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

By Sandra M. DeJong

Blogs and Tweets, Texting and Friending: Social Media and Online Professionalism in Health Care summarizes the most common mistakes — and their legal and ethical ramifications —made in social media by busy health care professionals. It gives best practices for using social media while maintaining online professionalism. The book goes on to identify categories of caution, from confidentiality of patient information and maintaining the professional's privacy to general netiquette in tweeting, texting, blogging, and friending. And it guides you in setting up a faculty page (or choosing not to) and managing your online footprint.

The connected generation regularly uses social media, including health care professionals, but what happens when a patient wants to friend you? Or when you've already posted a rant on a patient that gets viewed by others? What information may already be floating on the Internet that a patient may find about you in a Google search and that might impact your therapeutic relationship?

Whether you are new to social media or an expert user in your private life (but haven't thought about what this means for you professionally), this book is for you. It’s the "when" and "how" to use social media effectively while maintaining online professionalism.

• Identifies social media best practices for maintaining online professionalism
• Covers multiple forms of social media, from blogs and tweets to texting and friending
• Includes case vignettes of real-life actions and their repercussions
• Intended for the protection of both the professional and the client or patient

• Language: English
• Publisher: Academic Press
• Release date: Jul 4, 2013
• ISBN: 9780124080683

Book preview

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 limitations, 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 paycheck, leaving the patient on the table (Swidey, 2004). Other times they are more implicit, only inferable by overly casual dress, sloppy documentation, 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 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 hospital 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.

Hafferty, 2006, p. 2152

The relationship between patient and health-care professional carries a fiduciary duty: The professional has an obligation to act for the patient’s benefit and the patient places ultimate faith in the abilities and good intentions of the professional. Professionalism is the foundation for the trust patients place in their caregivers. When that trust is broken, patients rightfully protest: Breaches of professionalism are a common cause for patient complaints and for negative media reports about health-care professionals (Hickson et al., 2002). In one retrospective study, physicians who were disciplined by state licensing boards were three times more likely to have shown unprofessional behavior in medical school than were those with no such disciplinary actions (Papadakis et al., 2005).

Health care has come under closer scrutiny in recent years as professionalism has been challenged by changes in health-care delivery, growing expectations by the public, the increasing role of corporate entities, and technology. The American Board of Internal Medicine (ABIM) began its Project Humanism in the 1980s and its Project Professionalism in the 1990s. Guidelines for medical schools and certification standards require demonstrated professionalism at the undergraduate and graduate level (Association of American Medical Colleges, Institute for International Medical Education, American Council for Graduate Medical Education; see Rider, 2007, p. 189). Given these requirements, efforts have been underway to try to define and assess professionalism.

In the United States, the definition of professionalism has focused more on the attributes of clinicians and their capacity to self-monitor, self-reflect, and self-regulate. Qualities such as compassion, competence, integrity, consistency, commitment, altruism, leadership, and insight come to mind (Rider, 2007). In this model, professional clinicians are those who are constantly assessing their clinical and technical skills and trying to improve; taking care of patients from the standpoint of values of humanism and empathy; shunning self-interest to focus on the care of others.

Closely related, but with a somewhat different emphasis, is the patient-centered professionalism model (Irvine, 2005). Writing in the UK, Irvine emphasizes the expertise of the clinician (knowledge base and skill set); the adherence to ethical virtues of beneficence, nonmaleficence, autonomy, and justice; and the service to the patient. This model reinforces the importance of developing a patient-centered health-care culture, and of a regulatory system to assess and monitor clinicians’ expertise, since patients themselves are unable to do so. Implicit in this model is the notion that health-care providers should be truthful and open with their patients, and maintain patient confidentiality; they should provide patients with information so that they can make informed decisions with their providers about their care; they should acknowledge their own limitations of professional competence; and they should be respectful and unbiased towards the patient’s individual and cultural values.

As Irvine’s model makes clear, professionalism is often closely associated with ethics, which are typically delineated in professional codes such as the American Medical Association’s code of ethics (http://bit.ly/kaaxBG). American psychiatrists Glen Gabbard and Laura Roberts have pointed out that professionalism is embodied in ethical action (Gabbard et al., 2012, p. 17). They emphasize the key role of biomedical ethics concepts in professional behavior (Table 1.1).

Table 1.1

Important Principles of Medical Ethics¹

¹Gabbard , G. O., Roberts, L. W., Crisp-Han, H., Ball, V., Hobday, G., & Rachal, F. (2012). Professionalism in Psychiatry (pp. 21–22). Washington, DC: American Psychiatric Press.

