples feedback and discussions. I'll try to do it daily and see if that works out well, or weekly. But hopefully even if it doesn't get much response it can just be a store for me to look back on things! (Providing I keep up with it).
So I'll start now, with a short reflection on my career aspirations which have been pretty much firmed up, but today I gave a presentation that I felt really galvanised me into this. So I want to do Emergency Medicine and Expedition Medicine (on the side more than as my main job). Emergency Medicine appeals to me as I love primary care and being the first to see patients, but I want to see them when they're ill and have a role in the puzzle solving, as it were, that is their issues. Possibly more to the point I want to do this in a high pressure environment where acutely ill individuals come in, and I feel (having done placements in A&E and GP and AMU) A&E is the place for me to be.
Expedition Medicine on the other hand is something I accidentally stumbled upon really. In 2nd year I was part of a podcast group MedHeads that we tried to set up at my medical school. I interviewed Dr Amy Hughes of Expedition & Wilderness Medicine, a UK company, and I got really excited about the concepts she was talking about. Practicing medicine in the middle of nowhere, limited resources and sometimes only personal accumen and ingenuity to help you through. It sounded perfect! And since then I've wanted to do it, particularly being interested in Mountain Medicine and getting involved with some research groups.
Today in front of my group I gave a presentation on the effects of altitude on the brain (I'm on Neurology at the moment and we had to pick a topic that interested us). I spoke for 15 minutes, a concept that usually terrifies me truth be told, and I thoroughly enjoyed myself. Now I've given a fair number of presentations but this was the first time I was actively excited and really happy about talking! It seems to me that if that isn't the definition of why you should go for a job, then I need to talk to a careers advisor. This experience has definitely ensured I pursue this course with every resource I have available to me!
I would be interested in hearing how other people feel about their careers panning out and what got them into it so feel free to leave a comment!!
Recent 'tongue in cheek' research which has been reported in a Washington Post blog recently has caused a lot of questions to be raised concerning inattention blindness, which could cause concern unless you understand the underlying psychology.
Here's a CT scan:
During psychology lectures at Med School, you may have encountered the basketball bouncing students in front of a bank of elevators where you were asked to count the number of passes the basketball made from the player wearing the white T shirt, while a gorilla ran between the students. (Even if you did watch it before, you can re-watch the video on the Washington Post blog).
The recent study asked radiologists to identify and count how many nodules are present in the lungs on a regular CT thorax. If you look at the image you may see a gorilla waving his arms about. As a radiologist, I see the anatomy in the background, the chambers of the heart and mediastinum, but nothing there out of the ordinary.
As radiologists, we are looking for pathology, but also report pathological findings that are unexpected. The clinical history of a patient is very important for us in interpretation of imaging examinations, as we need to answer the question you are asking, but have to be careful we do not miss anything else of serious import. As we do not see any other pathology, we would not expect to find a gorilla in the chest, so our brains can pass over distracting findings.
The other psychological issue is the satisfaction of search, where we can see the expected pathology, but may miss the other cancer if we do not carefully and systematically look through the images.
So the main thing to learn from this is that your training should always keep you alert, not just to expected happening, but to not discount the unexpected, then many lives will be saved as a result of your attention to detail.
The Cardiff University Research Society (CUReS) held its second annual student research symposium on the 13th of November 2013 at the University Hospital of Wales. Medical students were invited to submit posters and oral presentations for the symposium. The event also launched this year’s INSPIRE program, a joint effort between Cardiff, Bristol, Exeter and Plymouth to give students connections to research groups through taster days and summer research programs. CUReS is a research society for medical students in Cardiff. All events and projects are completely free and available to all years. The research society has a particular focus on developing close bonds between researchers and students. In addition to INSPIRE, the society also releases a yearly list of summer research projects where medical students can find researchers interested in hosting projects over the summer.
