Over the next few posts I am going to tell the story of doing a survey using Twitter, and of the results. But I thought I would start with saying a great big thank you.
I opened the short survey at 6.01pm BST on 19/4/2012. Initially I was using a free Survey Monkey account which limited responses to 100. They started coming in fast and furiously and I realised that the free version didn't even allow export of data. So I splashed out £24 to get the next level of account which allowed me 1000 responses for each survey in 1 month. This morning there were almost 500 responses. I set myself the challenge of trying to get 1000 responses in 24 hours.
At 6.01pm BST 20/4/2012 there were 997 responses. At 6.07pm there were 1000.
(EDIT 21/4/2012 Actually I started designing the survey at 6.01pm but it only was finished and was published at 6.18pm. Therefore 1000 responses were in fact collected in 24 hours!!)
What does it all mean? The survey questions were about how people would like their doctors to introduce themselves and how they would like to be addressed by their doctors. After this survey how much more do we know? Should this have been a 'proper' research study? Should I have sought institutional ethics approval? I will try and answer these questions and any others that you think are important along with you.
You are my co-researchers. We managed to get this response because you participated and you recruited people into the survey. Now we can do the analysis together as well.
Within an hour of the survey closing I started tweeting some of the main quantitative findings. I also made the decision to make the results available to participants after they took part so that they had a sense of the project they were working in.
Today I deliberately targeted male followers and asked them to share the survey. We managed to move from 65% of respondents being female to 57% at the end. We also managed to increase the percentage of older participants during the day. I has asked Age UK to share the survey and they did. I'm sure that helped.
So there are a lot of questions to be answered but now I just want to thank you for your help so far.
This is taken from the GMC website. The GMC have published draft guidance on social media here. Take part in the consultation here.
This month, Dr Anne-Marie Cunningham (@amcunningham), a GP and Clinical Lecturer at Cardiff University, writes on the role of social media in doctors’ lives.
More than half the UK population now use Facebook. And more new users are over 50 rather than under 50. The dominance of Facebook means that if you are not there you are likely to miss out on what is happening with your family or friends. For most of us our use of Facebook has nothing to do with being a doctor. It is about being a mother, nephew, or friend. And it is because we want to protect these people that we care about, and ourselves, that we check our privacy settings and make sure that we are not publishing photos of our nearest and dearest to the world.
So if most of our social media use is about who we are when we are not at work do we need guidance from the GMC? What does using social media have to do with being a doctor at all?
Useful guidance or ‘moral panic’?
Some might think that the development of this guidance is a response to a near moral panic about what may be seen as the portrayal of unprofessional behaviour by doctors and medical students in their use of Facebook and other social networking sites. Breaking patient confidentiality is always wrong but these days what does it take to reduce trust in ourselves or the medical profession? Research seems to indicate that the main determinant of trust in doctors is their interaction with patients in consultations. Patients value doctors who listen to them and take their concerns seriously. They trust them. So are we worrying excessively about how the public may respond to the depiction of minor misdemeanours and hijinx which may not reflect how well an individual will carry out their professional role?
Blurred boundaries
In the past, the private life of a doctor living in a small community may have been well known to her patients. Social media facilitates this same kind of blurring of boundaries. We all have to consider how much of our private and personal lives should be revealed to the public and patients. Will ‘professional distance’ be a meaningful or helpful term in the 21st century? Medical decision making is no longer seen as objective and the role of the doctor, but as a shared task with the patient which acknowledges their values and subjectivities. Might this process be helped or hindered if patients understood our values and subjectivities too?
Doctors may also choose to use new technologies to interact with patients. What then are our responsibilities? As we have a duty to protect patients’ confidentiality we must assure ourselves of the appropriateness of any communications platform. If there are risks then we must make these clear to patients.
The importance of maintaining trust
We might also use social media to connect with other professionals. There can be many benefits to opening up the flow of knowledge within networks. Again, discussing the details of any clinical case should be done with patient consent. In the past when considering if a patient may be identifiable we tended to focus on whether others would be able to recognise the individual concerned. But if discussing a case in near real-time in a public space we have to consider whether the patient will be able to identify themselves even if no one else can. Without their explicit permission, this in itself may reduce trust in us as practitioners.
