Psychiatric Times.
No. 12
DIGITAL TECHNOLOGY FOR PSYCHIATRY
Networking, Professionalism, and the Internet
What Practicing Psychiatrists Need to Know About Facebook, LinkedIn, and Beyond
By Sandra M. DeJong, MD |
December 7, 2012
Dr DeJong is Associate Training Director in Child and Adolescent Psychiatry at Cambridge Health Alliance, Cambridge, Mass; Clinical Instructor at the Harvard Medical School, Boston; and Chair of the Presidential Taskforce on Professionalism and the Internet, American Academy of Directors of Psychiatry Residency Training in Cambridge. She reports no conflicts of interest concerning the subject matter of this article.
Using technology
The professional use of technology offers important opportunities for psychiatrists and patients. Which technologies to use and how they are used depends largely on the size of the practice and the manpower available. Online therapies can significantly improve access to care for hard-to-reach patients, such as adolescents or patients living in communities with few psychiatric resources. Interactive, computer-based programs, such as “Coping Cat” for treating anxiety in children or the online CATCH-IT program for preventing depression, may improve care.12,13
Technology provides an inexpensive means for rapidly disseminating important information to patients. Blogs and Web sites that provide accurate, up-to-date information for patients can provide important alternatives to the wealth of inaccurate content available online. Information directed toward groups of patients may be appropriate for social media. For example, using social media for advisories about a new FDA black box warning, the need for patients taking neuroleptics to use sun protection, or depot injection dates for a cohort of VA patients seem feasible and appropriate.
Technology can also enhance the logistics of running a practice. Findings from a recent study indicate that texting patients’ appointment reminders reduces the no-show rate.14 Protected portals for patients to e-mail medication refill requests or ask clinical questions of their psychiatrist can be efficient and helpful as well.
Some psychiatric treatments may improve with “bridging”—the use of patient networking sites for persons with chronic illness. Such patients may benefit from the support and resources these sites provide. Similar electronic “bridges” between psychiatrist and patient may be useful between sessions. Yager15 reports on improvement in the therapeutic alliance when e-mail was used to correspond with patients who had eating disorders. In working with children who have developmental disorders and their families, for which teams of multiple professionals are the norm, e-mail can significantly improve team communication.
Finally, online technology provides a means for professionals to network. While Facebook and YouTube are used by physicians for this purpose, professional social networking sites such as LinkedIn or Doximity (for physicians only) may be more appropriate for this purpose.
Recommendations for practice
In general, psychiatrists need to appreciate that technology is here to stay and represents a critical change to the framework of practicing psychiatry. By spurning technology, psychiatrists may risk failing to understand its importance in the lives of patients as well as its inevitable role in clinical practice. By embracing technology without caution, they risk violating professional roles and boundaries. By keeping in mind some caveats, psychiatrists can successfully employ technology in their practice:
• Be ever-vigilant about the impact of technology on the physician-patient relationship
• If you are using a specific technology, use it competently (Table 2); be wary about being unable to keep up with incoming information
• Know current professional guidelines and standards of practice regarding technology, including your institution’s policies (see Additional Resources box); violations can result in loss of licensure, job, and professional status16
• When you are in doubt about certain aspects of technology, ask an expert (eg, IT, risk management, legal, clinical, ethical)
Additional resources, here.
Also in this Special Report
References
1. Bodnar K. The ultimate glossary: 120 social media marketing terms explained. 2011. http://blog.hubspot.com/blog/tabid/6307/bid/6126/The-Ultimate-Glossary-120-Social-Media-Marketing-Terms-Explained.aspx. Accessed October 14, 2012.
2. DeJong S, Benjamin S, Anzia J, et al. AADPRT Curriculum on Professionalism and the Internet in Psychiatry. 2011. http://aadprt.org/vtodocs/professionalism_and_the_internet/AADPRT_Professionalism_and_the_Internet_Curriculum.pdf. Accessed October 30, 2012.
3. Recupero PR. E-mail and the psychiatrist-patient relationship. J Am Acad Psychiatry Law. 2005;33:465-475.
4. Cooney E. White Coat Notes: Flea’s fall sobering for other bloggers. May 31, 2007. http://www.boston.com/yourlife/health/blog/2007/05/fleas_fall_sobe.html. Accessed October 24, 2012.
5. Professional Risk Management Services, Inc. Risks Associated With Specific Internet Activities: A Guide for Psychiatrists. 2010.
6. Gabbard GO. Professionalism and boundaries in cyberspace. In: Gabbard GO, Roberts LW, Crisp-Han H, et al, eds. Professionalism in Psychiatry. Washington, DC: American Psychiatric Publishing; 2012:59-73.
7. US Department of Health and Human Services. Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules. http://www.hhs.gov/ocr/privacy. Accessed October 24, 2012.
8. Mostaghimi A, Crotty BH, Landono BE. The availability and nature of physician information on the internet. J Gen Intern Med. 2010;25:1152-1156.
9. Clinton BK, Silverman BC, Brendel DH. Patient-targeted googling: the ethics of searching online for patient information [published correction appears in Harv Rev Psychiatry. 2010;18:206]. Harv Rev Psychiatry. 2010;18:103-112.
10. Veeder VV. The history and theory of the law of defamation. Columbia Law Review. 1903. http://www.jstor.org/stable/1109121. Accessed October 24, 2012.
11. Chan JF. E-mail—A Write It Well Guide: How to Write and Manage E-Mail in the Workplace. Oakland, CA: Write It Well; 2008.
12. Kendall PC, Hedtke KA. Coping Cat Workbook. 2nd ed. 2006. http://www.workbookpublishing.com/coping-cat-workbook-2nd-edition-ages-7-13.html. Accessed October 24, 2012.
13. Iloabachie E, Wells C, Goodwin B, et al. Adolescent and parent experiences with a primary care/Internet-based depression prevention intervention (CATCH-IT). Gen Hosp Psychiatry. 2011;33:543-555.
14. Sims H, Sanghara H, Hayes D, et al. Text message reminders of appointments: a pilot intervention at four community mental health clinics in London. Psychiatr Serv. 2012;63:161-168.
15. Yager J. E-mail as a therapeutic adjunct in the outpatient treatment of anorexia nervosa: illustrative case material and discussion of the issues. Int J Eat Disord. 2001;29:125-138.
16. Greysen SR, Chretien KC, Kind T, et al. Physician violations of online professionalism and disciplinary actions: a national survey of state medical boards. JAMA. 2012;307:1141-1142.
17. Lagu T, Kaufman EJ, Asch DA, Armstrong K. Content of weblogs written by health professionals. J Gen Intern Med. 2008;23:1642-1646.
18. Chretien KC, Azar J, Kind T. Physicians on Twitter. JAMA. 2011;305:566-568.
19. Purcell K. Search and email still top the list of most popular online activities. 2011. http://www.pewinternet.org/Reports/2011/Search-and-email.aspx. Accessed October 24, 2012.
20. Modahl M, Tompsett L, Moorhead T. Doctors, patients, and social media. 2011. http://quantiamd.com/player/xsgsfqqy?cid=53. Accessed October 30, 2012.
21. Bosslet GT, Torke AM, Hickman SE, et al. The patient-doctor relationship and online social networks: results of a national survey. J Gen Intern Med. 2011;26:1168-1174.
