The Regina Lectures - Nov 28 Rounds to Regina pediatricians

1. The age of the
tweetiatrician
Communicating with patients in the digital
world
Nov 28, 2013
Regina
Pat Rich – Managing Editor, CMA
Communications
(@cmaer)
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2. My life on Twitter
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Social media staff resource at
CMA
Monitors and writes on health
IT development
Monitors Twitter on a
continuous basis
3100+ followers and follows
2000
Interacts with MD peer
leaders in social media on
daily basis
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3. Social media is BAD
In a newly revised policy statement released today, the American Academy
of Pediatrics recommends that parents make a media plan for their families
that takes into account not only the quantity, but the quality and location of
media used, and includes mealtime and bedtime curfews for media devices.
It also encourages keeping all screen media (TVs, computers, tablets, etc.)
out of kids' bedrooms.
USA Today, Oct. 28
“Social media is dangerous for kids, so we can’t model it.”
Conversation with CHEO Communications Director Ann Fuller about attitudes of some
senior staff at her hospital
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4. Not so fast
“Docs need to be role models for their patients/parents. There is definitely
conflict. It’s like pediatricians having TVs in their waiting rooms when they
should be recommending no TV for children <2 YO. I’d say the conflict is
best managed by sticking to themes like balance, moderation, etc.”
Personal Twitter exchange with Dr. Daniel Flanders, Nov. 25
Clinical research published by American Academy of Pediatrics showing
social media can have beneficial impact on children and adolescents
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5. Prologue
I think there are too many people on the Web offering advice to you on
how to use social media. Most of this advice is just regurgitated advice
from people you may never have heard of before, …
You really don’t need “How To” tips on blogging or Twitter. Oh, I’m
confident that you’ll be told otherwise – but those folks, wellintentioned as they may be, don’t understand that you’re smarter
than that.
You’re bright – you got through organic chemistry and medical school
and years of residency.
Rather than learn bad habits from the get-go, take advantage of your
lack of experience. It’s okay to make mistakes that don’t cause harm
and violate the privacy and dignity of others.
From: Physician Social Media: Has Advice About It Become a
Crock? Yes @philbaumann, Jan. 1, 2013

6. ▸ The digitally
connected pediatric
clinic of tomorrow
…. today
▸ Belleville, ON
▸ Pop: 50,000
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7. ▸
“Back in 2009 our patients
were young, early adopters
of social media so we
wanted to be where they
were.”
▸
“One of the jobs of a
physician is communication.
I know patients are going to
Dr. Google. It drives me
nuts. I want them to have
credible sources online so
that even if they never come
through my doors, they’ve
got an incredible source of
information that will answer
their questions.”
▸
Dr. Paul Demsey
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8. Digital/social media tools used at Quinte Pediatrics
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Secure email/patient portal
Website
Facebook
Twitter
Blog
YouTube
Secure email/patient portal
Instagram
Foursquare
Vine (in development)
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9. It’s a digital world out there
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Telemedicine/telehealth well established on a clinic to
clinic basis for remote delivery of health care
Use of mobile devices in health care ubiquitious
Patients requesting/demanding ability to interact more
immediately with health care providers using new
technologies
Millions of people in US and other countres using
email for communications with physicians
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10. “In the largest reform of
family doctor services in a
decade, GP surgeries will
be given extra resources to
open from 8am to 8pm, and
patients will be offered the
chance of consultations
through a Skype service.”
UK announcement – Oct.
2013
Oklahoma Physician
Disciplined For Using
Skype
A doctor living in eastern
Oklahoma was disciplined
for prescribing violations
and using Skype to treat
patients under his
care, the NewsOK.com
web site reports.
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12. E-mailing between
doctors and patients
“The use of e-mail between
physicians is becoming more
common and a number of patients
are expressing a strong interest in
being able to communicate with
their physicians in this way. Both
physicians and patients should be
aware of the legal risks of such a
method of communication and
agree to assume those risks.”
Source: College of Physicians and Surgeons of
Saskatchewan, June 2012
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13. E-mail communications with patients
The Canadian Reality
11% of Canadian family physicians report patients
can email their practice with questions or concerns
10% of Canadian patients report they can email their
regular practice with clinical reasons
BUT….
Only 2% of patients report emailing their regular
practice with a medical concern in the last 2 years
Source: Commonwealth Fund Survey, 2013