When discussing technological change we have to remember that social divides also exist. Julian Tudor Hart coined the phrase the ‘inverse care law’ for his observation that those who most need good medical or social care are least likely to get it. The digital divide describes inequalities in access to information and communication technologies. In 2011, 99% of those with a household income above £40,000 had internet access, whilst only 43% of those with household income below £12,500 did. The gaps are narrowing, but if we change our practices we need to consider how the digital divide will impact on access for the poorest, and most vulnerable.
So do we need guidance on the use of social media and networks? If the publication gives us cause to reflect on how use of these technologies fit with our professional roles and our professional practice then this can only be a good thing.
Oh! I've just received an email to my university address asking me to remove the NHS logo from my Twitter profile pic. There you go! #nhssm — AnneMarie Cunningham (@amcunningham) April 17, 2012
In August 2009 an ongoing debate on US healthcare reform jumped across to our side of the Atlantic. Club for Growth, a network which believes in prosperity and opportunity through economic freedom published the following advert.
It attacked the NHS and plans for 'government-run healthcare' in the US, and provoked a backlash in support of the NHS in the UK. Graham Linehan, the writer of Father Ted, started using the hashtag #welovetheNHS and spoke on Channel 4 about why he thought it was important to defend the NHS- and the power of Twitter to do this.
Many people- over 10,000 also added a 'twibbon' banner to their Twitter profile pic to demonstrate their support for the NHS. I was one of them.
I didn't remove the twibbon from my profile because there never seemed to be a right time to do that. I haven't stopped loving the NHS, or the principles which founded it.
Fast forward a few years and I was a surprised when today I received an email from the DH (English Department of Health) Branding and Identity Department, informing me that the use of the NHS logo on my twitter profile picture had been brought to their attention. As the NHS letters and logo should only be used by NHS organisations, or where NHS services are being provided (and my twitter account is certainly not providing an NHS service) they therefore asked that I removed the NHS logo from my Twitter profile picture. They asked me to confirm that I was able to do this, and thanked me for my cooperation.
In part I was surprised because I received this email to my university email address. Recently I started using about.me as a landing page from my Twitter profile, and this enables people to email me without making my email address public. But I use a personal email address for this service. It is how I would have expected someone to contact me with regards to my twitter account. But of course with a little googling my university address is quite easy to come by.
I tweeted about the request of course. And this provoked quite a lot of discussion. My original tweet above has been Rt'd more than 50 times. The response (storified by @evidencematters) was a mixture of amusement that the DH had time to monitor the use of their logo in this way, and anger that the NHS seemed to be no more than a corporate brand.
I replied to the email explaining why I had added the Twibbon to my twitter profile and why I had not removed it. I asked : "Do you think that having 'I love NHS' on my profile picture suggests that I am a provider of NHS services or an NHS organisation? Do you think that my use of the logo in my profile pic is damaging the NHS brand?
If you think that I am in some way demeaning or harming the NHS through the use of this Twibbon, I shall of course remove it."
The reply suggested that we have a quick chat about this by phone. Stephen Hale, head of digital at the Department of Health had also kindly sent me a tweet offering to organise a call from the branding team. So I managed to get speaking to someone who had time to look into what had happened. He explained that the person who had sent the original email was not familiar with the #welovethenhs campaign. He agreed that it was clear that I was not trying to impersonate an NHS service or organisation. The branding team were very heartened by the support shown for the NHS. But it was also important to protect the logo which is trademarked so that when it was used the public and patients could be assured of the service that they would receive.
So this episode is resolved. I have not removed the twibbon from my account. A few hundred other people have added it to their own twitter profile pictures.
Many organisations and companies are considering how they should use social media to protect and promote their brand. And it seems that the Department of Health and the NHS are learning just like everyone else.
Edit 18/4/2012 This morning I received the following tweet:
@amcunningham great that you wrote that up :) My only comment wld be we shouldn't label DH as poor at SoMe brand mngt due to one person. — Alex Talbott (@a_double_tt) April 18, 2012
Alex is one of the co-founders of the #nhssm (NHS and social media) chats which happen on Wednesday evenings. I would like to reply to Alex's comment. I am not an expert in brand management, and will be very surprised if I ever am as it in not one of my aims or objectives, I therefore would never comment on how good or bad the DH are at it. I have told this story because yesterday it caused quite a commotion on Twitter and I wanted to share how it had come about and how it had resolved. But I'd like to make clear that I do not think that this episode is about just one person. I don't think that the person who sent me the email is at fault. They were clearly following guidance which stated that if the NHS logo was being used by someone who was not an NHS organisation or providing an NHS service (in England) then they should ask for it to be removed as this was trademark infringement.
