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Social Wellness

When was the last time you met a friend from outside of medicine for a coffee? When did you last call your favorite family member? What was the most fun thing you did in the last month? With the understanding that your social contacts and activities play an important role in keeping you grounded and motivated, this section provides some social media guidelines for you as well as suggestions on how to strengthen those bonds and stay involved even during medical school/residency. 

 

Managing life and work:

A New York Times article on the importance of maintaining a balance between your personal life and a career in medicine.

How to say no effectively:

Sometimes, “No” is the only option. It is important to realize that you cannot please everyone and that you shouldn’t feel guilty about it. What’s more, you should not feel obliged to explain a legitimate decision to deny a request from a colleague, friend, or patient.

5 ways to say no effectively

How to say no to patients

 

Recommended Books

 

Social media “to do” list:

  1. Search your own name on the web and ensure that there is no inappropriate content associated with you online.
  2. Subscribe to Google Alerts. This will keep you informed if any new public information is posted on the Internet about you. 
  3. Review the privacy settings of all your social media accounts. 
  4. Review your friend list on a regular basis. 
  5. Read through any blogs you have written, your tweets, and your profiles. Remove any posts that might be considered unprofessional/inappropriate. 
  6. Review your institutional guidelines and familiarize yourself with them. Ignorance is not an acceptable excuse for unprofessional behavior.
  7. The Canadian Federation of Medical Students has released thorough social media guidelines for all medical students across Canada. These are available at: http://www.cfms.org/attachments/article/995/CFMS%20Guide%20to%20Social%20Media%20Professionalism.pdf

Social media scenarios

1. Patient confidentiality

You are a Med-2 currently rotating through oncology clinics. You return home feeling saddened by the case of a life-long smoker patient you had seen that day who had been given a diagnosis of metastatic lung cancer. Feeling the need to inform and maybe inspire some of your friends who smoke to think about quitting, you detail the patient’s young age and life story in your Facebook status update, concluding with a statement about the tragic diagnosis and a call for people to quit smoking.

Why is this an issue?

Regardless of the intention, it is unacceptable to breach patient confidentiality by publicly divulging details about patients and their illnesses, including on Facebook or any other social media forum. Even though this was done with the goal of “educating” and providing a positive message about the dangers of smoking, the description of a patient’s case on your Facebook wall is a violation of your medical school and Canadian Medical Association policy. It is grounds for discipline (see www.cma.ca/advocacy/social-media-canadian-physicians).

How can this be avoided?

Do not, under any circumstances, discuss (whether orally or electronically) details about a patient with anyone besides the other members of the health care team, and ensure that this is always done in a private environment. Think carefully before publicizing any information about your clinical activities on social media and make sure that you are not inadvertently breaching patient confidentiality by mentioning patient details that could be used to identify them in your online posting.


2. Inappropriate use of social media

In light of recent expansions in the legalization of same-sex marriage, there has been much public debate on this subject in the general and social media. Online one day, you notice that a Med-4 friend has posted a Facebook link to a website for a group that is explicitly homophobic, and has responded to critical comments on this by publicly re-iterating her disdain for gay individuals. She insists that it is a free country and that she has the right to express her opinion.

Why is this an issue?

While your friend is correct that it is a “free country”, she is in fact engaging in behavior through her social media use that shows discrimination and intolerance against certain groups. This is problematic at several levels:

  1. Links to hate groups do not represent the higher standard to which medical students are held by their school, and may constitute an act of unprofessionalism. This can be grounds for discipline if she was reported to them.
  2. Her demonstration of discrimination and intolerance on Facebook may compromise her professional integrity as perceived by colleagues and future employers as well as patient trust by members of the minority groups whom she has publicly discriminated against.

How can this be avoided?

While medical students have the right to express themselves and engage in debate on topical issues in social media, they must uphold the levels of professionalism and integrity expected of them. Engaging in online behavior that is explicitly discriminatory against a certain sub-group of people compromises these values.


3. Doctor-patient relationship

You are a medical student working in a clinic, and you are seeing a patient who has recently been brought to Montreal for treatment due to devastation in his home country. You examine the patient, and while taking his history you learn that he is around your age and is here without any of his family or friends. He is currently staying at a shelter. He casually suggests meeting up socially, and when you return home you see that he has requested to add you as a friend on Facebook.

How should you proceed and why?

Politely decline the online relationship to maintain sufficient professional distance.

Why is this an issue?

