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doc2doc interview with Anne Marie Cunningham about GMC's social media guidance for doctors

We met with Anne Marie Cunnigham in sunny Cardiff and asked her what she thought about the guidance issued by the GMC regarding doctors' use of social media,...
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7 mins of my thoughts on GMC guidance

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Social media and our personal identity construction

Social media and our personal identity construction | privacy and identity | Scoop.it

Using Facebook, I can very tangibly present myself as a certain kind of person. If I am thoughtful enough and approach it from a marketeers perspective, I can put up the right kind of photos, the right kind of statuses, timeline attributes and career positions to have myself be regarded in a certain way. I can produce something that is a visceral representation of my life that other people regard with real legitimacy that says to me and them, this is who I am. On some level, I believe that most people already do this, whether subconscious or not. Surely that can be more convincing as a tool for corroborating our self-imposed linear narrative structures than what we merely tell ourselves in our inner dialogues? Subversive non-linear narrative structures need not prevail.

AnneMarie Cunningham's insight:

Is social media harmful to our identity construction? Does it flood us with too many memories leading to incoherence? The blogger argues that it doesn't have to be this way. We can use Facebook as part of our identity projects. 

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What is Anonymity in Communication?

"That is, anonymity isn’t created by the communication channel; it’s created by users and similarly undermined or reduced by users. This process of social construction of the technology stymies research in online anonymity. While researchers wish to claim that online forums are anonymous simply because the users cannot be traced back to their offline selves, the users demonstrate that they are not interested in anonymity. Instead, they are interested in the possibility of multiple parts of self, some of which are revealed when interacting online. The difference between this and true anonymity is quite stark and important to recognize."

AnneMarie Cunningham's insight:

So not only is anonymity hard to achieve, but most people do not want it online either. Very well articulated. 

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GMC Guidance on Social Media – a true can of worms…

On 25 March 2013, the GMC published it's latest version of Good Medical Practice. For the first time, this included guidance on the use of social media.
AnneMarie Cunningham's insight:

This is a follow-up post from Phil, a GP. The interesting thing is that he shares, and others have commented, that this guidance and the clarification around it have made him uncertain of his understanding of the nature of our professional regulation. If I was the GMC I guess I would be paying attention to this.

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Response and clarification from GMC to criticism of their social media guidance

AnneMarie Cunningham's insight:

This is the GMC clarification of their guidance on social media published to their Facebook page. I've copied it to my blog in case people do not use Facebook.

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Real name sites are necessarily inadequate for free speech

Real name sites are necessarily inadequate for free speech | privacy and identity | Scoop.it

Offline people say things appropriate to the group they are in. That doesn’t mean they are two-faced, insincere or liars. It means people are context aware. People observe walls, clocks, furniture, fashion and music. These things guide us as to the appropriate way of acting. The guy writing his novel at the bar on Friday night is out-of-place. The guy who shows up to work drunk on Monday morning has a problem. Offline people don’t have to worry about their real name, because their behavior is tied to the context and the impressions the foster in that context. In fact, I’ll say that even more strongly – if your speech is not confined to the context you are in – but available to a potentially unknowable audience – you are online

AnneMarie Cunningham's insight:

This post by @blurky raises interesting oints which I expect are better explored in his book chapter. Many of the commenters disagree with him on  points that he makes. If nothing else, it is an interesting example of post-publication peer review.

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Why Twitter doesn't care what your real name is

Why Twitter doesn't care what your real name is | privacy and identity | Scoop.it
Why does Twitter allow users to have pseudonyms, while Google and Facebook require real names? Because Twitter realizes it can provide plenty of value for both users and advertisers without having to know your real name.
AnneMarie Cunningham's insight:

Interesting point here that identity on Twitter is builtaround reputation and influence... real names are less important. 

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GMC Guide to "Doctors’ use of social media" requires every Doctor who is active online to have a professional profile

GMC Guide to "Doctors’ use of social media" requires every Doctor who is active online to have a professional profile | privacy and identity | Scoop.it

I think that the advice should’ve been much clearer as if you follow the guidelines to the letter (any material written by a Doctor could “reasonably be taken to represent the views of the profession more widely” and it is appreciated that “content uploaded anonymously can, in many cases, be traced back to its point of origin“) there really should be no GMC registered Doctor posting content online anonymously.

I think this isn’t very well thought through. Some of the very best contributors to social media discussions (not just about healthcare) are Doctors who wish to remain anonymous or just want to be allowed to share their opinions as a member of society when they’re not working. The workload of Doctors is tough enough that there should be some capacity in this guidance for them to be able to use social media when taking time out from work.

