Blogs and Tweets, Texting and Friending Blogs and Tweets, Texting and Friending Social Media and Online Professionalism in Health Care

Blogs and Tweets, Texting and Friending Blogs and Tweets, Texting and Friending Social Media and Online Professionalism in Health Care Sandra M. DeJong, MD Harvard Medical School and Cambridge Health Alliance AMSTERDAM • BOSTON • HEIDELBERG • LONDON NEW YORK • OXFORD • PARIS • SAN DIEGO SAN FRANCISCO • SINGAPORE • SYDNEY • TOKYO Academic Press is an Imprint of Elsevier Academic Press is an imprint of Elsevier 525 B Street, Suite 1900, San Diego, CA 92101 4495, USA 32 Jamestown Road, London NW1 7BY, UK 225 Wyman Street, Waltham, MA 02451, USA Copyright © 2014 Sandra M. DeJong. Published by Elsevier Inc. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise without the prior written permission of the publisher. Permissions may be sought directly from Elsevier’s Science & Technology Rights Department in Oxford, UK: phone (+44) (0) 1865 843830; fax (+44) (0) 1865 853333; email: [email protected]. Alternatively, visit the Science and Technology Books website at www.elsevierdirect.com/rights for further information. Notice No responsibility is assumed by the publisher for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions or ideas contained in the material herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress ISBN: 978-0-12-408128-4 For information on all Academic Press publications visit our website at elsevierdirect.com Typeset by MPS Limited, Chennai, India www.adi-mps.com Printed and bound in the United States of America 14 15 16 17 10 9 8 7 6 5 4 3 2 1 For my family, whose love and support make so much more possible. Acknowledgments As a doctor, I learn from my patients; as an educator, I learn from my students. I am grateful to the former and current child psych iatry fellows at Cambridge Health Alliance for bringing the impor tance of this topic to my attention and urging me to teach about it. Thanks to Cambridge Health Alliance for supporting me as a Fellow at the Harvard Macy Institute’s Program for Educators in the Health Professions and to my Macy teachers and colleagues; without them, this work may never have gotten underway. Finally, I want to acknow ledge my indebtedness to members of the Taskforce on Professionalism and the Internet of the American Academy of Directors of Psychiatry Residency Training: Joan Anzia, MD, Sheldon Benjamin, MD, Bob Boland, MD, Nadyah John, MD, Jim Lomax, MD, and Anthony Rostain, MD. The work we did together in developing our Curriculum on Professionalism and the Internet for psychiatry is very evident in this book; I am grateful for their wisdom. In particular, I want to thank Dr. Benjamin, my former training director, who appointed me chair of the taskforce. As a teacher and mentor, he has a wonderful quality of believing in his students more than they do in themselves. LEGAL DISCLAIMER Care has been taken to confirm the accuracy of the information pre sented and to describe emerging accepted standards. However, the author, editors, and publisher are not responsible for errors or omis sions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of this publication. Application of the information in a particular situation remains the professional responsibility of the practitioner. ix Introduction A few years ago a child psychiatry fellow put in my mailbox a news- paper clipping with a Post-It note on it reading, “We should be talking more about this.” The clipping was a column by Richard Friedman, MD, entitled “Take two Prozac and e-mail me in the morning” (New York Times, July 16, 2008). The column started me thinking about all the ways in which the digital revolution has transformed health care. In particular, I became aware of how the pillars of professionalism – boundaries, confidentiality, privacy – were being transformed by technology. I started participating in national workshops with psychiatrists and psychiatric trainees. The scope of the problem as I perceived it grew by leaps and bounds. In 2010, a taskforce of psychiatric training directors in the United States was charged with developing a vignette-based curriculum on this topic. The demand was enormous and the response positive. When I was asked if I wanted to write a book on the topic, the need seemed clear. But some caveats are in order: I am a medical educator, not a “techie.” I am also a psychiatrist, not a nurse or a surgeon or a phys- ical therapist. Finally, I am human, and do not have a crystal ball to see what the future may hold in terms of social media, online search- ing, and digital technology in health care. What follows, then, is my effort to focus on