It is my impression that even if this Twibbon had not been part of a larger campaign, and I had in fact designed it myself to show my support of the idea of the NHS, then it is unlikely that I would have been infringing. I think this because I am not using the logo to identify a trade or service. This is unless someone would think that 'I heart NHS' indicates that I am speaking on behalf of the NHS. I don't think that the history of the 'I heart X' meme tends to suggest that someone using it is speaking on behalf of X, instead it says that they like/love/appreciate X. In fact, the city of New York has trademarked ' I heart NY' so they might have a bigger call over trademark infringement!
My use of the NHS logo on my avatar is non-commercial. I presume that the DH branding and identity department will be reviewing their policies on the non-commercial use of the NHS logo.
I should also note that Twitter has a policy on trademark violation. In the case of fan accounts it states that logos should not be used in avatars or background images without permission as a way of reducing confusion that the account is speaking on behalf of the organisation. They do not mention the meme of Twibbons which are about showing support for causes/ideas rather than for companies.
Professor Trish Greenhalgh has suggested that it might be better just starting from scratch:
About 50 100 women academics on Twitter (in no particular order) Last month a blog post listing "50 Medical School Professors You Should Be Following On Twitter" was doing the rounds on Twitter. We can all make our own lists and blog about them- it's one of the great things about social media. This list seemed short on women -something picked up by Professor Trisha Greenhalgh who tweets as @trishgreenhalgh. An extremely productive academic she shows better than anyone else I know how and why an academic should be on Twitter. Deciding that we needed a list that would flag up women healthcare academics she started the hashtag, #womenhealthcareacademics. She asked people to nominate others and themselves. Who is a woman healthcare academic? Simply: " those we classify, or who self-classify,as [a] women, [b] h/c and [c] academic ". This is an inclusive list. It is not just doctors or women who work in universities. It includes many doctoral students and others working in the community. What follows is the list crowd-sourced by Trish. I offered to host it for her on this blog and then realised that I had not nominated some of my own favourite women healthcare academics on Twitter so I have added these at the end. I've pulled everyone together in a Twitter list which you can find here. We're sure that there are many other people that should be in this list but aren't. Please leave a message in the comments or tweet using the #womenhealthcareacademics tag. EDUCATORS @amcunningham Medical educator from Cardiff, UK. “Determined not to be one of the sheep”. 6000+ followers @SarahStewart Educator, consultant, facilitator. 2500+ followers @fidouglas medical student, co-founder of @twitjournalclub 1000+ followers @misselspeth Medical student intercalating with PhD in medical education. 400+ followers @ajburls Director of postgrad education at Oxford Centre for Evidence Based Medicine Other educators recommended by Twitter community: @kathwoolf@clairehamshire@suzannevee EPIDEMIOLOGY / PUBLIC HEALTH @marionnestle Professsor in dept of nutrition, food studies, public health. 80,000+ followers @aetiology Microbiologist / epidemiologist 3000+ followers @AllysonPollock Academic, public health doc, 2000+ followers @murzee Physician / public health blogger. 1600+ followers @ProfKEPickett “Social epidemiologist, co-author of 'The Spirit Level' and co-founder of The Equality Trust”. 1200+ followers @imaginarygf “Stats nerd” 1300+ followers @lou_hurst “Public health, epi, stats and stuff”. 500+ followers @MegPopHealth epidemiology / nutrition. 500+ followers @siobhanfarmer Public health registrar, runner. 400+ followers @angelaraffle “Public health medic, interest in sustainable economies” 300+ followers @gingerly_onward “Newbie epidemiologist with interest in clinical outcomes research, ehealth” 200+ followers @erica_pool pulic health, NHS, climate change, more. 200+ followers @profhelenward Academic and activist, public health focus 100+ followers Plus others in public health / epidemiology recommended by Twitter community: @jennyhall33 @helen_barratt@vanessasaliba@jeanmadams@Talkingwalking@dr_asbo@epidemiologista@sadieboniface@Sara__Johnson GENERAL PRACTICE / FAMILY MEDICINE / PRIMARY HEALTH CARE @mgtmccartney “Evidence, medical professionalism, politics, screening, risk + more” 1200+ followers @trishgreenhalgh Doctor (GP), academic, agitator, ageing athlete. 