In 2002, ABIM, the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), and the European Federation of Internal Medicine jointly published a document entitled, Medical professionalism in the new millennium: A physician charter. The charter, based in part on the work of physicians Sylvia and Richard Cruess at McGill University in Canada, takes professionalism one step further to encompass not only relationships with patients, but also relationships with our students, colleagues, and society as a whole (Cruess, Johnston & Cruess, 2002). The writers argue that physicians (and arguably all health-care providers) are both healers and professionals, and that a social contract exists between physicians and society. This charter embodies three fundamental principles: the primacy of patient welfare; patient autonomy; and social justice. It entails ten professional responsibilities to which physicians should commit: professional competence; honesty with patients; patient confidentiality; maintaining appropriate relations with patients; improving quality of care; improving access to care; just distribution of finite resources; scientific knowledge; maintaining trust by managing conflicts of interest; and a commitment to these responsibilities (ABIM Foundation et al., 2002). This description of professionalism takes health-care professionals way beyond the treatment room, out into society as a whole where they have an important leadership role in advocating for quality and access, and equitable resource allocation (Table 1.2).

Table 1.2

Professionalism Attributes

¹www.acgme.org/outcome/comp/compFull.asp

²www.gmc-uk.org/guidance/archive/library/duties_of_a_doctor.asp

³www.abimfoundation.org/professionalism/pdf_charter/ABIM_Charter_Ins.pdf

How do health-care professionals get into trouble with unprofessional behavior? Examples of unprofessional behavior reported by those who teach medical students and residents include dishonesty (both intellectual and personal); being arrogant, disrespectful or abrasive to the patient, students, or coworkers; failing to take responsibility for errors and/or not being fully invested in the clinical outcome of the patient; conflict of interest and financial gain, such as accepting kickbacks when ordering certain treatments; failure to stay up to date in clinical care; and engaging in high-risk behaviors, such as substance abuse and sexual misconduct (Duff, 2004).

While such examples clearly represent a dearth of the professionalism described in the three models above (the individual and self-reflection, the patient-centered, and the social contract models; Table 1.3), many can also be described as transgressions of implicit or explicit boundaries. The concept of boundaries implies a border or limit. Boundary violations occur when such borders or limits are crossed inappropriately, causing real or potential harm to others. Boundary crossings take place when the boundary is crossed but without frank harm. Sometimes, the boundary is not so clearly crossed, but rather made permeable, leaky in such a way that it becomes murky and unclear.

Table 1.3

A Synthesis of Conceptual Models of Professionalism

¹Rider, 2007.

²Irvine, 2005.

³ABIM Foundation et al., 2002.

How does the concept of boundaries apply to professionalism and health care? First, implicit boundaries circumscribe the treatment relationship. The fiduciary relationship involves the patient placing complete confidence in the caretaker, not as a legal matter, but as a matter of the clinician’s moral responsibility that comes with being a health-care professional with knowledge and training that can help the patient. When patients present for care, they are putting not only their trust but their very wellbeing into the hands of the clinician. The treatment is framed by a set of assumptions related to professionalism: the care, which will involve the patient revealing potentially highly intimate information, will be confidential; the clinician will provide a competent service; the clinician will prioritize the needs of the patient; any conflicts that the clinician has regarding the care of this patient will be directly disclosed and discussed; the clinician’s role is to provide expertise and compassionate care, while the patient’s role is to meet the clinician halfway and to participate in treatment decision processes.

Another set of boundaries circumscribes the health-care facilities and academic institutions in which the clinician practices. We expect, for example, that a clinician might share information with a colleague who is taking care of the patient in another service in the hospital. In fact, electronic medical records were designed in part to facilitate this process. Just as the patient may develop trust in the individual practitioner, so too may the patient learn to trust the institution as having the patient’s best interests at heart.

Finally, advocates of the social contract concept of professionalism might argue that boundaries define the health-care profession. Society has an expectation that health-care practitioners will behave within a boundaries framework: They do the work that they do not just as a job, but rather as a calling – to do good, to help people. The assumption is that while health-care professionals may certainly charge reasonable fees, they are not primarily doing the work as a business venture. They are assumed to be solid citizens, community contributors, and individuals of moral standing. In exchange, society affords these practitioners respect, autonomy, and a voice in health care and society at large (Cruess,

Reviews for Blogs and Tweets, Texting and Friending

[Gwen Dy Agra · Rating: 4 out of 5 stars]

a very thorough review of all technological advances and its utility in healthcare and possible risks for the patient and the health care provider.