broad-based concepts of the importance of professionalism in medicine and the ways in which professionalism is at risk in the face of the scope, speed, and permanence of digital technology. I have tried to provide some context to these concepts and illustrate them with clinical vignettes. Finally, I have tried to provide both general and specific recommendations to guide health-care professionals in clinical practice as we all walk this uncharted terrain together. I apologize in advance to those who do know a lot about technology for wherever my ignorance is in evidence. Similarly, I ask health- care professionals from other disciplines and specialties to take my vignettes with a grain of salt; they are used to make a teaching point about technology, not to reflect the reality of clinical care. The panoply of new technological devices and innovations is more than can be fully covered in this book. Two emerging areas not included are Skype and other video-chat technologies and electronic medical records (EMRs). The former largely falls under the rubric of telemedicine and is subject to its regulations and licensing xi xii Introduction requirements. EMRs raise complicated issues for health-care facilities but largely do not involve interaction with the public except through protected portals. For these reasons, neither is addressed here. Technology like social media and the Internet brings extraordinary opportunity to health care. How that technology is used is, at least partly, in our hands. My hope is to re-assert the professional frame in which we work and to guard the trust that our patients put in us as individual practitioners, in our hospitals and institutions, and in our profession. Chapter | One What is Professionalism? The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head. Osler, 1932, p. 3681 Professionalism, to paraphrase Shakespeare’s Hamlet, is often noted more in the breach than in the observance. When trainees in health-care professions are asked to define professionalism, they tend to describe examples of lack of professionalism: clinicians who mistreat patients or colleagues, who put their own needs ahead of the team or the patient, who lack competence but refuse to acknowledge their limita- tions, and whose approach to clinical care lacks the compassion and empathy that Osler so eloquently described when he called medicine “a calling in which your heart will be exercised equally with your head” (DeJong, 2010–12). Sometimes these deficits are glaringly obvious, such as the surgeon who left the operating room to go to cash a pay- check, leaving the patient on the table (Swidey, 2004). Other times they are more implicit, only inferable by overly casual dress, sloppy docu- mentation, poor time management, inappropriate tone of voice. How professionalism is manifested and perceived may vary by developmental stage, gender, and geographic, ethnic and institutional cultures. Some evidence suggests that women value professionalism more than men (Roberts, Warner, Hammond, Geppert & Heinrich, 2005). Some studies suggest that views of professionalism shift over the developmental trajectory of practitioners’ careers in health care (Nath, Schmidt & Gunel, 2006; Wagner, Hendrich, Moseley & Hudson, 2007). What is considered professional in one health-care 1 I am indebted to Dr. Elizabeth A. Rider, who reminded me of this quotation and whose chapter “Professionalism” in Rider, Nawotniak & Smith (2007) guided my thinking about this topic. 1 S. deJong: Blogs and Tweets, Texting and Friending. DOI: http://dx.doi.org/10.1016/B978-0-12-408128-4.00001-1 © 2014 S. DeJong. Published by Elsevier Inc. All rights reserved. 2 What is Professionalism? environment may not be in another: Jeans, open-toed shoes, and low- cut blouses may be acceptable at some institutions in some parts of the world, and within some specialties, but not in others. And culture can change over time: While scrubs used to be prohibited outside the hospi- tal in the United States, they have now become commonplace. But professional presentation and etiquette are not a substitute for fundamental professional attributes; the latter go deeper to the level of moral judgment, ethics, integrity, and altruism, to what Hafferty has called “the professional self”: Taking on the identity of a true medical professional… involves a number of value orientations, including a general commitment not only to learning and excellent of skills but also to behavior and practice that are authentically caring… There is a meaningful (and measurable) difference between being a professional and acting professionally.

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