Category Archives: e-Health

Breathing New Life 2013 (Part 1)

It is quite fitting that I sit down to write this summary of the Breathing New Life (BNL) conference held in Canberra recently. At the conference last year, I was so inspired by the stories of other GPs and the use of blogs and twitter, I decided to start my own blog. It is the one you are reading now. Since then I have kept updating my flying training progress, commented on social media policy in healthcare and attempted a humorous post (or two). Unfortunately, I never got around to summarising my experience at BNL 2012 and you can still see the lonely post here. But luckily, I was inspired once again…and hopefully a little more motivated and better at writing!

The BNL conference is the annual showpiece event for General Practice Registrars Australia (GPRA). They are the peak representation body for GP registrars in this country. In the past, GPRA has successfully advocated for National Minimum Terms and Conditions, timely GPRIPs funding, teaching guidelines and many other registrar issues. As a Registrar Liaison Officer with my GP training provider, I am lucky enough to sit on the advisory council of GPRA. We meet bianually before BNL and GPET conference in September to discuss such issues and workshop solutions.

But BNL itself is a day long conference held in the Great Hall of Parliament House that aims to bring GP training, recruitment and support into the spotlight. 2013 was no exception. From the outset, use of Twitter was encourage to pose questions, comment on speeches and connect using the hashtag #bnl2013. As the day progressed, we even started to see comment and opinion from our collegues in New Zealand. It is with this real-time connection, that the role of Twitter in health care is immediately obvious:

Highlighting the importance of the venue for the day were keynote speeches by the Health Minister, The Hon Tanya Plibersek MP and The Hon Peter Dutton MP which were both warmly received. Even though the Minister needed to hurry off to an ALP caucus meeting and the Shadow Minister was a touch late in arriving before a feisty Question Time in the house of Reps and didn’t get to answer one last question from Dr. Jonathon Ramachenderan:

Health Minister talking up GP

Health Minister talking up GP

The Minister reiterated the importance of general practice stating that “GPs are at the heart of our universal medical system.” She also affirmed the position and continuation of the e-Health record and Medicare Locals. I was heartening for all present to note that the Governments thinking in relation to the future challenges of health care revolve around improving GP access. The Shadow Minister retorted in his address that he thought that the Government could do a lot better in primary health care and echoed the Minister saying that “GP care would be central” to any future health system. My question from the floor The Shadow Minister was “given there is a lot of uncertainty about the future of government initiatives such as the e-Health record and Medicare Locals in this election year, what advice can you give to the future of GP assembled in front of you.” The response didn’t cover e-Health, but he hinted strongly that Medicare Locals were not the most efficient or efficacious way forward. Once again, Twitter provided the means to pose a few rhetorical follow-ups:

The Hon Jim McGinty discussed the work of Health Workforce Australia 2025 and the issues surrounding retention and planning with our current state of workforce maldistribution. The recent controversial paper entitled “Too Many GPs” was also given attention. And promptly panned:

With The Hon McGinty describing the report as “full of inaccuracies ,” he was quick to remind all present that given the current state of GP distribution, more are needed at the coal face. However, a number of references to nurses evidently ruffled a few Twitter feathers:

https://twitter.com/notjustagp/status/313782950024056832

Following this brief look at the future, we were allowed a moment to reflect on the amazing work done by the General Practice Student Network (GPSN) which celebrates its fifth anniversary in 2013. We heard of humble beginnings and a huge base of support that now includes over 9,500 student members. This we were told, had been largely driven by the tireless work of council chairs, their councils and the representatives on the medical school grounds holding numerous events.

It was heartening to see that indeed future GPs are out there and will be ready to meet our nations challenges in health demonstrated by Jim McGinty. The Twittersphere also erupted in e-birthday wishes for GPSN:

Indigenous health was a highly anticipated topic of the day and was supported by the GPRA Closing the Gap campaign launch. We heard from The Hon Warren Snowdon who stated that “GPs have an important central role in improving Indigenous health.” MP and Dr Andrew Laming MP noted in his speech that the “100,000 Indigenous people living in remote communities will be the real test of the Close the Gap efforts.” It was refreshing to hear bipartisan support and understanding for once.

Also On each table were a number of wristbands that will serve to draw attention to and remind wearers to effect their own small change in this area. To discuss some of the change possible, the Indigenous health panel debated, discussed and took questions from the floor and twitter:

Make a difference

Make a difference

The response to this were themes relating to difference in cultural and educational experiences felt by Indigenous students and registrars. Also that the Indigenous population are a heterogeneous mob all over the country and as such may require personalised consideration. Some suggestions from Indigenous doctors in the audience included needing to recognise cultural differences and reducing threats like ‘you might be kicked out.’ Dr Aleeta Fejo was a standout member on the panel who commented that at the GP registrar level “they are already brilliant people, as they have overcome so much just to get there.” She is a testament to this herself having recently passed her RACGP written exams and winning the inaugural indigenous General Practice Registrars Network award:

Aleeta also shared some gems about encouraging young Aboriginal children to join the GP workforce. She showed that it was as easy as asking “Are you going to be a doctor like me? ‘Coz I need your help!” Planting the seed early with children and especially their parents was the message. Getting across to the family that this prospect is actually possible. The facilitator Dr Mark Wenitong tempered that he would always check a kids ears for pus before putting the stethoscope in their ears!

