THE PHYSICIAN & PATIENT IN SOCIAL MEDIA DO WE NEED A CODE OF ETHICS?

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Alvina Pauline D. Santiago, MD Pediatric Ophthalmology & Strabismus Student, Health Informatics October 17, 2014

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DISCLOSURE / DISCLAIMER

I am not an expert in Health Informatics. I

am a student.

cdm.depaul.edu

I am not an expert in ethics. I am a student.

WHAT IS LACKING IN OUR CODE OF ETHICS FOR HEALTH INFORMATICS:

!CODE OF ETHICS

FOR THE FILIPINO PHYSICIAN & PATIENT USING SOCIAL MEDIA

A requirement of Health Informatics 271 Ethics in Health Informatics

Submitted by Alvina Pauline D. Santiago, MD September 30, 2014

3http://worldofdtcmarketing.com

TROUBLESHOOTING AUSTRALIAN MEDICAL ASSOCIATION

Have you ever…

Googled yourself?

Googled your patient without their consent?

Posted information about a patient or person from your workplace on Facebook? Have a look through your old online posts and blogs;

Added patients as friends on Facebook or MySpace?

Added people from your workplace as friends?

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www.tradebit.com

TROUBLESHOOTING AUSTRALIAN MEDICAL ASSOCIATION

Have you ever…

Made a public comment online that could be considered offensive?

Become a member or fan of any group that might be considered racist, sexist, or otherwise derogatory? Browse through all the groups that you have joined and consider whether these are an accurate reflection of the person you are, and the values that you hold.

Put up photos or videos of yourself online that you would not want your patients, employers or people from your workplace to see?

Checked your privacy settings on Facebook or MySpace?

Felt that a friend has posted information online that may result in negative consequences for them? Did you let them know?

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http://mywindowshelp.com

ETHICS DEFINITION

Branch of moral philosophy

Attempts to distinguish that which is right from wrong.

Basic concepts and fundamental principles of right human conduct

HI271 Lecture, Ethical Theories and Bioethics, Dr. M Rilazan, 081514

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www.acfe.com

SOCIAL MEDIA DEFINITION

‘social media’ refers to web and mobile technologies and practices that people use to share content, opinions, insights, experiences, and perspectives online.

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cpso.on.ca

sys2K.com

SOCIAL MEDIA DEFINITION

forms of electronic communication (as Web sites for social networking and microblogging) !through which users create online communities !to share information, ideas, personal messages, and other content (as videos)

8www.merriam-webster.com

bcg.connect.com

WHY USE SOCIAL MEDIA

“opportunities to enhance patient care, medical education, professional competence, and collegiality…”

“connectivity need not come at the expense of professionalism”

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cpso.on.ca

localseosites.com

wikipilipinas.org

-Farnan et al

WHAT THE PHILIPPINES HAS

PMA Code of Ethics

Bill of Rights, Philippine Constitution 1987

RA10175. Cybercrime Law

Code of Ethics of Subspecialty Societies

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PMA CODE OF ETHICS, 2008

Article 1. General Principles.

Section 2. On entering the profession, a physician assumes the obligation of maintaining the honorable tradition that confers the well deserved title of a “friend of mankind”. The physician should cherish a proper pride in the calling and conduct himself/herself in accordance with this Code and in the generally accepted principles of the International Code of Medical Ethics.

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PMA CODE OF ETHICS 2008

Article 1. General Principles.

Section 3. Physicians should fulfill the civic duties of a good citizen, must conform to the laws and cooperate with the proper authorities in the application of medical knowledge for the promotion of the common welfare.

Section 4. Physicians should work together in harmony and mutual respect.

Section 5. Physicians should cooperate with and safeguard the interest, reputation and dignity of paramedical and other health professionals.

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PMA CODE OF ETHICS 2008

Article 1. General Principles.

Section 6. Physicians should be upright, diligent, sober, modest and well-versed in both the science and the art of the profession.

Section 7. The promotion and advancement of the health of the patients should be prioritized over the benefits of the physicians and the health products industries.

