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Professionalism and the Internet in Psychiatry

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Buvana Padhman

on 14 February 2013

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Transcript of Professionalism and the Internet in Psychiatry

Professionalism and the Internet in Psychiatry So, what now? Social Networking Sites 2008 University of Florida: 64% medical students, 13% residents on Facebook

Survey of 78 deans:
- 60% reported students posting unprofessional content
- 13% reported students violating patient confidentiality online
- 19% had a task force 2008, survey of 271 blogs:
- over half had identifiable authors
- 22% displayed photo of author
- 18% described patients in negative light (including insulting comments)
- 30% featured negative comments about the health professions

2008, survey of 331 blogs:
- 75% wrote under their real names
- 41-54% published books and/or articles as well Dr Buvana Padhman
15th Feb 2013 What is the Internet all about? Blogs Search Engines Resources What are the potential problems? Social Media Privacy of psychiatrist - friend requests
- compromising pictures ("tag")
- personal revelations
- privacy settings (80% don't manage)
- identity theft Privacy of patient - status post (even if disguised) Blogs Blogs are public - blogs tend to be accessible to general public
- bloggers tend to enjoy sharing ideas
- 74%: "share practical knowledge and ideas"
- 56%: "influence the way other people think" Blogs are permanent - searchable by date/keyword
- linkable
- archivable
- can be copied/pasted Search engines Full disclosure without self-disclosure - personal information about psychiatrists and their families
- doctor rating sites
- online complaints/libel
- travel/conference details
- property/tax information
- genealogy Communication Communication Anytime, anywhere! - communication errors
- diagnostic errors
- missing emergency situations
- liability What are the implications? Ethical concerns Beauchamp's 4 principles - Confidentiality breach -> potential to harm
- Dual relationships -> compromise boundaries
- Patient autonomy means they can google you (Patients not bound by ethics code)
- Feeling violated? It's countertransference! Professionalism Issues How we behave - viewed by others as in professional role when in public -- whether at work or not
- off duty activities have implications at work
- negative comments about colleagues = publicly denouncing them
- disparaging comments about patients appear unprofessional Clinical Dilemmas - self disclosure in therapy is different from online
- inadvertent "extratherapeutic contacts" difficult, but not unethical
- erroneous/distorted information online
- collateral information - ethical? boundaries? How it affects our work What to teach and how to teach it? Liability Confidentiality and Privacy Psychotherapy and Boundaries Safety issues and Mandated Reporting Requirements Potential Libel Potential Conflicts of Interest Academic Issues "Netiquette" Email:
- set appropriate limits
- establish turnaround time for messages
- restrict non-urgent use
- appropriate message headers
- privacy and confidentiality issues
- permissible content

Emails are discoverable and should be saved (printed?)
Institutional and legal standards - Hospital policy for use of social networking sites in the workplace
- Support residents and provide for appropriate outlets (including supervision)
- Separate personal and professional online content
- Be aware of your "web-face" and "wash" it reguarly

Privacy settings are not absolute! Once on the internet, content is likely there permanently. Psychotherapy principles of neutrality, anonymity and abstinence may be compromised when patient accesses psychiatrist's details online

- Need to anticipate being confronted by patients about online content
- Have written policies about email communication Online information is yet another source of collateral information

- Need to report if patients or their potential victims are in danger

How to justify "patient-targeted googling"? Defamation - communication of false information, stated as fact, which brings harm to the subject

Patient-generated material may be libelous if both untrue and harmful -> need to recognise

- Supervisory consultation
- Legal counsel
- Reputation defender company "a situation in which a physician has competing roles, relationships or interests that could potentially interfere with with ability to care for patients" - Roberts and Hoop

- Taking online surveys
- Blogging about current posting (derogatory)
- Political opinions and/or advocacy
- Anonymous online endorsements Plagiarism is more efficient in the digital age

In age of file-sharing, concepts of ownership and copyright more difficult to grasp

- copying text without attribution
- "paraphrase plagiarism"

- Need to reconsider the philosophy behind academic honesty Lessons on interpersonal and professional etiquette may not cover the potential pitfalls of electronic communication

- Pausing before posting online or responding to text/email
- Learning when to set a limit on forwarding

Technology should never serve to discharge feelings that are better worked through in supervision or therapy - Internet as extension of self rather than external resource
- Interactive technologies have fostered new attitudes towards privacy and boundaries
- Physicians must carefully construct online personae in keeping with professionalism principles

Online professionalism and boundary issues should be discussed during training
Institutional guidelines should address this issue Mobile internet vs the frontal lobe Unintentional fame and immortality - emails can be forwarded
- whatsapps can reach a wider audience than you realise!
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