julian walter on social media: law & order

Law and Order in Social Media

A new frontier or the wild west?

Dr Julian WalterMedico-Legal Advisor (Solicitor)

Same problems, different

ways

COMMUNICATION

Same problems, different ways

= TROUBLE

Old problemsNew mediumNo time to think

Wide audience

Same problems, different ways

“Not quite the tablets I had in

mind”

Same problems, different ways

Same problems, different ways

Where are we now?

Same problems, different ways• Widening use of social media by medical practitioners

September 2012

Same problems, different ways• AHPRA speaks ........... And we wait

http://t.co/5h04G4Gk

Same problems, different ways

WHAT DID AHPRA SAY?

• Advertising• Maintaining Professional Obligations• Professional Boundaries• Professional Behaviour

• Confidentiality & Privacy

Same problems, different ways

Is this the end of Social Media before it even began?

Same problems, different ways

We have to ask the right questions

What are the ‘rules’?

What are the ‘RULES’?

MEDICAL BOARD OF AUSTRALIA

CODE OF CONDUCT

http://www.medicalboard.gov.au/documents/default.aspx?record=WD10%2f1277&dbid=AP&chksum=eNjZ0Z%2fajN7oxjvHXDRQnQ%3d%3d

What are the ‘RULES’?

AMA

https://ama.com.au/social-media-and-medical-profession

What are the ‘RULES’?

American Medical Association

http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion9124.page

What are the ‘RULES’?

British Medical Association

Professional Boundaries

Professional Boundaries

BOUNDARY VIOLATIONS

Professional Boundaries

“Professional boundaries are integral to a good doctor–patient relationship. They

promote good care for patients and protect both parties”

Professional Boundaries

“Never use your professional position to establish or pursue a sexual, exploitative or

other inappropriate relationship with anybody under your care”

Professional Boundaries

“Avoid expressing your personal beliefs to your patients in ways that exploit their vulnerability

or that are likely to cause them distress”

Professional Boundaries

Professional Boundaries

MORAL PANIC ??

Professional Behaviour

Professional Behaviour

www.foxnews.com

Professional Behaviour

“In professional life, doctors must display a standard of behaviour that warrants the trust and respect of the community. This includes

observing and practising the principles of ethical conduct”

Respect for colleagues

Respect For Colleagues

Respect For Colleagues

“Good patient care is enhanced when there is mutual respect and clear communication between all health care professionals involved in the care of

the patient - Communicating clearly, effectively, respectfully and promptly”

Confidentiality

Confidentiality

Confidentiality

“Patients have a right to expect that doctors and their staff will hold information about

them in confidence, unless release of information is required by law or public

interest considerations”

Confidentiality

Photography

PhotographyYOU

3rd Party

Photography

IMPORTANT POINTS:

Disclosure only if purpose directly related to the primary reason for data collection;

AND

Disclosure is within the reasonable expectation of the patient National Privacy Principle 2.1(a) - Privacy Act 1988 (Cth)

Photography

To infinity ...... and beyond!

Photography

IMPORTANT POINTS:

"child abuse material“ = the private parts of a person who is, appears to be or is implied to be, a child.

s91FB (1)(d) Crimes Act 1900 (NSW)

Photography

IMPORTANT POINTS:

- Informed consent, audience and purpose-Maintain confidentiality & privacy- Part of the record- Secure storage- Beware the Policy

Photography

Photography

Clinical images Explanation only

Research - Written ConsentEducation - Written Consent Publication - Written ConsentBranding - Written ConsentAdvertising - Written Consent

Photography

Does a unique image identify the patient?Obtain consent even for de-identified images

Online doctor rating

Online doctor rating

Currently in the US, approximately 16% of doctors rated on this sitehttp://www.jmir.org/2013/2/e24/

Online Rating

Difficult area

Just ‘over the fence banter’

Or

Something more serious ?

Online Rating

Legal solution is not ideal

Online Rating

Legal solution is not ideal

Defamation action:Who is the poster?Opinion? Fact? Defamatory?

Risks: expensivecostlyno guarantee of successpublicises complaint

Online Rating

Social Media driving the profession?

Online Rating

Conclusion:

In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with:

- greater inpatient use of healthcare- higher overall healthcare and prescription drug expenditures- increased mortality

http://archinte.jamanetwork.com/article.aspx?articleid=1108766

(26% more likely to die than those who had the lowest satisfaction)

Social Media driving the profession?

QUESTIONS?

Dr Julian WalterMedico-Legal Advisor (Solicitor)