AHPRA’s ‘Consultation Paper’ on social media.

Given that this is a ‘Preliminary Consultation Paper, the level of consultation from AHPRA thus far on this issue has left much to be desired. I wonder how many health professionals and members have received any communication at all from AHPRA informing them of this process or the existence of this ‘Consultation Paper’ and the invitation to comment.

It is an irony that may well escape AHPRA that were it not for Twitter, (@AHPRA) blogs and social media, many health professionals, myself included, would never have even heard of this ‘consultation’. Similarly, any health professional looking for the ‘Consultation Paper’ on the AHPRA website will have a difficult time. So well hidden is the document that most will have to rely again on social media sources to locate a copy. (You can find it here). A reasonable expectation would be that the document would be clearly located and downloadable from under the existing menu tab called “Current Consultations“, but as of writing this, no. (Blog update 7/9/12….If it is the case that this paper was sent for consultation to only some selected bodies, organisations or people for comment, then AHPRA has learned another invaluable lesson about social media and contemporary ‘consultation’.)

This is, in my view, one of the most unfortunate, unnecessary, unthinking, unclear and virtually meritless ‘Consultation Papers’ that I can recall.

It appears to have been written from a vantage point of almost complete unawareness of the workings of social media. This may be unsurprising as AHPRA appears to have no social media presence or involvement at all. It appears to have no active Facebook page, Twitter account, Google Plus page, Linkedin involvement, AHPRA blog, or other indication that it speaks with any kind of experience or authority on the topic of social media among health professionals. Indeed the APRAH website is bereft of any sign of social media awareness to the point where there does not even appear to be any ‘share’ buttons or links through which they might share information with the vast majority of their members who may indeed inhabit the social media world.

Thankfully, the Nursing and Midwifery Board page acknowledges social media, has a Twitter account and has produced its own, considerably more sensible set of social media guidelines, as has the RCNA/Australian College of Nursing.

It is difficult to know where to begin with the actual substance of the ‘Consultation Paper’, slender though that is, but let me take one of the most glaring flaws first. That is the almost total lack of awareness of the positive power and potential of social media and arising from this myopia, a consequent lack of any positive suggestions as to how health professionals can engage with, develop and create exciting new ways of engaging with patients, colleagues, students and communities. In only one example, Boston Children’s Hospital physician, Claire McCarthy notes that: “Having been online, blogging and doing other social media, it has become increasingly clear to me that I need to be there — and that more doctors need to be there with me. The main reason? Because that’s where the patients are.” For ‘doctors’, read ‘all health professionals’.

On this ‘positive project’ of social media and its potential, AHPRA has nothing at all to say. What is offered instead are seven pages of punitive, fear-driven, risk-averse, lifeless, unimaginative warnings about what might ‘go wrong’ or what ‘someone might do’ in misusing social media.

Similarly, the forebodings about health professionals ‘advertising’ and using ‘testimonials’ are not so much red herrings as pale pink ones. These proscriptions should be the next edifice of restriction to be radically reconfigured to match the times that we live in. These ‘bans’ were born in an era when a monolithic state health system needed desperately to bolster the fiction that all hospitals and health systems were somehow ‘equal’, as were all health professionals. Any challenge to this most convenient untruth could now be re-cast by a regulator as ‘professional misconduct’.

In the coming decades health needs innovation, imagination, social entrepreneurs and health professionals starting their own businesses to address some of the existing and emerging health challenges that have so flummoxed our existing system. These new entities cannot be shackled by such arcane restrictions. For them to responsibly publicise and alert the public to their services and to both seek and share their patients’ and clients’ views, assessments and experiences is not mere ‘advertising’, it is an ethical and professional imperative.

Currently, the shonks, shysters and charlatans spruiking their colonic cancer cures, magnetic manipulation miracles and dodgy diet drivel can advertise and scatter testimonials around with seeming impunity while, according to AHPRA, a legitimate health professional or hospital could be in trouble for publicly sharing the freely offered views of patients who thought that their service was wonderful. Go figure.

There are some specific points and suggestions in the Consultation Paper that, far from providing any of the “clarity for the public and health practitioners”, that is promised (p.2), may engender nothing but confusion.

For example:
1.2 Professional behaviour
“As in any other context, registered health practitioners should act in a professional manner when using social media. While respect and good communication with colleagues and other practitioners enhances good care, critiquing or comparing and contrasting other health services does not.”