1700+ followers @JuliaHCox GP epidemiologist, QRisk queen @PennyL50 Academic nurse with interest in depression management @ClareRCGP Chair of the Royal College of General Practitioners and soon to be honorary Professor at King's College London HEALTH ECONOMICS @kbloor Health economist 450 followers HEALTH SERVICES RESEARCH / HEALTH SYSTEMS @DTFinegood Professor in systems thinking from Canada @DinaBalabanova Health systems researcher, LSHTM @TaranehDeann @butlerceri@RowanM@ir4b health services research CLINCIAL DOCTORS (INTERNAL MEDICINE / PAEDIATRICS / SURGERY) @silv24 Junior doc, global health, in @Twitjournalclub, 2000+ followers @dr_fiona Hospital doc. Nudging 2000 followers @drmlb Professor of Pediatric Surgery, USA @DrMarkham Haematologist, oncologist 600+ followers @VerranDeborah Transplant surgeon, Australia @DrSuparnaDas Anaesthetist with MBA 300+ followers @ingridjohanna66 “UK child health on the front line” 300+ followers @lungsatwork respiratory consultant
LAB SCIENCE @ani2tall cell biologist, working mum. 200+ followers PSYCHOLOGY / MENTAL HEALTH @drpetra Psychologist, ‘evidence-based agony aunt’, sexual health researcher, also tweets about combining motherhood with academic work. 7000+ followers @doseofnuxvomica Psychiatry and music. 600+ followers @soozaphone doing PhD on cannabis / psychosis / depression. 400 followers @essividing professor of developmental psychopathology. 200+ followers @whole_patients “Demystifying psychiatry and psychotherapy for patients and doctors” SOCIAL SCIENCE / HEALTH POLICY / NURSING @Viil “Socio-technical PhD student” 2000 followers @Ermintrude2 Social policy, health policy, social care, social justice. 1700+ followers @HealthCulture Historian of science/medicine 1000+ followers @JulieLeask Social scientist, Sydney. 600+ followers @KateT_health “Health policy, post-socialism, higher education” 300 folllowers @nzruthdesouza Academic nurse from NZ, social justice / feminism. 400 followers @ProfSandyOliver Sociologist, “making knowledge more democratic”. 200+ followers @cj_pope Medical sociology prof @profsophieday Anthropology prof @jomaybin Fellow in health policy at Kings Fund @lizforbat therapist working in cancer care JOURNALS / EDITORS @JAdvNursing Journal of Advanced Nursing (edited by a man, but many excellent papers relevant to women academics and practitioners). 1100+ followers @Ed_N_Researcher Editor of Nurse Researcher 800+ followers @trished BMJ / BMJ Open 1300+ followers @katiejcole “Public health doc, co-founder of Lancet UK Policy Matters”. 500+ followers @deb_cohen BMJ investigations editor OTHER DISCIPLINES (e.g. GEOGRAPHY / MANAGEMENT / INFORMATICS) @mariawolters E-health 700+ followers @renarde “liberal atheist feminist geek” 600+ followers @christineburns Equality / diversity, business / IT @geodianna Geographer who maps health data @fraslette Geographer / population health analyst @Keeping_Mum carer 100+ followers @Subu_OT Occupational therapy + art. 400 followers Anne Marie's nominees not otherwise included! @salma_patel - doctoral student at Warwick in eHealth and frequent contributor to the #nhssm (NHS social media) discussions @deevybee Professor of developmental neuropsychology who has a great blog @claireOT OT and blogger and so much more @nlafferty Lead for elearning in Dundee medical school sometimes to be found leading #meded chats with me @bonnycastle One of the first medical education bloggers, from Saskatoon, Saskatchewan @thinkbirth A passionate scholarly midwife @bronwynah Speech pathologist and NHRMC post-doctoral fellow (and her colleagues @tricmc@sattspeech@salhew@walters_joanne) @VirtualOT Canadian OT and PhD student @evidencematters Great tweets on EBM etc @motherinmed Internist, medical educator and researcher, and blogger @jane_mooney medical educator, PhD student, training in a/e (can code in Flash!) @elaineleung Training as an academic in O/G @kateellington Physician in training- with particular interest in global health and health disparities @drjengunter Obs and gynae doctor, and blogger who often uses her 'lasso of truth' :) @kind4kids academic paediatrician @suzanakm Palliative care doctor and medical educator @kerryhood Statistician and trialist- and a very good friend and colleague in Cardiff University @claudiamegele Psychotherapist and senior lecturer and great tweeter @psychepi psychiatric epidemiologist and policy analyst @laylamccay UK doctor relocated to DC- tweets about all