Welcome from GEMS LP!

Hello and welcome to the first blog post from ACEP’s International Section’s Global Emergency Medicine Student Leadership Program. We are thrilled to partner with iEM in the hosting of this blog, and we thank them for their collaboration and enthusiasm.

Global EM is a young, quickly growing field in the world of health care, but there remains much work to be done. The GEMS LP program was designed to involve students in this exciting and fulfilling specialty. The program itself falls under ACEP’s International Section in conjunction with the International Ambassador Program. All of these entities share a common goal: the advancement of the emergency medicine specialty worldwide.

Through this blog, we hope to educate, inspire, update, and collaborate on all things global EM.  Every couple of weeks, you can expect to read the ‘key points’  from our journal clubs. In each meeting, we review fundamental global health topics through a book chapter and a research paper, followed by a dynamic discussion with a diverse group ranging from medical students to attendings, working both in the US and abroad. Additionally, you can look forward to interviews with some of ACEP’s International Ambassador team members, interesting case discussions, GEMS LP project highlights and other fun commentaries from our mentees and team! 

We look forward to providing you relevant content that will encourage discussion, contemplation, and promotion of the field of global emergency medicine. Thank you for joining us on this new adventure! Please visit our page (https://iem-student.org/gems-lp/) for more information about our leadership team, awesome mentors, and upcoming events and meetings. 

Comments, suggestions, additions? Please reach out to us!

[cite]

Social Media Ethics for Medical Professionals

ethics

From Twitter to LinkedIn, every single one of us use social media every day. While using social media is not an obligation (obviously), imagine how you would be surprised by someone who has no social media account. Our posts on social media are meant to be there forever, carefully protected from deletion by Terms and Conditions of the social media site we used. Once you shared a post, it takes its place in the digital world as our footprint. “Who cares?”, you might ask. Well, the answer is EVERYBODY. Employers routinely check social media accounts of the individuals to grasp an opportunity to “reveal” their identities and and use this data in recruitment processes. Advertising companies are using our “share/like” data to select  “suitable” ad contents for us. States constantly monitor the soical media contents of their citizens.

In one sense, social media profiles are like the diaries of the past. However, there is a fundamental difference: While diaries are meant to be a confidante of the individual, social media “diaries” are notoriously verbose speakers ready to ruin us.

Statements

American Medical Association’s (AMA)  “Professionalism in the Use of Social Media” webpage emphasizes some basic (yet vital) rules. They can be summarized as follows:

  1. Physicians should be aware of patient privacy standards at all times, and must refrain from posting identifiable patient information online.
  2. When using social media for educational purposes or to exchange information professionally with other physicians, follow ethics guidance regarding confidentiality, privacy and informed consent.
  3. Physicians should use privacy settings to safeguard personal information and content to the extent possible, but should realize that once on the internet, content is likely there permanently. Thus, physicians should routinely monitor their own internet presence to ensure that the personal and professional information about them is accurate and appropriate.
  4. If physicians interact with patients on the internet, they must maintain appropriate boundaries of the patient-physician relationship.
  5. Physicians should consider separating personal and professional content online.
  6. When physicians see content posted by colleagues that appears unprofessional they have a responsibility to advise against it. If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities.
  7. Physicians must recognize that actions online and content posted may negatively affect their reputations among patients and colleagues, may have consequences for their medical careers (particularly for physicians-in-training and medical students) and can undermine public trust in the medical profession.

World Medical Association (WMA) issued a statement on the professional and ethical use of social media in 2011 which has some additions to the rules mentioned above:

  1. Physicians should study carefully and understand the privacy provisions of social networking sites, bearing in mind their limitations.
  2. Physicians should consider the intended audience and assess whether it is technically feasible to restrict access to the content to pre-defined individuals or groups.
  3. Physicians should adopt a conservative approach when disclosing personal information as patients can access the profile. The professional boundaries that should exist between the physician and the patient can thereby be blurred. Physicians should acknowledge the potential associated risks of social media and accept them, and carefully select the recipients and privacy settings.
  4. Physicians should provide factual and concise information, declare any conflicts of interest and adopt a sober tone when discussing professional matters.
  5. Physicians should draw the attention of medical students and physicians to the fact that online posting may contribute also to the public perception of the profession.
  6. Physicians should consider the inclusion of educational programs with relevant case studies and appropriate guidelines in medical curricula and continuing medical education.

British Medical Association’s (BMA) “Ethics of Social Media Use” page has detailed information on both benefits and risks of social media. Its “Social Media, Ethics and Professionalism Guidance” emphasizes the arguably most important reminder: “You are still a doctor or medical student on social media”. Touché!

Tips from Experts

The rules and codes are of course very important in theory. However, experts in this field will know best how to apply them in practice. For this article, we asked the leading names of the #FOAMed World the following question: “What is your FIRST RULE while using social media?”

Here are their answers:

Skin in The Game

“If you haven’t somehow got skin in the game, your opinion is probably worthless and/or unwanted.”

– Karim Brohi [*]

Stick to the Science

“Dr. Sapna Kudchadkar’s basic Twitter rules applies to all social media.

Always remember “a tweet is forever” it does not disappear.

Stick to the science and be collegial are my rules.”

-Yonca Bulut [*]

Dr. Sapna Kudchadkar’s Basic Twitter Rules

“Don’t ever give specific medical advice or try to diagnose online.

Don’t write about actual patients or cases.

Don’t ever sacrifice collegiality due to a difference of opinion.

Don’t forget to cite the source.

Don’t tweet slides of unpublished data.”

-Dr. Sapna Kudchadkar

No regrets!

“I never post anything I might regret in the future.”

-Shanta W. [*]

Vice Versa

“Don’t just try to project the best version of yourself on social media. Try to become more like the better version of yourself that you want to project on social media.”

-Elias Jaffa [*]

THINK

“One word: THINK. T: Is it true? H: Is it helpful? I: Is it inspiring? N: Is it necessary? K: Is it kind?”

-Manrique Umana McDermott [*]

Know the Rules

“So many important things to consider….one of the bigger ones is know your institution’s rules and guidelines… Most have them—some are strict and some aren’t. But know the rules. Many institutions literally have someone assigned to watch social media output among employees.”

-Rob Rogers [*]

A Force for Good

“Be a force for good in the world. Don’t say anything you wouldnt say in front of my mother & chair.”

-Seth Trueger [*]

Once You Write…

“Every single letter is a long lasting prey of the web.”

-Nicolas Peschanski [*]

Not an Online Hospital

“1- Patient privacy rules are also valid here.

2- Social media is not an online hospital.

3- Social media is not a scientific journal.

4- Social media is not a suitable platform to debate with colleagues.”

-Fatih Beşer

Think Before You Speak

“The best tweets are the ones you don’t ever send. You should consider not sending the vast majority of tweets.”

-Bruce Lambert [*]

Conclusion

“What should I be known for?” A social media account that you have shaped around this simple question will undoubtedly lead to incredible opportunities. In any case, there is no escape from using social media.

By carefully reading and implementing the rules mentioned in this post, you can prevent social media from doing you more harm than good.

[cite]

Pain Relief

Healthcare providers should have a sound understanding of the anatomy, physiology, and psychology of addictive behaviors. A focused history and examination should concentrate on items that can indicate inconsistencies or falsifications associated with inappropriate drug-seeking behavior. It was always difficult as a decision has to be made between “losing” to drug seekers and denying analgesia to patients who are genuinely in need. It is best to give patients the benefit of the doubt with due diligence.

"Drugs for pain relief' chapter written by Nik Ahmad Shaiffudin Nik Him and Azizul Fadzi was added into the content list.