Wednesday, December 26, 2012

My (informal) social media policy

I use social media - mostly Twitter and this blog - to share content (journal articles, news stories, blogs, tweets, pictures, videos, etc.) that I find interesting and worthy of dissemination. For Twitter, I often make the decision as to its worthiness at the moment I am reading it, so it is usually unfiltered and spontaneous. However:
  • Sharing it does not mean I endorse it, agree with it, or necessarily believe it represents a balanced or carefully researched viewpoint.
  • RT in Twitter does not mean I endorse the tweet or the link contained in the tweet. It just means I think it is something my followers should see.
  • "Favoriting" a tweet does not mean I approve it; usually it just means I intend to read it later. Sometimes I RT or marked a tweet as a favorite only for note-taking purposes.
  • If I share it, I usually will have read the linked article completely enough to understand the main points and general concepts the author(s) intend to convey. However, there are exceptions - I may RT something that looks particularly interesting or provocative without reading it in detail, but usually only if I am familiar with the source.
  • Since tweets are only 140 characters, it is often difficult to convey nuance or detail, and read out of context are by definition prone to misinterpretation.
My audience is both a professional audience (other physicians or healthcare/IT specialists) and a lay audience (patients). Whenever I tweet or write a blog post, I do not intentionally create the content exclusively for one audience or the other. I recognize there is a lot of overlap in interests, and I believe that is a good thing.

Sometimes I will link to articles that require a personal or institutional subscription to view the full text, or as some call it, articles that are behind a "paywall." I do regret that all of my readers will then not have full access to what I am sharing, but that is the reality of publication today. I'm not going to wade into that discussion here, but I will say that I recognize current business models mean that many journals can't stay afloat financially without advertising directed at paid subscribers. Sorry folks. 

I will not share any patient-specific information, and certainly not anything that would run afoul of HIPAA. Patient privacy is a sacred trust for physicians, and protecting that is my highest priority.

Moreover, while I may share some perspectives and experiences surrounding patients I have encountered, I will do so in a general way, and individual patients should not be able to identify themselves. I realize that it is still possible to reveal enough information in a scenario or vignette to violate privacy without including a patient-specific identifier, so I won't do that.

If I do share a vignette or patient story, it will be a conglomeration of multiple patients or it will be otherwise fictionalized so that an individual won't be able to identify him- or herself. The exception would be if I chose to share a specific patient story with the explicit permission of that patient.

Tweets or blog posts do not represent medical advice. Any interactions I may have with individuals on this blog or Twitter are of a general nature about the health condition but not your health condition. These interactions do not constitute a doctor-patient relationship. You should always consult with your personal physician for questions about your health.

My blog posts and tweets are my opinion only and not that of any other person or organization. They do not represent the opinion of the Johns Hopkins University School of Medicine (my employer) or the American Society of Clinical Oncology (where I volunteer). I am not speaking on behalf of Hopkins or ASCO. I do attempt to honor the social media policies of both organizations, however.

While some have advocated that physicians and other professionals have completely separate social media accounts for their personal and professional uses, I don't totally agree with that (who has the time). I have one blog (this one) and one main Twitter account (@rsm2800). I do use LinkedIn for professional contacts and Facebook on occasion for keeping in touch with friends. However, on LinkedIn I generally only accept connections from people with whom I have a prior or existing business relationship, and I only accept friend requests on Facebook from personal friends.

I am honored to have my patients read my blog or follow me on Twitter, but I do not practice medicine using social media. If you are a patient and you need to contact me about a specific health concern, please DO NOT do so on those channels since I cannot guarantee your privacy or assure you a timely enough response. (At the time of your visit, we will discuss the best way of reaching me or my office - a phone call is always the safest and most direct.) Also for reasons of privacy - yours and mine - I do not accept LinkedIn connection requests or Facebook friend requests from existing or past patients. 

I enjoy being visible on social media and interacting with Twitter followers and readers of this blog, but that doesn't mean I am available 24/7. I have a demanding job and like everyone else I need to tune out at times, not think about work, not read email etc. Some of those times I may still be on social media, so you may see me there even if I am not in the clinic, answering email, etc. If I have any email unavailability longer than an overnight or a weekend, I will use my Out of Office message so you can know when that is. For my Hopkins patients, there is always an oncologist on call 24/7, who can be reached by calling my office number day or night, so if I am not around, someone else covering for me will be.

And finally…

Remember that the strength of social media is its immediacy and accessibility, and the content shared is often spontaneous and unpolished. The ideas may be further developed by sharing and interaction (RT's, blog comments, etc.), and that means that the tone and conclusions may evolve. Pediatrician and social media expert Dr. Bryan Vartabedian calls this "public thinking," and I would agree with his premise that physicians are starting to have an obligation to connect and spread ideas in this very transparent and public space. But by definition, that makes social media a much different communication channel for me as a physician than traditional ones - interacting one on one with a patient in the exam room, publishing in the scientific literature, or speaking at a conference. So while I will always endeavor to make the content I share publicly on social media accurate, timely, and relevant, readers of this blog and my Twitter stream must appreciate the differences between the traditional and social channels. And it is important to do both well!


[UPDATE 1/2/2015]

On 12/3/2014 I became a full-time employee of the American Society of Clinical Oncology (ASCO), meaning that my previous employment at Johns Hopkins has ended. My position at ASCO is Senior Director, Quality and Guidelines and Medical Director, CancerLinQ. From time to time, I will continue to update this blog, Perspicacity. I remain active on Twitter at @rsm2800. The views I express on any and all of my social media channels are personal views and do not necessarily represent the views of ASCO. I am not speaking on behalf of ASCO. As noted above, "retweeting" or "favoriting" on Twitter does not mean I endorse the content of the tweet. "Following" another user on Twitter does not mean I agree with the positions or policies of that person or organization. And tweets/blog posts never represent medical advice.

Thursday, December 20, 2012

Electronic Health Records Infographic

The blogs that I read regularly are full of posts from physicians bemoaning the shortcomings of electronic health records, from poor usability to exorbitant costs to the impact on face-to-face (or at least eye-to-eye) contact with patients. As someone heavily involved in the design and implementation of the Epic system at Johns Hopkins, I know most of these comments represent an accurate depiction of a technology that is a long way from achieving its stated goals of increasing interoperability, enhancing patient safety, and ultimately improving patient outcomes. But this great infographic from the Office of the National Coordinator for Health Information Technology (ONC) reminds us that despite all of their faults, EHR's are able to connect patients and doctors much more effectively than paper records ever could, and there is no turning back if medicine wants to thrive in the 21st century.