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PMA CODE OF ETHICS 2008

Article 2. Duties of Physicians to their patients

Section 5. A physician should exercise good faith and honesty in expressing opinion/s as to the diagnosis, prognosis, and treatment of a case under his/her care…..A physician shall not conceal nor exaggerate the patient’s condition except when it is to the latter’s best interest. A physician shall obtain from the patient a voluntary informed consent…

Section 6. The physician should hold as sacred and highly confidential whatever may be discovered or learned pertinent to the patient even after death,except when required in the promotion of justice, safety and public health.

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1987 CONSTITUTION

Article 3. Bill of Rights

Section 3. (1) The privacy of communication and correspondence shall be inviolable except upon lawful order of the court, or when public safety or order requires otherwise, as prescribed by law.

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RA 10175. AN ACT DEFINING CYBERCRIME

byte-notes.com

RA 10175. AN ACT DEFINING CYBERCRIME

CHAPTER II PUNISHABLE ACTS

SEC. 4. Cybercrime Offenses.

(a) Offenses against the confidentiality, integrity and availability of computer data and systems:

(1) Illegal Access.

(2) Illegal Interception.

(3) Data Interference.

…

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http://media2.arabia.msn.com

MANIFESTO: #HEALTHXPH

T1. I am a physician and I will conduct myself in a manner worthy of my profession even online.

T2. Whatever I post online in relation to my medical expertise should be of benefit to my countrymen. I will prioritize the promotion and advancement of health rather than medical products.

T3. I will not use online platforms to rant against or bash patients and healthcare professionals.

T4. I will refrain from posting information online that will compromise patient confidentiality..

18http://www.endocrine-witch.net/2014/02/12/social-media-and-medical-professionalism-a-manifesto-from-healthxph/

CODE OF ETHICS OF THE FILIPINO PHYSICIAN USING SOCIAL MEDIA

How to use social media

Meet professional expectations

Assume all content in internet is not private and accessible.

“Define standards of the professional MD in digital environment” - Farnan teal

19wikipilipinas.org

The Physician must

maintain patient privacy and confidentiality.

exercise caution when posting information online that relates to an actual patient to maintain privacy and confidentiality.

obtain informed consent even in an unnamed patient that may still be identifiable through a range of other information, such as a description of their clinical condition, or area of residence, or place of consult

Breaching confidentiality undermines the public's trust in the medical profession.” -wma.net

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wikipilipinas.org

Patterned after cpso.on.ca and wma.net

The Physician must

maintain appropriate professional boundaries with patients.

limit posts about patients only to health-related issues and concerns.

not post about patient’s personality flaws, whether perceived or real.

refrain from establishing personal connections with patients or persons closely associated with them online.

“adopt a conservative approach when disclosing personal information…”-wma.net

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wikipilipinas.org

Patterned after cpso.on.ca and wma.net

The Physician must

maintain professional and respectful relationships with patients, colleagues, and other members of the health-care team.

refrain from seeking out patient information that may be available online without prior consent.

not malign other physicians / colleagues, recognising differences in management can exist.

not malign health institutions.

not comment on another physician’s patient case management online (as one did not have the benefit of a full examination and evaluation of the patient)

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wikipilipinas.org

Patterned after cpso.on.ca and wma.net

The Physician must

not treat patients through social media exchange.

avoid giving clinical advice to specific patients through social media.

(It is acceptable, however, to use social media to disseminate generic medical or health information for educational or information sharing purposes.)

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wikipilipinas.org

Patterned after cpso.on.ca and wma.net

The Physician must

protect his/her own reputation, and that of his profession, by not posting content that could be viewed as unprofessional.

“monitor his own Internet presence to ensure that the personal and professional information on their own sites and, to the extent possible, content posted about them by others is accurate and appropriate.” -wma.net

be proactive in removing content posted by themselves or others which may be viewed as unprofessional.

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wikipilipinas.org

Patterned after cpso.on.ca and wma.net

The Physician must

apply the strictest privacy settings necessary to maintain control over access to personal information, and social media presence undertaken for personal purposes only.

“study carefully and understand the privacy provisions of social networking sites, bearing in mind their limitations.” (wma.net)

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wikipilipinas.org

Patterned after cpso.on.ca and wma.net

The Physician must

comply with relevant PMA Code of Ethics with respect to advertising.

not endorse product online.

comply with the law as regards defamation, copyright, and plagiarism when posting content online

avoid conflicts of interest and disclose fully when such exist.