I can also see a multitude of ways that this could impact on Patient safety as it’s quite clear that whistle blowing Doctors don’t have an easy time. It’s possible that this guidance document itself could make any Doctor who leaks a Patient safety issue anonymously liable to not meeting their duties as a Doctor (because they will have run foul of guidance by trying to do it anonymously in the first place).

AnneMarie Cunningham's insight:

This is a post from a doctor who primarily works as a digital doctor. It asks interesting questions about how the GMC might suport doctors to have a digital profile. It also suggests that there may be a need for guidance on 'tracking' patients online. Also see this post on the 'twittering kidney patient' re tracking. http://www.rmmlondon.com/rmm-sector-story/the-case-of-the-twittering-kidney-patient-healthcare-and-the-ethics-of-social-media-monitoring/

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doctor zorro: GMC talks out of it's arse

doctor zorro: GMC talks out of it's arse | privacy and identity | Scoop.it
GMC guidance for social media, extract from para 17. “Any material written by authors......as doctors......may reasonably be taken to represent the views of the profession more widely” What utter, complete, unsubstantiated, unsupported and unevidenced bollocks! And even if it were true, so fucking what! I know the GMC thinks that the law doesn't apply to them when it comes to tyrannising the medical profession but perhaps they should read this before they start issuing threats to doctors who dare to express their opinion.
AnneMarie Cunningham's insight:

That's the whole post. Is Dr Zorro correct that "the public" do not have a concept of "what doctors think"? I suspect he is at least in part correct. 

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Christian Medical Comment: Doctors should identify themselves on line and respect colleagues and professional boundaries, says GMC

Christian Medical Comment: Doctors should identify themselves on line and respect colleagues and professional boundaries, says GMC | privacy and identity | Scoop.it

Comment fromPeter Saunders "I suspect it would only come into play if there was a genuine complaint about people failing to maintain professional boundaries or confidentiality, being defamatory or insulting or giving incorrect information."

AnneMarie Cunningham's insight:

Also written on the day the guidance came out, this post is less concerned about the anonymity issue than others. 

 

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New GMC Guidance on Social Media

New GMC Guidance on Social Media | privacy and identity | Scoop.it
The GMC today released Good Medical Practice 2013 which, for the first time, contains guidance on doctors using social media. Most of it is what you would expect, but one section has caused some co...
AnneMarie Cunningham's insight:

From a Dundee medical student- initial thoughts posted on the date the guidance waspublished. 

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danah boyd | apophenia » “Real Names” Policies Are an Abuse of Power

danah boyd | apophenia » “Real Names” Policies Are an Abuse of Power | privacy and identity | Scoop.it

Everyone’s abuzz with the “nymwars,” mostly in response to Google Plus’ decision to enforce its “real names” policy. At first, Google Plus went on a deleting spree, killing off accounts that violated its policy. When the community reacted with outrage, Google Plus leaders tried to calm the anger by detailing their “new and improved” mechanism to enforce “real names” (without killing off accounts). This only sparked increased discussion about the value of pseudonymity. Dozens of blog posts have popped up with people expressing their support for pseudonymity and explaining their reasons.

AnneMarie Cunningham's insight:

I started this scoopit back in the summer of 2011 shortly before danah boyd wrote this post. The GMC guidance has highlighted issues around privacy and identity for online doctors in the UK, but the issue has been around for a much longer time.

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The General Medical Council muzzles British doctors who want to post anonymously

The General Medical Council muzzles British doctors who want to post anonymously | privacy and identity | Scoop.it
The General Medical Council in Britain released new guidelines on social media for medicine. Essentially, if you are a doctor in the United Kingdom Big Brother the GMC does not believe that you sho...
AnneMarie Cunningham's insight:

From @drjengunter this is the 1st post that I am aware of on the GMC guidance from outside the UK. She again focusses on the issue of whistleblowing as many of the othetr posts including Peter English's have done. She also raises the issue of doctors (in their own names) posting non-evidence based medicine, which @mgtmcartney also thinks is a bigger issue that pseudonymous posts. 

 

So does anyone think that the GMC have got this right? 

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How Big Data Is Playing Recruiter for Specialized Workers - New York Times

How Big Data Is Playing Recruiter for Specialized Workers - New York Times | privacy and identity | Scoop.it
New York Times
How Big Data Is Playing Recruiter for Specialized Workers
New York Times
After high school, Evan experienced a full-blown identity crisis. He flopped at college, kicked around jobs, ...
AnneMarie Cunningham's insight:

Wondering how this could recruit in to other fields... or maybe it already has. Will online reputations translate into useful metrics for recruitment in business/medicine/law/education?

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Why the ‘i’ in iPhone Will Stand For ‘Identity’ | Cult of Mac

Why the ‘i’ in iPhone Will Stand For ‘Identity’ | Cult of Mac | privacy and identity | Scoop.it

Establishing one’s company as the de facto digital identity layer is the single biggest business opportunity in history. Any company that acquires this status could become the world’s credit card, the world’s gate keeper to all transactions and the world’s main source of digital security in all its myriad forms.