The purpose of the conference was to mark the launch of the INSPIRE taster days and display some of the impressive work that has been accomplished from the taster sessions and the funded summer projects. The symposium aims to give Cardiff medical students valuable experience in presenting their research and to motivate students interested in pursuing an academic career. CUReS president Huw Davies gave the opening speech, while INSPIRE lead Colin Dayan introduced the INSPIRE program. Previous INSPIRE students gave talks on their research and experiences gained from the program. Three successful applicants were invited to give oral presentations that were judged by the Cardiff Dean of Medicine Professor Paul Morgan, Professor Colin Dayan and Professor Julian Sampson, who also gave the keynote speech on his research.
The symposium was a great success thanks to the enthusiastic medical students who presented posters and gave oral presentations on their research. First prize for an oral presentation was awarded to Georgiana Samoila for her work on Histological Diagnosis of Lung and Pleural Malignancies, while Lisa Roberts and Jason Chai were awarded runner-ups. The award for best poster was given to Thomas Lemon. Two further awards sponsored by Meducation, assessed by Peter Winter, were given to George Kimpton and Ryan Preece for their poster presentations. There was also a Meducation stall and the Cardiff University Research Society greatly appreciates the support.
To get in touch with the CUReS, please email firstname.lastname@example.org or
visit our website at www.cu-res.co.uk for more information.
Written by Robert Lundin
Hello & Welcome!
You may have already read my blog on 'My Top 5 Tips to use Social Media to Improve your Medical Education' and if so you will have an idea of what 'Social Media' is and how it can be harnessed to improve medical education. There are also features that could improve health promotion and communication but today I would like to focus on where we have to be careful with these resources.
In my last blog I circumnavigated the drawbacks of social media in medicine so that I could give them the full attention they deserve in their own blog today. But its not all doom and gloom! I also hope to give you a brief overview of the current social media guidance that is available to doctors and medical students and how we can minimise the risks associated with representing ourselves online.
But firstly, what actually is social media and why do i keep blogging about it? If you are new here I recommend giving 'Social Media' a quick google, but the phrase basically includes any website where the user (i.e. you) can upload information and interact with other users. Thats a definition of the top of my head, so don't hold me to it, but most people would agree that this definition includes the classic examples of Facebook, Twitter, YouTube, Linkedin etc, but there are many many more. These sites are important to us as (future) health professionals because they can be both used and unfortunately abused. However, several medical bodies including the General Medical Council and the Royal College of General Practitioners agree that these resources are here to stay and they shouldn't (and probably couldn't) be excommunicated. With this in mind, there has been much guidance on the topic, but as you are about to find out a lot of it is common sense and your own personal discretion.
Before you read on, I'd like to forewarn you that I try and keep things lighthearted with this topic. I'll hope you can excuse my levity of the situation, especially if any of the original authors of these guidelines end up reading this post. But as I am sure you are aware, this is a dry topic and hard to digest without the odd joke or two...
British Medical Association - Using Social Media: practical and ethical guidance for doctors and medical
The BMA guidance is the earliest guidance originating from a major medical body that i've come across. That said, I have not done a proper literature review of the subject. This is a blog, not a dissertation. But still, the BMA gives an early and brief summary of the problems facing health professionals using social media. Key points such as patient confidentiality, personal privacy, defamation, copyright and online professionalism are covered and therefore it is a nice starting point. It is also quite a short document, which may appeal to those who are less feverent on the subject.
On the other hand, I personally feel that the BMA guidance does social media an injustice by not going into the great benefits these resources can yield. There are also no really practical tips or solutions for the drawbacks they've highlighted to students.
Read it for yourself here or just google 'BMA Guidance Social Media'
Royal College of General Practitioners - Social Media Highway Code
The RCGP guidelines are my favourite. After a cheesy introduction likening the social media surge with the dawn of the automobile they then take a turn for the worse by trying to continue the metaphor further by sharing a 'Social Media Highway Code'. Their Top 10 Tips that form the majority of the code don't look to be much more than common sense. However, each chapter there after dissects each of their recommendations in great detail and provides practical tips on how to make the most from social media whilst protecting yourself from the issues raised above.