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wikipilipinas.org

Patterned after cpso.on.ca and wma.net

CODE OF ETHICS OF THE FILIPINO PATIENT USING SOCIAL MEDIA

Online Content Creator – blogger, a video blogger, a podcaster, a microblogger or a general social media participant (mor10.com)

27pinoymdcentral

A FILIPINO PATIENT USING SOCIAL MEDIA MUST

realise that posting his/her own health data…

signifies an implied consent of waving privacy and confidentiality.

carries a realisation that a potential exists that others may self-diagnose and self-treat based on his/her story.

28pinoymdcentral

A FILIPINO PATIENT USING SOCIAL MEDIA MUST

not malign physician nor health institutions.

recognize differences in opinion and management exist.

obtain consent from physician or health care institution if their name or situation may be recognisable with his/her post.

29pinoymdcentral

A FILIPINO PATIENT USING SOCIAL MEDIA MUST

maintain a professional relationship (not personal) with their health care providers and health institutions.

not expect his/her HCP to accept a personal friend request.

limit posts about physicians and health institutions only to health-related issues and concerns.

not post about physician’s personality flaws, whether perceived or real.

refrain from establishing personal connections with physicians or persons closely associated with them online.

30pinoymdcentral

A FILIPINO PATIENT USING SOCIAL MEDIA MUST

not expect treatment advice in social media exchange.

not expect his/her HCP to comment on another physician’s patient or management.

comply with the law as regards defamation, copyright, and plagiarism when posting content online

31pinoymdcentral

A FILIPINO PATIENT USING SOCIAL MEDIA MUST

be “fair, honest and respectful not only toward your fellow [netizens] but also toward fact.”

“present fact as fact and opinion as opinion"

32based on mor10.com

THE FILIPINO PATIENT USING SOCIAL MEDIA MUST

tell the truth at all times.

state your allegiances and disclaimers to stay independent

admit and correct your mistakes immediately.

always respect a person’s character and identity, privacy, race, nationality and belief. Never draw attention to personal or private aspects if they are irrelevant.

33pinoymdcentralbased on mor10.com

REFERENCES

Are you maintaining professional standards online? In Social Media and the Medical Profession. Accessed September 29, 2014. https://ama.com.au/are-you-maintaining-professional-standards-online

Code of Ethics for Bloggers, Social Media and Content Creators. Accessed September 29, 2014. http://mor10.com/code-of-ethics-for-bloggers-social-media-and-content-creators/

Constitution of the Republic of the Philippines, 1987. Accessed September 29, 2014. http://www.gov.ph/constitutions/the-1987-constitution-of-the-republic-of-the-philippines/the-1987-constitution-of-the-republic-of-the-philippines-article-iii/

Farnan J, Sulmasy JD, Worster BK, etal. Online Medical Professionalism: Patient and Public Relationships: Policy Statement from the American College of Physicians and the Federation of State Medical Boards. Ann Intern Med 2013; 158: 620-627.

Lirazan M. Lecture on Ethical Theories and Bioethics. Lecture given the Health Informatics 271, August 15, 2014.

Philippine Medical Association Code of Ethics 2008. Accessed September 29, 2014 . https://www.philippinemedicalassociation.org/downloads/pma-codes/FINAL-PMA-CODEOFETHICS2008.pdf

Republic Act 10175. An Act Defining Cybercrime, Providing for the Prevention, Investigation, Suppression and the Imposition of Penalties Therefore and for Other Purposes. Accessed September 29, 2014. http://www.gov.ph/2012/09/12/republic-act-no-10175/

Social Media Appropriate Use by Physicians. The College of Physicians and Surgeons of Ontario. Accessed September 29, 2014. http://www.cpso.on.ca/policies-publications/positions-initiatives/social-media-appropriate-use-by-physicians

WMA Statement on the Professional and Ethical Use of Social Media, 2011. Accessed September 29, 2014. http://www.wma.net/en/30publications/10policies/s11/index.html.

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