This warning on the alleged dangers of ‘comparing health services’ is unlikely to alarm bodies such as the ‘My Hospital website‘ or the existing statutory bodies that collect health data with the explicit aim of “comparing and contrasting other health services”. Nor is it likely to cut any mustard with the many social media sites and other websites worldwide where patients, families and yes, staff are already making public the views and experiences of healthcare that had been so effectively silenced before the advent of social media.

To suggest, as section 1.2 does, that health professionals who express a view as to the comparative quality of different services are somehow guilty of ‘unprofessional behaviour’ beggars belief. For example, I recently posted an example Linkedin update suggesting that, “The Cleveland Clinic is a better hospital than Mid-Staffs circa The Francis Report”. While some may wish to disagree with the proposition (exactly how, I have no idea), I can think of no rational sense in which expressing such a view online or in social media could be interpreted as ‘unprofessional’. Equally erroneous is the jaw-dropping assertion (I will give it no more weight than that), that “critiquing health services does not enhance good care”. Many in health care would argue that, on the contrary, such critique may be one of the few things that does improve care and services. One latest piece of research is telling here, showing the adverse effects that may arise when health professionals are not sufficiently ‘critical’.

1. Professional obligations
“It is almost impossible to separate ‘public life’ and ‘professional life’ in a social media environment. If aspects of a practitioner’s private life are accessible online in social media, that information may be open to misinterpretation by others.”

Quite which golden age of hermetically sealed privacy this harks back to is unclear. Practitioners may post some ‘private information’ online. Well, ‘Hold the front page’ indeed. In this veiled warning, there is no sense at all of which ‘aspects’ we should be concerned with or why; the photos of your child’s birthday party? your pet dog’s name? your blog about the difficult shift you have just completed? the footy team you barack for? or your clandestine sex-tape? All ‘aspects’ of your private life seem the same to AHPRA. Worse still, we are told, this may be ‘misinterpreted’ by others. Thus according to AHPRA, health professionals now appear to be culpable for the cognitive inability of others to ‘interpret’.

2. Confidentiality and privacy
”Registered health practitioners have an ethical and legal responsibility to maintain patient privacy and confidentiality. Practitioners should not make comments about patients on social media, even in a de-identified way, as it may breach the patients’ privacy and confidentiality.”

There are no quibbles at all about professional responsibilities towards privacy and confidentiality, although whether AHPRA adds anything new or substantive to practitioners’ understandings here is debatable.

Where AHPRA over-reaches itself is in claiming that “de-identified” discussion or comment regarding patients within social media is some kind of ‘breach’. If this were then case then no professional journal would exist ‘on-line’ as de-identified descriptions and accounts of patients and cases are part of their stock in trade, the ‘case study’ as we know it would vanish from our literature and presentations, the patient story or narrative that is now so revered in understanding and improving patient experience would be outlawed. Researchers would be unable to publish rich qualitative data about patients’ lives and experience, for fear that someone might ‘tweet’, ‘like’ or ‘forward’ their article using a social media sharing option.

Health professionals have no shortage of advice and guidelines on the responsible use of social media. Nurses and Midwives have better guidelines and numerous health sites online offer more sensible and workable ‘social media policies for health providers’ than these. Social media of course means that health professionals can access better information and advice than AHPRA has managed here (see eg this Croakeyblog) Health professionals may even have their own individual hospital AND state or territory health department’s guidelines and policies to contend with as well.

All of this ‘governance’ and guidelines mania is of course, a rather desperate attempt on the part of the professions and bodies such as AHPRA to wrest back control in world where the internet and social media has well and truly pulled the rug out from underneath them. This particular genie has long since escaped the bottle and is NOT going back. As Tim Berners-Lee commented recently, “The internet does not have an ‘off’ switch”. To that I would add, “and social media does not have a mute button”. This ‘Consultation Paper’ is a rather clumsy attempt to create the impossible illusion, that ‘guidelines’ or ‘policies’ control behaviour. The forlorn hope is, that if enough of these are written, then ‘nobody will do something stupid on Facebook’.

The reality of course, is that at some point someone certainly WILL. That is a fact of life, not a failure of ‘governance’. The culprit is not suffering from a ‘policy deficiency disorder’. They are personally responsible for their poor judgement and will hopefully learn from the mistake and not repeat it. As thinking, responsible, autonomous health professionals, the vast majority of social media users will not make such serious errors. We will use social media wisely, creatively, enjoyably and in ways that will benefit our colleagues, students, patients and clients.

If AHPRA cannot support this movement positively and enthusiastically, then it should at least have the grace and wisdom to step out of the way and do not obstruct it.

Philip Darbyshire, 7/9/2012

Leave a Reply