Reasons to be careful

On the recent ‘festival’ of live tweeting from A+E/ambulances/GP surgeries;

If done carelessly, thoughtlessly, or simply unimaginatively, this can be unpleasant or even  dangerous.

Consider: (and I’m paraphrasing)

* A tweet commenting that ‘lots of ladies are coming in to A+E for emergency contraception. Didn’t they know they can get it from pharmacies!’

This could make someone, possibly a vulnerable someone, feel stupid, idiotic, clumsy, or/and that their personal details and failings had been passed to a media department for tweeting to make an example of them.

Why not  tweet  ‘do you know you can get emergency contraception from high street pharmacies without a prescription?’ The PR department sending the tweet shouldn’t even know that this type of problem have been dealt with that day.

Or:

* A tweet saying that ‘a young person has been admitted with urinary problems and abdominal pain, and is going for a scan now.’

What if you knew someone that had went to hospital that day? What if you were not that person, but another person in hospital – it is clear that permission has been sought? And is it right that we should be asking someone who is acutely unwell if a press department can tweet details of their case – why is this necessary? Confidentiality is crucial to enable the relationship between doctors and patients. Hospitals can be difficult enough places to contain information – communal wards, busy A+E departments, waiting areas – but this should be reason to preserve details about patients even more, not less.

Why not just say ‘patients with serious illness are routinely brought through A+E to be triaged’.

*A tweet saying that ‘someone came in because they were deaf –  the earphone from their ipod had got stuck in their ear’ or ‘someone came in because a false nail had fallen off’.

Apparently some tweeting Trusts used ‘historical’ or ‘anecdotes’ from staff. This was possibly one.

But

– these may not be wholly true – embellished for the story

– these will not have been given permission by the patient to be disseminated

-the patient may recognise him/herself

-the patient or family/carers may be left feeling a bit stupid

– other people reading the anecdotes may feel worried that their stories in future – if they don’t get attendance ‘right’ – might be used like this

– things that seem like ‘trivial’ to doctors and nurses may not seem so minor to patients. This does not excuse careless use of A+E by patients, but makes me uncomfortable about ‘public shaming’ exercises via twitter. For example, a person may have a mild flu like illness, but because a relative died from an illness that seemed to begin in a similar way, they be more anxious than a healthcare professional would expect from a minor infection.

* A tweet saying ‘an ambulance has been called for an elderly lady who has hit her head’.

– why do we need to know this? The area covered may be geographically small; what if a neighbour sees an ambulance and deduces the background? While it should be possible for people to know what public services are doing, do we need this level of detail – which is also pegged to a specific time frame, being twitter? Who is it helping – the patients, or a public image?

In conclusion

– the massive advantages of a real time connecting system for discussion – twitter – gives scope to erode confidentiality

– just because it can be difficult to maintain confidentiality in acute settings does not mean that we should further threaten or spoil it via thoughtless tweets discussing specific patient care

– Trust hinges on confidence in confidentiality between patients and healthcare professionals. We lack evidence that tweeting can improve use of emergency care and we have not investigated the potential harms

– We should consider whether tweeting is being done to benefit us, professionals, institutions or a media or PR department  before patient care.

 

 

6 Responses to “Reasons to be careful”

  1. Holly Ann Rivera December 19, 2012 at 7:39 am #

    Good points! I have seen a similar situations with therapy groups who have social media accounts. Just because you used “I have a client who” instead of a name doesn’t guarantee anonymity. (The use of “I” with a business social media account is another problem!) Social media brings up a whole new form of medical ethics that seem to be overlooked too often, in my opinion!

  2. Matt Dinnery December 20, 2012 at 3:36 pm #

    Purely considering you point about a tweet commenting that ‘lots of ladies are coming in to A+E for emergency contraception. Didn’t they know they can get it from pharmacies!’

    Your response was that this could make someone, possibly a vulnerable someone, feel stupid, idiotic, clumsy, or/and that their personal details and failings had been passed to a media department for tweeting to make an example of them.

    And then you said “Why not tweet ’do you know you can get emergency contraception from high street pharmacies without a prescription?’ ”

    Well, the answer is rather simple – from my VERY cynical perspective – if they’re turning up to A&E to get an emergency contraceptive, rather than their nearest pharmacy, it’s quite likely that they’re unaware of the huge range of contraceptive choices available to them in the first place!

    So, really, the tweet should be something about planning contraception in advance, mentioning the different methods – ie implant, injection, IUD, IUS, mini-pill, pill, condom, femidom, spermicide, etc…
    Thus completely negating the need for emergency contraception!

  3. steve December 21, 2012 at 9:04 am #

    Hi Margaret – confidentiality is a very interesting topic but one, I fear, that is such a “sacred cow” that is has never been properly studied as to do so invokes hostility of almost fundamentalist fervour.
    I have a copy of a book called Fit to Lead written at the end of the 1970s which is quite scary when you realise how ill so many of those great leaders of the 70s that had their hands on the nuclear button were.
    I think we have become so obsessed with confidentiality that it actually stifles discussion and that is not good for the health of the population as a whole.
    For example, I think Tony Blair may have inadvertently helped fuel the MMR scare in the UK by refusing to confirm whether or not his own son had had the MMR vaccine. Of course, that was his right but was it really the best thing to do?
    I personally have no problem with people knowing about any medical problems I might have and it’s sometimes helpful to share life experience in this respect with others if appropriate – a genuine case of “I know how you feel or what you mean”.
    I think we would be much better off if positive role models like sportsmen and women or musicians/popstars or famous actors and, of course, world leaders were much more open about having depression or asthma or diabetes or whatever.
    One of my boyhood heroes was a footballer called Asa Hartford who played for Scotland with a “hole-in-the-heart”. He was very open about his condition and as a child I was unbelievably impressed that he was so open and, despite his condition, he played for Scotland! It had a real motivating effect on me.
    I think more openess about ill heath would, in the longer term, help to “normalise” ill-health as part of the human condition and remove the gross prejudice that curently surrounds it in our society.

  4. Steven Kinnear December 21, 2012 at 10:12 am #

    Margaret. Thanks. I enjoyed this post. When I first saw live tweeting from an ED I thought it was a good idea, but wondered how confidentiality and consent issues were being properly addressed. This question became more salient when I read a tweet about a seriously ill patient. It sounded like they were too ill to give consent, or if able to consent, that it would have been inappropriate to ask.

    I do think live tweeting by EDs, ambulance services, GPs and others is useful but the issues around confidentiality and consent need to be ironed out and content of tweets carefully considered.

    It would be helpful if the coming GMC guidance on doctors’ use of social media covered this in more detail.

  5. flo(disabledmedic) December 21, 2012 at 4:04 pm #

    I tend to agree. I can see the thinking behind live tweeting – giving folk an idea of what is/isn’t an ‘appropriate’ reason for attending A and E, for example, in a less preachy way – showing what departments deal with in a day hoping that people might be more sympathetic to waiting times etc. However, patients must come first. I was be horrified if i could recognise myself (especially as my local A and E has an appalling record treating folk with mental health issues so I would not trust them to tweet on that subject appropriately).

  6. Derek Tunnicliffe December 21, 2012 at 6:23 pm #

    These folks in A&E can’t be very busy if they have time to send tweets out to the world at large.

    Anyway, for me (old fuddie-duddie), tweets reduce the value of a message to a few trivial (oft abbreviated) words. Note that President Obama tends to use complex sentences, designed to prevent ‘sound-bites’. Like him, my messages are always too complex for reduction to a tweet.

    Bonnes fêtes!

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