the very interesting events she attends @laikas Dutch medical librarian with a fantastic blog @susannahfox researcher for Pew Internet on the place where technology meets healthcare @cascadia Patient centred design evangelist- says it all:) @pfanderson emerging technologies librarian, ehealth, blogger @nfreundlich journalist, health policy wonk and blogger @lindy2350 CUNY adjunct professor, journalist focussing on health policy @shannonbrownlee researcher and author of 'Overtreated' @marilynmann Lawyer, breast cancer survivor, blogger @drkkolmes psychologist and blogger @emmaburnettx doing a PhD on risk perceptions of C Diff, nurse, lecturer @loracenna nursing professor likes killer heels! @faejones Medical student and @medsinUK joint national coordinator @anyagopfert National policy and advocacy director for @medsinuk @ellypilavachi Co-chair of BMA medical students committee @genbois medical student with passion for global health @snaraghiTraining director for @medsinuk @katerinahilari SLT, reader in acquired language impairment @naomi_cocks SLTsenior lecturer at City University @nicolabotting Reader in developmental language impairment at City University, London @maroeskarovers professor of evidence-based surgery @nicolainnes academic dentist and blogger @profsuewhite Professor of Social Work at University of Birmingham @brigid39 OU social work professor @annehollows Social work academic specialising in children and families policy and practice @meganqb Professor of Healthcare education at Newcastle university, UK @gillybean42 education adviser on medical, dental and veterinary education to HEA @glittrgirl enthusiast for open educational resources in medical education. and she knits! @m2hansen assocaite professor, school of Nursing, university of San Francisco @coleenkraft paediatrician and medical educator @drbarbara1 researcher in autistic intelligence @catbonfiglioli senior lecturer in media studies, with special interest in portrayal of obesity, Sydney @closetohomeMD paediatrician, blogger, Virginia USA @francesmair Professor of general practice at Glasgow University @jessienyc Sociologist, cyber racism, at CUNY @drpattiethomas medical sociologist, educator and blogger @lisagualtieri teaches digital stategies for health communication and more at TUFTS @m_lin emergency medicine physician at UCSF - blogger++ @drbrid Irish, public health pragmatic realist! @doctorblogs one of the first UK female doctors on Twitter with excellent EBM based tweets:) @doctorpreneur Training as psychiatrist, with special interest in clinical leadership and author of MBA for Medics @gastromom gastroenterologist and blogger @TaborF doctor and writer, researcher at Hopkins @iClinicalApps UK doctor training in paediatrics, now in Sydney working on health innovation and #meded @dbensonsmith Professor of politics, race, gender and public policy @ProfHolloway bioethics, gender, race, medicine and law Suggested by twittersphere @drcris PhD student and general surgical registrar @doctorfullerton physician blogger @dr_ginni Sydney media doctor @dr_val founder of better health- medical blog collective @doctorJLB Melbourne based doctor interested in malaria and economics @anacfelix neurologist and educator
Ok, so if necessary to have #rctforapps before being prescribed, should they be available to public to pay without regulation by MHRA, say?(Wed, 22 Feb 2012 10:46:38 +0000)
Establishment of an evidence base for medicine has been slow/painful. Let's not throw that away when it comes to shiny new tech. #rctforapps (Wed, 22 Feb 2012 10:50:12 +0000)
#rctforapps evidence on user involvement indicates variation in involvement based on condition/severity. Same might be case for apps. 1/2(Wed, 22 Feb 2012 10:53:18 +0000)
#rctforapps Pts like to see and be reassured by doctors which costs more than an app. so danger is app see as cost effective solution. 2/2(Wed, 22 Feb 2012 10:53:55 +0000)
Of course this does all seem to be Mr Lansley using apps as a way to save money by keeping patients out of the GP surgery... #rctforapps (Wed, 22 Feb 2012 11:04:36 +0000)
In software you start with a functional spec - work out what you want it to do before you start. That's where focus should be #rctforapps (Wed, 22 Feb 2012 11:39:37 +0000)
Perhaps it isn't #rctforapps that is needed, but an open & connected 'big data' play that ensures app data can be analyzed in real time?(Wed, 22 Feb 2012 11:41:18 +0000)
Due to speed of development, results from #rctforapps would be meaningless in time. We need to ID & test the underlying behavioural theory(Wed, 22 Feb 2012 15:21:33 +0000)