According to the BMA guidelines on social media, relationships outside the clinical environment raises multiple ethical issues:

  • to maintain trust and prevent exploitation of patients it is important to be aware of the power-imbalance that exists in any doctor-patient relationship
  • In smaller communities, doctors may have personal relationships with patients. Even in these situations, physicians and medical students must maintain a professional relationship.
  • Many doctors and medical students report receiving friend requests on Facebook from patients. Since online social media websites allow greater accessibility of personal information, there is an increased likelihood of inappropriate boundary transgressions. “Difficult ethical issues can arise if, for example, doctors become party to information about their patients that is not disclosed as part of a clinical consultation.”

Quoted and paraphrased from: http://www.bma.org.uk/images/socialmediaguidance_tcm41-206859.pdf Accessed March 18, 2012.

How can this be avoided?

“The BMA recommends that doctors and medical students who receive friend requests from current or former patients should politely refuse and explain to the patient the reasons why it would be inappropriate for them to accept the request.”
Quoted from: http://www.bma.org.uk/images/socialmediaguidance_tcm41-206859.pdf Accessed March 18, 2012.


4. Posting information online

You are a medical student on call working late. The health of one of the patients on your service begins to decline rapidly, and unfortunately, the patient passes away. This is the first time that you have witnessed the death of a patient. You find this to be a difficult experience, and want to share your emotions. You post on a social media site, “Just declared my first dead. This one hurts.” In a string of other responses to your post, you eventually also write, “It’s not a big deal. He was old anyway.”

By posting this, have you violated any aspect of professionalism?

Yes.

Why is this an issue?

Posting any information about interventions or cases in which you participated in the hospital violates patient confidentiality. While there was nothing noted in the post about the identity of the patient, those close to the patient may have identified you as someone who was taking care of the patient, and in turn could have been able to link the patient’s identity to your post. Furthermore, by downplaying the significance of the event, you also have disrespected the patient.

How can this be avoided?

According to the CMA guidelines on social media:

  • “Individual patient information should be restricted to the circle of care.”
  • In any communication with patients apart from face-to-face, physicians and medical students must use “a secure electronic communication platform”.
  • “Patient information, including images, should never be posted online or shared in electronic communications of a general nature.”
  • “On social media websites, physicians must use the most stringent security and privacy settings available for the particular platform.”
  • “All employees handling patient information should be made aware of issues concerning patient confidentiality in their own use of social media.”
  • “Social networking sites cannot guarantee confidentiality. Anything written on a social networking site can theoretically be accessed and made public.”


5. Irresponsible behaviour

You go out to a party one night and consume a significant amount of alcohol. At the party, some of the people take compromising photographs depicting you consuming alcohol and acting in a sexually suggestive manner. The next day, these photographs are posted online and you are “tagged”. Over the year, you forget about them until they are brought up by a program director while on a medical elective at another school.

Have you acted in an unprofessional manner?

Yes.

Why is this an issue?

This situation raises multiple red flags. First, publication of pictures depicting irresponsible behaviours implies an endorsement of these actions by the person performing them. If these photographs are accessed by your coworkers, superiors and patients, it can compromise trust and credibility.

What can be done to avoid this?

You should periodically check the privacy settings on any social media account and conduct a web search to censor what has been published about you. Remove photographs that might be unprofessional. Additionally, it is advisable to remove any aspect of an online profile, including posts, pictures, videos, that might compromise your integrity. There are search tools that will automatically search a particular query for you (see: http://www.google.com/alerts) and send the results to you via email. Using a tool such as Google Alerts will keep you updated on your online presence.


6. Tweeting

You are now in PGY1 at MGH, congratulations! Your colleague, AL, with whom you, JD, just enjoyed a glorious night out for St. Patrick’s Day has decided to Tweet her enthusiasm on the way back from the party: “F***ing awesome party 2nite. You are a dog @JD.” You reply right away “@AL you know it B****!” The next morning you look at your Tweets and feel uncomfortable about the language you might have used to express yourself last night.

Have you acted inappropriately? What can you do next?

Yes. Remove post, apologize for language. Talk to your colleague and ask them to do the same.

Why is this an issue?

Even though there is no law that has been broken, vulgarity on a social media outlet can compromise your reputation. A third party viewing this exchange would consider you to be disrespectful towards women.

How can this be avoided?

As a professional, you have the responsibility to maintain your integrity online. First step in this process is to find safe outlets to express yourself. You are encouraged to explore other options such as talking to family and friends over the phone or through email from the privacy of your home. A good strategy to prevent a similar incidence in the future is to limit access to social media outlets when you know your judgment may be compromised.


7. Disrespectful behaviour

You decide to enroll in the Medical French workshop offered by the Faculty to improve your French language skills. In this class, there are three nursing students, two residents and four medical students. During the group discussion regarding Euthanasia, you have a difference of opinion from one of the nursing students. You come home frustrated and change your Facebook status: “Nurses don’t see the patients the same way we do. How can they know when to make important decisions regarding life and death.”