As I mentioned earlier, the RCGP recognise the inevitability of social media and they acknowledge this in the better part of their introduction. They make a great point that older doctors have a responsibility to become technologically savvy, whereas younger doctors who have grown up engrossed in social networking probably have to develop their professionalism skills more than their older colleagues (I'm aware this is a generalising statement). Either way, the RCGP highlight that everyone has something to take away from this set of guidelines.
Read it for yourself here or google; 'RCGP Social Media Guidance,' but be warned, this is one of the more lengthy documents available on the topic.
General Medical Council - Doctor's Use of Social Media
The GMC guidance kicks off with a little summary of the relevant bits of 'Good Medical Practice.' Again, nothing much that isn't common sense. That being said, they then go on to write that 'Serious or persistent failure to follow this guidance will put your registration at risk,' which sounds ominous and probably warrants a quick flick through (do it now! - the PDF is at the bottom of their page).
Reassuringly, the GMC does not try and place a blanket ban on social media. They give a 'tip of the hat' to the benefits of social media and then go on to outline all the drawbacks as many of the guidance already has. Asides from the issue of anonymity there is really nothing new covered and the GMC actually gives a lot of autonomy to doctors and medical students. However, the GMC are, in many ways, who we ultimately answer to and so you would be a fool not to revisit the issues they cover in their version of the guidance.
As I mentioned, the GMC brought online anonymity to the forefront of our minds. Should we, shouldn't we? A lot of health professionals believe that the human right to a private life extends to the right to have anonymity online. However, before we go into this any further lets take a closer look at what the GMC actually says...
If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name. Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the view of the profession more widely.
As you can see, the use of the phrase 'Should also identify yourself by name' gives some room for manoeuvre and is a world apart from what could have been written (i.e. you must). To those who believe their human rights are being infringed, perhaps a solution is to stop identifying yourself as a doctor online, although I appreciate this can be difficult if you are tagged in certain things. There are a number of good points why doctors shouldn't be anonymous online and it is certainly a must if you are in the trade of offering health promotion via the world wide web. However, I can see the point of those who want to remain anonymous for comical or satirical purposes. A quick google of the topic will reveal that the GMC has said that they do not envisage fitness to practice issues arising from doctors remaining anonymous online, but from the temptations that arise from running an anonymous profile such as cyber-bullying and misinformation.
Read the GMC guidance yourself here.
National Health Service (Health Education) - Social Media in Education
The NHS-HE guidelines are high quality and cover the entire scope of what social media means to medicine. There are several key issues that I haven't encountered elsewhere. This set of guidance is written from a managerial, technical perspective. It doesn't really feel aimed at doctors or medical students but it gives such an overview of the subject that I thought it was worth including.
If you feel brave enough, read it for yourself here.
To my knowledge, these are the current key guidelines for the use of social media in medicine. I hope you have found this blog useful in providing a quick summary of a topic that is becoming increasingly swamped with lengthy guidelines. In the future we need to see material produced or delivered that educates health professionals in how to use social media, rather than regurgitating the pros and cons every couple of months. I think webicina is a good example of a social media 'training course,' . There should be more material like this. Perhaps this is where I'm headed with my next project...
As always, if you have anything to add to this blog, please feel free to add to the comments below. I will be able to take difficult queries forwards with me to the Doctors 2.0 conference next week! If you are a student and interested in coming to the conference in Paris next week you should get in contact with me directly (@LFarmery on twitter).
Also, it would be a great help if you could fill out my very quick pilot survey to help me understand how doctors and medical students currently use social media.
Also see my website Occipital Designs
The thoughts and feelings expressed here are those produced by my own being and are not representative in part or whole of any organisation or company. Occipital Designs is a rather clunky, thinly veiled, pseudonym. If you would like to contact me please do so on Twitter...