Guidelines for Managing Online Presence in Psychiatry

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Assessing and Managing Online Presence and Clinical Use of Social Media: Lessons from the Group for Advancement of Psychiatry (GAP) 2010 Fellows Plenary Session 2010 GAP Fellows: Neil Aggarwal, MD; Benjamin Brody, MD; Gwyn Cattell, MD; David Cochran, MD; Mandy Garber, MD; Stephanie Giannandrea, MD; HeshamHamoda, MD; Steve Koh, MD; Aaron Krasner, MD; Fred Langheim, MD; Chad Lemaire, MD; Rebecca Lewis, MD; David Sasso, MD; Megan Testa, MD Lessons Learned Future Directions and Limitations GAP Survey – Methods and Results Discussion Social Media Penetration Introduction / Background • Many physicians are posting professional and personal information on organizational and non-professional websites • Research is only now being done on the impact of online presence vis-à-vis the doctor-patient relationships and mutual safety and privacy • Ethical, legal, safety, privacy and other concerns are being raised about the physician online presence • Electronic media is still unfamiliar to many practicing physicians and many are unaware of the potential risks posed by the Internet • More and more physicians are using email to communicate with patients and colleagues • The Group for the Advancement of Psychiatry (GAP) is an American professional organization of psychiatrists, founded in 1946, dedicated to shaping psychiatric thinking, public programs and clinical practice in mental health. Its 29 committees meet semi-annually and choose their own topics for exploration. They explore issues and ideas on the frontiers of psychiatry and in applying psychiatric insights into general medical, social, and interpersonal problems. • Selected Currently Available Guidelines • E-mail Guidelines (Kane and Sands, JAMIA, 1998) • Establish turnaround time and types of transactions • Inform patients about privacy issues • Print all messages in chart • Avoid sarcasm, anger, etc. • Get informed consent to use email • Social Networking Guidelines (Guseh et al., J Med Ethics, 2009) • Avoid dual relationships (“friend” requests) • Respect patients’ privacy • Exercise restraint in personal social networking • Read and understand site-specific privacy settings • Patient-targeted internet search guidelines (Clinton et al., Harv Rev Psych, 2010) • Why am I conducting search? • Would it advance or compromise treatment? • Should I obtain consent? • Should I share results with patient? • Document findings in medical record? • How do I monitor my motivations and risk-benefit profile? • What is missing in current guidelines • Texting • Online presence • Comprehensive guidelines covering various modes of electronic communication • Discipline-specific guidelines endorsed by professional organizations • Why are there so few guidelines? • New technologies emerging quickly • Few legal precedents • Generation gap • SURVEY METHODS • Anonymous survey of GAP membership • Distributed at annual meeting and by mail • Results collected and analyzed using SPSS and Microsoft Excel SURVEY RESULTS – DEMOGRAPHICS 178/212 (84%) members responded Mean age: 58.3 ± 14 Practice patterns: 56% academic; 41% private Effort: 73% FT; 27% PT Lessons Learned • Establish acceptable means of communication • Establish expected response time • Avoid friending a patient • Discuss friending requests with patients • Consider how to respond to requests to view online information about a patient • Are your decisions going to advance or hinder treatment? • What information gathered online enters a patient’s chart? • Security of electronic communication (with patients, other clinicians) • Security of electronic devices (phone, computer, etc.) • FUTURE DIRECTIONS – What is needed • A comprehensive set of guidelines covering issues of treatment frame, patient privacy, medico-legal issues, and professional issues, across multiple domains of electronic communications that addresses discipline-specific issues and is accepted by the professional community as the standard of care. • LIMITATIONS OF STUDY • Nonrepresentative Sample of Practicing Physicians • Overrepresentation of Academic Clinicians, Age >50 • Social Media usage has increased exponentially in the past decade across all segments of society Patient Privacy Treatment Frame References and Acknowledgements Chretien KC, Greysen SR, et al., “Online posting of unprofessional content by medical students,” JAMA 2009, 302(12):1309-15. Clinton BK, Silverman BC, Brendel DH, "Patient-targeted googling: the ethics of searching online for patient information," Harv Rev Psychiatry 2010, 18(2): 103-12. Eysenbach G, "Towards ethical guidelines for dealing with unsolicited patient emails and giving teleadvice in the absence of a pre-existing patient-physician relationship systematic review and expert survey," J Med Internet Res 2000, 2(1): E1. Gorrindo T, Groves JE, “Web searching for information about physicians,” JAMA 2008, 300(2):213-5. Guseh JS, Brendel RW, Brendel DH, "Medical professionalism in the age of online social networking," J Med Ethics 2009, 35(9): 584-6. Jain SH, “Practicing medicine in the age of Facebook,” NEJM 2009, 361(7):649-51. Kane B, Sands DZ, "Guidelines for the clinical use of electronic mail with patients. The AMIA Internet Working Group, Task Force on Guidelines for the Use of Clinic-Patient Electronic Mail," J Am Med Inform Assoc 1998, 5(1): 104-11. Shapiro DE, Schulman CE, "Ethical and legal issues in e-mail therapy," Ethics Behav 1996, 6(2): 107-24. Silk KR, Yager J, "Suggested guidelines for e-mail communication in psychiatric practice," J Clin Psychiatry 2003, 64(7): 799-806. Spielberg AR, "Online without a net: physician-patient communication by electronic mail," Am J Law Med 1999, 25(2-3): 267-95. Thompson LA, Dawson K, et al., “The intersection of online social networking with medical professionalism,” J Gen Intern Med 2008, 23(7): 954-7. The GAP Fellows would like to acknowledge Larry Gross, MD, David Baron, DO, and the GAP membership for their help and support during the tenure of our fellowship and preparation of this presentation. Medicolegal Issues Professional Issues • Understand your institution’s guidelines/policies • Create your own guidelines • Obtain written informed consent from patients about expectations for communication, response time, potential risks and benefits of electronic communication • FACEBOOK STATISTICS • >500 million users • 50% log on in a given day • 36% of time on the internet • 70% of Facebook Users outside the US • Average User: • 130 “friends” • 80 community pages, groups, events • 90 pieces of content each month • > 55 minutes per day on Facebook • What is online about you? • Think twice about posting online about yourself • Understand the privacy settings of the online sites you use * The above may apply to multiple domains of online communication, e.g., email, texting, social networking, etc. - Data from Facebook.com