There were some great opinions on how to encourage non-Indigenous registrars to consider working in an Aboriginal Medical Service. Dr David Chessor pointed out that he has got much more out of AMS work than he put in. David Townsend, current chair of GPSN commented on the need to spread this sort of message:

He went on to say that AMS cases are much more interesting and complicated. Perhaps then this side of registrar training needs to be better advertised? With Rural Health Workforce Agency doing so much good with their #gorural campaign, maybe it’s time for #goAMS? Drs Tim Senior and Michael Bonning are already doing some amazing and innovated work with the #supertwision project and should be followed with interest:

RACGP president Dr Liz Marles weighed into the benefits of AMS work given her long experience in the area with comments like “learning from patients every single day”,”…rewarding place to be” and “patients are non-demanding, generous and trusting” leading to many registrars thinking that these traits in patients have been lacking in their own non-AMS practices.

To come in part 2: The Great Debate, general practice and the defence force, GP Leader’s forum, the GPRA update from CEO Mr Amit Vohra and plenty more tweets!

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Filed under BNL, e-Health, General Practice, GPRA, Health Policy, Rural GP

Over regulation of social media in medicine: stifiling progress?

Dr. Google will tweet you now. Like?

Over the past three days, over 600 people involved in general practice education and training converged on Melbourne for the annual GPET conference. Peppered throughout the gathering were sessions relating to the current and more excitingly, possible future use of social media in the medical field. Some areas that have already started down this track and will in the future include:

  • National e-Health Record (PCEHR)
  • Registrar and medical student training
  • Connection of doctors, nurses and allied health
  • Patient education and FAQ videos or sites
  • Medical Practice information, booking and contact details
  • Videoconferencing between rural patients, GPs and specialists

At the afore mentioned GPET2012 conference, one notable session was run by noted internet savvy practitioner Dr. George Forgan-Smith (The Healthy Bear). He highlighted to the standing room only session the different uses of internet based systems. It was inspiring to hear about the use of exciting and ever-changing web-based tools. For example:

  • YouTube: for the production of medical themed videos
  • Facebook: for your own advice site and medical practice information
  • Yahoo Answers: providing common sense answers to those too scared to ask
  • Google: Patients being able to find you and your practice

It was especially heartening to listen to this doctor who has seen lots of misinformation on the internet trying to provide his own considered (and safer) information. As a GP registrar, I am both excited and wary of the prospect of this brave new world. Already after the conference and session run by Dr. Forgan-Smith, I am newly motivated to explore the role of producing amongst others: online teaching videos, patient consent videos and education snippets.

“why don’t they just get another cup?”

Recently, the national board AHPRA has released a consultation paper to help “to clarify…the expected standards relating to social media use.” Some blogs have already highlighted the lack of clarity offered by this statement. They have punctuated the areas (below) with related examples. I won’t delve into these myself, but please visit Impacted NurseCroakey and Phillip Darbyshire as all have summarised this very nicely.

  • Professional boundaries
  • Professional behaviour
  • Confidentiality and privacy

Interestingly, Impacted Nurse has observed that already their social media activity (along with mine and many others!) would already be in breach of the proposed policy. The whole tone of the AHPRA statement is restrictive and casts a dim view of social media in medicine. In fact it highlights a lack of knowledge and experience in the very area that they look to place boundaries around.

But AHPRA is not the first group to try to address professionalism relating to social media.  The Royal College of Nurses have already released useful and supportive guidelines. Medical peak representation bodies have also been proactive and drafted guidelines addressing these issues. The AMA DiT, NZMA DiT, NZMSA and AMSA released a joint initiative way back in 2010. They identified that there was the potential for legal and professional risks. As such, many medical defence organisations have drafted and published case studies, guidelines and recommendations for their members. In the age of an increasingly connected society and the further blurring of professional and social boundaries, an increase in medico legal cases with a social media focus is inevitable. Although I agree that there is a need for nationally regulated guidelines or policy regarding online conduct and behaviour, they need to be permissive enough to allow innovation and progress while maintaining professional standards. We must not let a nanny-state approach stifle this form of interaction that has to potential to do so much for a great number of patients in an increasingly fast paced online world.

Given that AHPRA is calling for feedback on the issue of social media in medicine, the lack of Twitter/Facebook*/YouTube presence is notable. Therefore, AHPRA is asking for feedback by regular old email (socialmediaconsult@ahpra.gov.au) by COB on 14 September 2012.

*The only AHPRA site to be found on Facebook is “Asociación Hondureña Protectora de los Animales y su Ambiente”

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A copy of the letter that I help GPRA co-author as a submission to AHPRA, sent on Friday 14th September 2012:

AHPRA SM Policy Response

 

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The story is picked up by Medical Observer on the 17th September 2012:

 

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Response from AHPRA on Wednesday 19th September 2012:

“Thank you for your submission to the preliminary consultation process on the National Boards’ draft Social Media Policy.

Your feedback will be considered by National Boards but as this was a preliminary consultation process, your feedback will not be published.

There will also be a public consultation process in which you are also welcome to participate, and information will be available on the Board’s website about this soon.

Thank you again for your interest in this issue.”

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Filed under AHPRA, e-Health, General Practice, Health Policy, Rural GP