I think Apple can succeed where the social networks failed.


Read more at http://www.cultofmac.com/225352/why-the-i-in-iphone-will-stand-for-identity/#PDG77tAJVpDLfr2u.99

AnneMarie Cunningham's insight:

NIce background to how social networks have tried to colonise this territory, but what will happen to non Apple users? Won't android betrying to do the same thing?

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Privacy in social networks

Privacy in social networks | privacy and identity | Scoop.it

Privacy in social networks (and privacy literacy) are critically important concepts in the digital age. Educators and social media users debate a range of issues about privacy in social media but especially whether privacy has changed as a result of our newly-acquired social habits or whether it is as strict as ever. Facebook CEO Mark Zuckerberg argued in 2008 that "privacy is dead". In response, boyd said that when Facebook makes "data visible in a more ‘efficient’ manner, it is startling, prompting users to speak of a disruption of ‘privacy’." Clearly, there's a deep need to examine citizens' attitudes towards the use of personal information whether it's for sharing with advertisers or making it available for social networking purposes.

 
AnneMarie Cunningham's insight:

From the excellent wiki started by @giustini. Introduces a new to me concept of 'privacy literacy'. I'm not sure what is to be gained from separating this from digital literacy when we are discussing online social networks but perhaps some people do not include it. I will read further! 

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sjhoward.co.uk » Some thoughts on GMC social media guidance

By and large, I think the GMC should stick to outlining principles. I no more expect to see supplementary guidelines on social media use than I would on letter writing or telephone conversations. Although, if – like many hospitals – you’re using a VOIP system, it could be argued that these guidelines apply. Just like the GMC does with those two media, I think case studies would have been a better way to illustrate the application of principles, rather than a list of inflexible “rules”. I don’t think it’s sensible or advisable to try and give over-arching “explanatory guidance” about an area of life which is changing so rapidly.

After all, these are only supposed to be explanatory. They are not intended to introduce new regulation. Though, to my reading, their poor formulation does lead to new regulatory burdens being placed on doctors.

When the last Good Medical Practice was published, Twitter had barely been conceived, and Facebook had yet to open to the general public. These guidelines aren’t clear now, so goodness knows what we’ll think of them in seven years’ time. I think they should be withdrawn.

AnneMarie Cunningham's insight:

On the day after the supplementary guidance was published Simon asked me if I thought that it would apply to all cloud-based applications which could be used to exchange information about patients. In some ways it might be a good idea if it did apply to all these situations, but rather than placing a blanket ban, it said that doctors had a responsibility to ensure the confidentiality and consent of patients, in particular by considering risks. Developing this kind of digital literacy is going to be essential for health professionals (and patients and the public) in the future.

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Wishful thinking in medical education: 50 years ago the GMC were more circumspect about commenting on doctors and the media

Wishful thinking in medical education: 50 years ago the GMC were more circumspect about commenting on doctors and the media | privacy and identity | Scoop.it
AnneMarie Cunningham's insight:

Up until the mid-1980s the medical professions position was that doctors should not use their real names when addressing the media in case they might be accused of advertising. Many feel that today, a bigger issue than pseudonymity is non-declaration of conflicts of interest my those who are using social media.

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Pseudonyms and the Rise of the Real-Name Web by Bernie Hogan :: SSRN

Pseudonyms and the Rise of the Real-Name Web by Bernie Hogan :: SSRN | privacy and identity | Scoop.it

Despite their ubiquity, pseudonyms are an under-theorized element of online participation, as is the use of real names (or names commonly used to personally identify someone). This absence has become especially acute in recent years as sites listing an individual’s real name have become common. This shift towards real names is not merely a technical convenience, but a specific political turn. As pseudonyms are often associated with Internet trolling and cyberbullying, it is useful to track the use of pseudonyms in history and to consider many of their positive functions. Ironically, pseudonyms help to solve a problem that Facebook creates – the single heterogeneous audience, i.e., the collapsed context.

AnneMarie Cunningham's insight:

This is a free download of a chapter of a very expensive book. Haven't read the whole thing yet but looks very good.

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Britain seeks opt-out of new European social media privacy laws

Britain seeks opt-out of new European social media privacy laws | privacy and identity | Scoop.it
'Right to be forgotten' laws, giving users – rather than services such as Facebook – control of personal data will save billions of euros and thickets of red tape. So why is Britain resisting?
AnneMarie Cunningham's insight:

Main complaint from ministy of justice seems to be that legislation is unrealistic and need rewritten. But surely other countries must have same issue?

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Northern Doc: Foot in mouth.

