Thursday, 18 April 2013

What you need to know about Twitter...

What you should know about twitter..... from Anne Marie Cunningham

This morning I had the great pleasure of giving this talk at a workshop on mobile learning in medicine and dentistry as part of the Changing the Learning Landscape project.

Arriving at the venue I thought it would be useful to record the audio of my session and share it on Slideshare. I didn't have my Zoom Q3 audio recorder with me so decided to record the audio on my iPhone. I downloaded an app Audio Memos and set it running.

When I got home I set about figuring out how to get the audio file off the iPhone and on to my computer. I tried emailing it but it was too big and I was advised to purchase the full version for 69p, But it was still too big to email. I tried and failed to enable servers but the solution was to send the file to google drive and then download it to laptop. It then needed to be converted from a .wav to mp3 file. Fortunately I had written a blog post about the first time I had made a slidecast, so I was able to refer to the screencast I had made in 2010 to remind myself how to use iTunes to do this! (Yay for self-archiving!)

It is still as easy as ever to sync audio with slides in Slideshare so the last stage was easy.

I think the end result is worth the effort. And I do think that when you are using mainly images in slides, hearing what someone is actually saying is pretty essential to understanding the point of the presentation. So I will try to do it again as I do more presentations this year.

Thanks to Jane and the team behind today's workshop for the great organistation, and to all the other really interesting presenters and such an engaged audience. A special plug for my colleague Duncan Cole for his great prezi on Digital Curation

Wednesday, 10 April 2013

Hospital doctors contacting GPs...

The following storify is from a conversation earlier today. Many hospital doctors talk about finding it hard to contact primary care, just as GPs find it hard to get in touch with them. I'm posting it here so that you might share some of your solutions.

My first podcast!

You might have noticed that I took a little break from blogging. I've been very busy though and one of the things that I was involved in was organising the first Digital Doctors conference that took place last December. The team have been producing a series of podcasts which you can find here and iTunes. All those which I have listened to have been excellent so I strongly recommend them.

Last week it was the turn of Jeremy Walker, technical director at Meducation (@ihid) and I to join Stevan Wing, neurology registrar and digital doctor (@stevancw) for a chat about social media. Here is the result. Hope you enjoy!


Talking about social media and health professionals....

I came across a Guardian  article on how to delete yourself from the internet this evening. That would be quite a task for me. It mentions a search engine,, which does not track internet searches. I decided to check out how good it was by searching for myself. It is good.

Through it I managed to find this video of a conversation between Clare Gerada, chair of the Royal College of General Practitioners (@clarercgp), Stephanie Bown, director of policy, comms and marketing at the Medical Protection Society (@drstephbown), and myself. We were ably chaired by Sharon Alcock, journalist and  founder of Lime Green Media (@LimeandGinger).

The chat took place at an event last year where we were discussing the RCGP and DNUK producing guidance on social media. The final version of the RCGP Social Media Highway Code was published last month.

I had seen this before on the DNUK website but as far as I knew it was not available publicly so I am very pleased to be able to share it with you now. It's quite a lively discussion! Should GPs be discussing patients' underwear on their blog? <- No! Will we be doing consultations via Tweetdeck in the future? <- I doubt it. How will be deal with the digital divide? <- to be decided.

Let me know what you think.

Response and clarification from GMC to criticism of their social media guidance

Last Monday the GMC published this response to the discussion of their new social media guidance on their Facebook page.  I'm posting it here in case some people do not want to access it through Facebook, and because my previous blog post on the topic has over 100 comments.

Jane O'Brien from the GMC's standards and ethics team on our new social media guidance.

On the 25  March 2013 we published new explanatory guidance on Doctor's use of social media (PDF) alongside the new edition of Good medical practice for all UK doctors.

The response from the  profession has been lively — particularly about the phrase:
'If you identify yourself as a doctor in publicly accessible  social media, you should also identify yourself by name.'

Like all our  guidance, Doctors' use of social media describes good practice, not minimum standards.  It's not a set of rules.

But the response from the profession shows that doctors are unclear or uncertain about:
  • Why  we included this in the guidance
  • What  'identify yourself as a doctor' means in practice
  • Whether  this curtails doctors' rights to express their views
  • Whether  the GMC would take disciplinary action against a doctor because they used a  pseudonym
  • Why  doctors shouldn't raise concerns anonymously
We’ve answered these questions below and also provided some background information about how the guidance was developed.