14. College of Physicians and Surgeons of
Saskatchewan – June 2012
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Physicians must make every effort to ensure that information is sent
to a confidential e-mail address specific to the patient (e.g. not a
corporate address accessed by others in the patient’s workplace).
Physicians must comply with the privacy requirement in
Saskatchewan (see Office of the Information and Privacy
Commissioner
Physicians should consider getting a written form for patient consent
to the use of e-mail communications. (Sample form is included on
the CMA website at
http://www.cma.ca/index.php?ci_id=89745&la_id=1)

15. CMPA
Other
guidance
Using email communication
with your patients: legal risks
(June 2013)
CMA
Online communications with
patients (2005)
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16. The pediatric hospital experience
“We get letters from parents about how great the care
was or how crappy the care was and often the letters
that say how great the care was do make reference to
the fact their doctor was available via email. You’re
seeing that it changes the perception of the
engagement level.”
Ann Fuller, Communications Officer, CHEO

17. “In short, using email with patients
can be really helpful and
personally rewarding if they are
motivated and if I set up some
clear boundaries at the outset
Dr. Jessica Otte
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18. Why consider using social media
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To stay informed
As a learning tool in medical education
Communicate (engage) with peers and patients
Disseminate information
Advocate for/against something
Because if you decide not to use social media, your decision should be
based on sound knowledge about what you are choosing not to use
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19. “My hairdresser can text me, my car can send an email to my
mechanic, and the only way I can deliver my message is
through a telephone?” Dr. Nancy Burgert says.
Something had to change.
Digital media turned out to be the fastest, cheapest way for
her to do her job more effectively …
As with most physicians, she was worried about five major
factors: liability, privacy, compensation, time, and technology.
She learned to get over her fears. Once she started writing
her blog, she found that she saved time talking to patients
because they would read her posts before coming to an
appointment.
“What I do online positively impacts the health care of
children,” Burgert says. “In order to reach that potential, your
information has to be of value to your organization.”
Courtesy Jessico Levsco, Jan. 2012

20. Social media and pediatrics
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Facebook (for your friends and family)
YouTube (for your educational campaigns and
advocacy)
Twitter
 To stay informed
 To engage in discussions with peers and patients
 To follow conventions and meetings from afar
 To recruit patients for clinical trials
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21. Case study: The Screaming Baby on Facebook
A pediatric gastroenterologist receives a Facebook friend request from a
woman in his community. Unfamiliar with the woman, the pediatrician
messages back by asking where they may have met or how they might
know one another. The woman replies, “You don’t know me, but I have an
8-week-old baby who won’t stop crying and will only take 12 ounces of
formula per day.”
From American Association of Medical Colleges: Digital Literacy Toolkit
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22. As a physician with an online presence, how
should this type of request be handled?
 A. Don’t respond to request.
 B. Reply to the request with the suggestion that the
mother address the issue with her own pediatrician.
 C. Reply with specific steps for addressing the
issue.
 D. Reply with the intent of getting the child seen as
soon as possible.

23. Guidance
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College of Physicians and Surgeons of Saskatchewan Guidelines
Canadian Medical Association – Issues and Rules of Engagement
Canadian Paediatric Society “Paediatricians, social media and blogs:
Ethical considerations” May 2012
Canadian Medical Protective Association
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24. CMA guidance
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Rules of Engagement
 Understand technology and audience
 Be transparent
 Respect others
 Focus on areas of expertise
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25. American Academy of
Pediatrics – 2013
meeting (#AAP13)
1,151 Tweets
361 Participants
8th most active tweeter Dr. Dan Flanders, Toronto
pediatrician,
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26. Dr. Wendy Sue Swanson – Elevator rules
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Never discuss patient-specific issues’
Never by anonymous
Remember everyone’s watching
Be nice
From presentation to AAP, Oct. 2013

27. Another one to follow
Dr. Bryan Vartabedian (@Doctor_V)
* Pediatric gastroenterologist, Texas Children’s Hospital, Baylor
College of Medicine
* Leading US commentator and thinker on issues relating to
physician use of social media
* 33charts.com – regular blog on these issues
* Contributor to Wing of Zog – blog on med ed and social media
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28. -“For those of us
who have the
philosophy that we
want to graduate
docs who are
better than we are,
Twitter is a great
thing.”
Dr. Chris Simpson, cardiologist
and CMA President-Elect
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29. Using YouTube
CHEO: Baby vaccination; the secret to a calm and peaceful
immunization – 10,000 plus views
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30. Courtesy Dr. Mistry, SickKids

31. It’s not rocket science … or even
pediatric oncology

32. Thank you …..
Questions?
With thanks to Ann Fuller for use of
some materials + input
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