By posting this, have you violated any aspect of professionalism?

Yes.

Why is this an issue?

Firstly, this statement is incorrect and shows a severe lack of judgment on the part of the author. Medicine as a practice and a profession is not viable without the cooperation of multiple health care professionals. Mutual inter-professional respect and teamwork is essential for appropriate care of a patient. On a more basic level, each individual you encounter is entitled to their own opinions. A blanket insensitive statement like the one above is in clear violation of the student code of conduct as the student failed to (amongst many others):

  • “communicating clearly and interacting appropriately with colleagues, other health professionals, patients/clients and their families and other members of the broader Faculty community”
  • “behave with honesty, integrity and fairness towards all with whom they come into contact whatever the context”
  • “maintaining the highest ethical and professional standards expected of members, actual or aspiring, of their health profession”
      Quoted from the Student Code of Conduct: http://www.medicine.mcgill.ca/ugme/academicpolicies/professionalism_code_en.htm.

How can this be avoided?

All students must be aware of the standard of expected behavior established by the code of conduct. There is zero tolerance of disrespectful behaviour. Having informed debates regarding sensitive yet important topics like Euthanasia is essential to the progress of medicine. There are various platforms available for students to discuss their views and learn more about key issues. In fact, we are encouraged as aspiring health care professionals to educate ourselves and be involved in these debates. However, the discussions must be carried out in a respectful manner where all parties have a fair opportunity to share their views. Violations of code of conduct: http://www.medicine.mcgill.ca/ugme/academicpolicies/professionalism_viol....


8. Boundaries

You are a Med-4 teaching a small group on physical exam skills for Med-1s. In order to make this experience as practical as possible, you bring in your phone into a patient’s room. You ask the patient at a MUHC site for their permission to record some physical findings. Then you create an “educational video” to post on to YouTube and share with the students. This video is discovered by a family member of the patient in question who now threatens to sue the institution.

Have you acted in an unprofessional manner?

Yes.

Why is this an issue?

In your enthusiasm, you may have overlooked the policies set by the institution you are assigned to. Since you are a student and not directly legally liable for the patient’s health, you have to be mindful of your boundaries. Your actions can have severe consequences for the attending physician, residents as well as other health care workers and the hospital. Moreover, there are valuable resources available through the library website for student education.

How can this be avoided?

Be familiar with the Code of Ethics at the institution you are working at. When in doubt, err on the side of a safer decision. At the hospital sites you have supervisors and other professionals you can talk to. If sharing patient information, permission must also be requested from the attending physician and residents responsible for the patient in question. At a teaching institution, it is understood that students will be working with patients under supervision. However, this is a privilege and should not be taken lightly. McGill Libraries provide access to all students to invaluable resources that can be used to learn physical exam skills amongst other topics. Familiarize yourself with the available resources and how to access them. The Code of Ethics for MUHC can be found at this website: http://muhc.ca/homepage/page/code-ethics.


9. Online identity

You are a fourth-year medical student in the midst of the CaRMS application period. You are aiming for a particular specialty, and in the time of your elective rotations for that specialty you have developed online social media relationships with the residents you met. You post a lot of photos, music videos, funny news stories, tag photos of friends and yourself, and share quite polarized opinions on various recent world issues.

Although you did exceptionally well in your clinical rotations, you do not match to your program of choice. When seeking feedback, you are told that the selection committee got the uncomfortable feeling that you were socially irresponsible and that you just ‘rubbed them off the wrong way.’

Why is this an issue?

By having initiated online relationships with residents, your personal online content became potentially visible to the residents you don’t know, and even the program director. Medicine remains a hierarchy and individuals in more senior roles can have an impact (either positive or negative) on your transition through the system. Moreover, there are anecdotal reports that, as part of the recruitment process, residency programs are not reluctant to survey the online profiles of potential candidates. You have to be aware that in the medical profession, there can exist a very sensitive balance of perceptions that can dictate your credibility and the trustworthiness your colleagues and preceptors place on you. Although the student in this scenario may have always been well intentioned, he/she failed to self-reflect on the nature of his/her online identity and it’s unfortunately unpredictable impact on how others can perceive it.

How can this be avoided?

  • The student could have avoided having senior residents on his Facebook, and instead opted to keep in contact via e-mail or telephone.
  • The student is encouraged to adopt and maintain the highest privacy settings for his Facebook profile. He/She can be selective about the kind of information he/she chooses to share, or selective about which audience can view certain pieces of his online content.
  • Some medical students even opt to change their names on Facebook during the CaRMS process. Examples include lengthening or abbreviating first or last names, and/or intentional misspelling of first or last name.
  • Students are encouraged to reflect on their online identity in order to sustain their online credibility and garner the trust of those in the medical profession.