Why identifying yourself as a doctor is good practice?
Patients and  the public generally respect doctors and trust their views — particularly about  health and healthcare. Identifying yourself as a member of the profession gives  credibility and weight to your views. Doctors are accountable for their actions  and decisions in other aspects of their professional lives - and their behaviour must not undermine public trust in the profession. So we think  doctors who want to express views, as doctors, should say who they are.

What does 'identifying yourself as a  doctor' mean in practice?
There is a bit of judgement involved here. For  example, if you want to blog about football and incidentally mention that  you're a doctor, there is no need to identify yourself if you don't want to.

If  you're using social media to comment on health or healthcare issues, we think it's  good practice to say who you are.

In the guidance we say 'you should' rather than 'you must'. We use this language to  support doctors exercising their professional judgement. This means we think it  is good practice but not that it is mandatory.

We've  explained the difference in our use of these terms in paragraph 5 of Good medical practice, and at:

Does this restrict doctors' freedom  of expression?
We are not  restricting doctors' right to express their views and opinions except:
  • Where  this would breach patient confidentiality 
  • Where  comments bully, harass or make malicious comments about colleagues on line. (A  colleague is anyone a doctor works with, whether or not they are also doctors).
One of the  key messages in the guidance is that although social media changes the means of  communication, the standards expected of doctors do not change when  communicating on social media rather than face to face or through other  traditional media (see paragraph 5 of the social media guidance). 

Will the  GMC take disciplinary action if I decide not to identify myself online?
This is  guidance on what we consider to be good practice. Failure to identify yourself  online in and of itself will not raise a question about your fitness to  practise.

Any concern  raised is judged on its own merits and the particular circumstances of the case.  But a decision to be anonymous could be considered together with other more  serious factors, such as bullying or harassing colleagues, or breaching  confidentiality (or both) or breaking the law. The guidance doesn't change the  threshold for investigating concerns about a doctor's fitness to practise. 

Does this guidance apply to personal use?
The GMC has no interest in doctors' use of social media in their personal lives —  Tweets, blogs, Facebook pages etc. But doctors mustn’t undermine public trust  in the profession. Usually this means breaking the law, even where the  conviction is unrelated to their professional life. 

For an example, read the recent Fitness to Practise Panel decision on the MPTS web page (PDF).

Why can't  I raise concerns anonymously in social media?
We are not trying to restrict discussion about important issues relating  to patient safety and certainly don't want to discourage doctors from raising  concerns.

However, we wouldn't encourage doctors to do so via social media because  ultimately it's not private and it might well be missed by the people or organisations who are able to take action to protect patients.

Our confidential helpline — where you can speak to  an advisor anonymously — enables doctors to seek advice on issues they may be dealing  with and to raise serious concerns about patient safety when they feel unable  to do this at local level. Our Confidential Helpline number is 0161 923 6399.

If  you want to talk to an independent organisation, we work with Public Concern at  Work whose legal advisors are trained in managing whistleblowing calls. They  can support and direct doctors who wish to raise concerns.

Why do publications like the BMJ  allow anonymous blogs/letters articles? Does the guidance mean they can't do  that anymore?
BMJ is entirely  independent of the GMC, and it is a matter for them to decide what is  appropriate for their website. However the Committee on Publication Ethics  considered a case and published their conclusions at 

Many blogs  are published without formal editorial or publisher control — although there  may be moderation on some sites. Using your name (or other identifying  information) provides some transparency and accountability.


How did we consult on the guidance?
We consulted  on the explanatory guidance in 2012 and wrote to all registered doctors via our publication GMC News in May 2012 asking them to tell us their thoughts on the  draft social media guidance. 

As part of this  public consultation, we received 80 responses from organisations and  individuals (with 49 of the individual respondents identifying themselves as  doctors). Specifically we asked whether it was reasonable for us to say that  doctors should usually identify themselves when using social media in a  professional capacity and 63% (49 respondents) agreed while 16 respondents  disagreed and 13 were unsure. 39 of those who responded commented on this  point.

Some of the responses from doctors in the consultation included: 

'Doctors should take ownership of  information given in a professional capacity as it is important that we are  accountable for our professional actions.'

'Too often, people hide behind  usernames on internet and on social media — if you have something to say,  don't be a coward.'

Patients groups also felt that being  open and honest when communicating online was important saying:

'Doctors should also be conscious of the widespread access to much social media, e.g. Twitter, which could mean that their social media engagement could endanger public confidence in the profession.'

Of course, some expressed the opposite view including:

'A doctor should be able to state that they are a medical professional without having to publicise their personal data. For example, when commenting on an online article it may be relevant that the comments come from a doctor but it should not require full identity disclosure. Where a comment is formal and part of a professional role, it would be more reasonable to expect identity disclosure.'