Northern Doc: Foot in mouth. | privacy and identity | Scoop.it

Have the GMC made a slight omission and are they in fact acting in a very discriminating fashion towards certain doctors? We appreciate that totalitarian control freaks who consider themselves above all laws both British and European never make mistakes but a glance at some old GP magazines and BMJs reveals that some doctors dare to write anonymously or use pseudonyms in these journals. 

Is therefore according to GMC non-logic an article in paper format allowed to be published anonymously while the exact same content published on social media has to have the author identified if they are a doctor? Of course paper is always easier to burn than the internet so maybe the GMC feels it has more control here as it can send the stasi round with some matches to a warehouse far more easily than have to observe the legal niceties that would have to be followed for phone and internet tracing/hacking and buildings do sometime burn down spontaneously, mi lud. Perhaps they will invoke anti terror legislation to track down those they do not like as there is a clear threat in their "guidance"?

AnneMarie Cunningham's insight:

Northern Doc is pretty angry about this guidance. He highlights that in the past (and currently) print journals have allowed pseudonyms. He should read my post on the hostory of GMC and guidance to doctors on anonymity in the media. 

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Fun times for a trainee doctor: My thoughts on the new GMC guidance.

Fun times for a trainee doctor: My thoughts on the new GMC guidance. | privacy and identity | Scoop.it

My main issue with the anonymity is one of safety. I have always been taught not to put too much information about myself on the internet. I've been told such strong statements as if you have your picture, your DOB and your full name on the internet, you could be subject to identity theft, so I tend to avoid having all three together on a site.
Even ignoring the risk of identity theft, I don't want to make it very easy for my patients to find me online. I have already in my life been subject to the unwanted attentions of several people online that it took me a while (and several rounds of blocking their new usernames) to get rid of. I don't like the idea that a patient with strong feelings about my practice (good or bad) could easily try and take this up with me on a personal level outside of my place of work.

AnneMarie Cunningham's insight:

This is a very thoughtful post from a medical student which explores the pros and cons of the guidance. 

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Does the GMC social media guidance breach the Human Rights Act?

Does the GMC social media guidance breach the Human Rights Act? | privacy and identity | Scoop.it

From what I can see, there hasn’t been much case law in this area yet, but it would be interesting to see what would happen if it was tested. From my perspective, I think it just makes the GMC guidance even more unenforceable. Consider the cost, time and manpower involved in petitioning Twitter or Facebook for the details of an anonymous user, then the ISP to link the details of the user to an actual person, only for that person to then appeal it before the UK courts under the Human Rights Act.

AnneMarie Cunningham's insight:

Another post from Christopher McCann who has a background in IT. 

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How will the UK ban on doctors using social media anonymously affect patients? | Neurobonkers | Big Think

How will the UK ban on doctors using social media anonymously affect patients? | Neurobonkers | Big Think | privacy and identity | Scoop.it
First things first - I’m not a doctor, but the surprise new rules issued by the GMC (the British regulator for doctors) still worry me. Not just because I might perhaps one day be a doctor, but because I certainly will one day be a patient.
AnneMarie Cunningham's insight:

This post is written by a scientist who uses pseudonymity to challenge 'quacks'. He is concerned about the timing of this challenge and like others thinks that it will challenge the ability of doctors to whistleblow through social media.

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Surgical Opinion: Twitter Wars on Anonymity of Doctors on Public Social Media Networks

Surgical Opinion: Twitter Wars on Anonymity of Doctors on Public Social Media Networks | privacy and identity | Scoop.it
There are valid reasons to be anonymous

This is something I do agree with.  Particularly with whistle blowing and for doctors working in small communities.  Additionally, if you want to actively debate controversial emotive topics that can truly put ones safety in danger such as abortion issues, this is also a valid reason.  These doctors have good reason to not comply with 'should' and could make good argument to the case.  To quote the GMC guidance:-

'You should’ is used when we are providing an explanation of how you will meet the overriding duty. ‘You should’ is also used where the duty or principle will not apply in all situations or circumstances, or where there are factors outside your control that affect whether or how you can follow the guidance.
CONCLUSIONS

In conclusion, I think that for most this will end up being just a storm in a teacup.  Several commentators are propagating the argument that 1+1=3.  The suggestion that doctors who say that they are doctors 'should' (not MUST) use their real name is my opinion perfectly reasonable.
AnneMarie Cunningham's insight:

@DrHWoo is an Australian doctor. He thinks there has in the man been an over-reaction to the GMC social media guidance. He points to the fact that doctors are told that they 'should' identify themselves rather than must, and this leaves quite a lot of rrom to manoeuvre for all concerned. Above all he feels that there are valid reasons to use pseudonyms and this is allowed for by the guidance.

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