What does the final guidance say?
So after  careful consideration of all the views and the arguments on both sides the  final guidance 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 views of the  profession more widely.

What's happened since we published?
We  acknowledge the level and strength of feeling the petition represents. However,  there is nothing in the guidance that restricts doctors' freedom of speech  online or stops them from raising concerns. The guidance is a statement of good  practice, and the paragraph on anonymity in the guidance is framed as 'you should'; rather than 'you must'; to support doctors exercising their professional judgement.

To read the new edition of the Good medical practice for UK doctors, please visit GMC website.

Monday, 1 April 2013

50 years ago the GMC were more circumspect about commenting on doctors and the media

Richmond Council of Churches, WRVA-TV
Richmond Council of Churches, WRVA-TV from The Library of Virginia

For most of the 20th century doctors in the UK were urged to stay anonymous when speaking in public. The big fear was that doctors would use publicity to advertise themselves; to suggest that they were better than other doctors.

Here follows an extract from the BMJ in 1962 called "The Doctor's Code". It is written by Sir David Campbell a past president of the GMC (General Medical Council). 
"The other example is advertising, whether directly or indirectly, by canvassing or touting for patients or by causing articles to appear in the press drawing the attention of the public to the superior skill of the advertiser. If such practices were permitted, it would cut at the root of all decent relationships between members of the profession, and the public might be grossly misled. For there would be no guarantee of the superior merit of the doctor with the fewest scruples in praising himself and his methods. "
So that is why doctors were urged to stay anonymous. The BMA had it as part of their code of coduct until the 1980s. It was regularly debated at the Annual Representative Meeting. By 1984 the leadership of the BMA was perhaps out of step with the voting membership as this report in the BMJ states.
he representative body
wanted anonymity "preserved in all cases, except where a
practitioner is acting as the official spokesman of a health
authority or professional body, or where the public interest
clearly demands the naming of the practitioner.I had been mildly surprised at Manchester that the representative body had supported this motion: it had a Canute-like ring. Most committee members were of the same mind, for they saw little wrong with a doctor being identified in the media."

But the BMA resolutions were not enough for some. They wanted the GMC to come out and take a stand on anonymity and the doctors who they perceived as breaking it. A letter to the BMJ in 1968 from Athur Wigfield states:
Pious resolutions on the subject by the
B.M.A. are patently ineffective. The mainpurpose of this letter is to ask if we may ever expect the General Medical Council, some ofwhose members may be presumed to read the papers, to deliberate or act. Medical ethics are surely not limited to sober driving and impeccable conduct in the presence of patients. They extend to the steps of the hospital. In the interests of all of us someone should remind others of us that it is better to earn lifelong respect and adulation of colleagues than achieve ephemeral notoriety in the eyes of a sensation-lapping and morbidly curious public."
Let's go back to the ex-GMC president, Sir David Campbell. This is another extract from his piece the Doctor's Code where he explains that although some call for the GMC to make pronouncements on what are acceptable standards of behaviour in the light of new media, they can not.
"And here I would like to say something with regard to a criticism which has sometimes been levelled at the Council and indeed at the President. It is said that while the carefully worded notice tells practitioners in broad outline what they should not do, the Council has not seen fit to define in a positive sense what the practitioner might do. It is alleged that the Council is strangely mute or evasive when it is pressed for a pronouncement on, for example, any adjustment of conduct which might be permitted in the light of modern facilities for the health education of the public through the medium of the press or the radio or television. And it is averred that practitioners doubtful about their position in these matters receive little help of a practical nature if they address direct questions to the President or to the Council. Any hesitation to express an opinion or reticence on the part of the Council or the President is due to their statutory position. They are the judges of professional conduct in the last resort and are bound to judge every case that comes before them on the facts of the case as presented in evidence. Neither the Council, therefore, nor its President, who in fact has to deal with correspondence of this nature, can possibly commit the Council in advance to a specific view on any question which is not covered by decided cases. I may add that the Council while indicating the desirability of anonymity in broadcasting has not attempted to prevent the publication in the press of articles on medical subjects or broadcasting by registered medical practitioners. It rests, however, with practitioners who contribute such articles or take part in such activities to exercise their discretion so as not to afford ground for complaint to the Council."
So half a century ago new media was causing a bit of a furore. The GMC was cautious about taking a stand. Fast forward to 2013 and the GMC issues guidance that doctors should shun anonymity in social media. They have stepped in to territory that they sought to avoid 50 years ago and this is the result.