Medical studentsand Facebook:

threatened professionalism?

Introdução à Medicina IIAno lectivo 2011/2012Turma 17

Professor regente: Altamiro Costa PereiraProfessora supervisora: Cristina da Costa Santos 1

Introduction• One-on-one contact virtual contact.(1)

Is being replaced by

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• Medical students’ social networks overuse may lead to consequences(3);

MEDICAL

PRINCIPLES

Principles of agood medical practice (4)

1. Primacy welfare;

2. Patient autonomy;

3. Social justice.

3

Studies

4

Online information shows lack of professionalism: (5)

Photos of behaviors that are

not morally correct;

Discussion of clinical cases

between medical

students;

Offensive

language;

Racism statements;

Sexism comments.

Irresponsible postings on

social networks

physician-patient relation

may affect

Disrespect patients;Lead the profession into disrepute;Diminish confidence in the doctor;Expose patients’ personal lives;Influence a doctor’s career;Lead to a health student dismiss;Result in denial for a job applicant(6).

Ethical Issues

5

StudiesConclusions: (5)

The use of social networks is more frequent amongst medical students than it is on residents;

The majority keep their profiles widely open to the general public.

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“Although the sample size of the study is small, the findings are certainly interesting enough to

warrant further investigation.”(3)

Studies

7

What is potential patients’ and medical students’opinion about the influence of

Facebook on medical professionalism and if there are valid reasons to think that

medical professionalism is threatened?

Research Question

8

Main Objective

To evidence the opinion of potential patients

and medical students about the influence of the

use of Facebook amongst health care

professionals and students on medical

professionalism through concrete questions

based on the Portuguese Constitution

To evaluate their knowledge of laws in this

issue.9

Objectives To study if the patients had knowledge of cases of

disclosure of personal information by doctors on

Facebook;

To compare the opinions of the two populations in

study and evidence their similarities and differences;

To evaluate the possible positive and/or negative

aspects of Facebook’s utilization on medicine students’

academic itinerary.

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Methods

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Target-populations• Medical students of the “Faculdade de

Medicina da Universidade do Porto”;

• General population.

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Sampling Process

• Medical Students: Selection of students of 2nd and 5th

years of college, who filled our questionnaire.

Stratified Sampling Process Questionnaire

13

Sampling Process• General population

Delivery of 40 questionnaires to different people of “Hospital S. João” who are not busy and sick (in different places at different times and dates)

Stratified Sampling

Questionnaire14

Study Design

• Application of a questionnaire to two population samples.

15

Several common groups of questions

A specific group of questions

Variables of Study

The opinions of the two target populations about the role of Facebook on Medical Professionalism;

Their knowledge about the Portuguese Laws that are related to professionalism on the health care services.

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Outcome variable: if there are motives to be concerned about the effects of overuse of Facebook by medical students and young doctors on medical professionalism.

Limits of Our Conclusions

×Geographically limited space;

×Other people’s opinions could differ of those opinions on which our conclusions will be based on, (differences on cultural and social status);

×Our sample contains some biases of selection;

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Statistical Analysis• For the closed item

questions, the chi-square test was used when the expected values lower than 5 for cells were less than 20%. When that did not happen, to analyze the relation between two categorical variables, Fisher's Exact Test was performed, considering the answers "I do not know" as Missing Values .

• For the scaled item questions, median and range were used as description measures because the sample did not follow a normal distribution. For comparisons, it was used Mann-Whitney test.

• .

Comparison between sexes

• For the closed item questions, it was used the chi-square when we could.

• For the scaled item questions was also used median and range as descriptive measures. Kruskal-Wallis test was used to compare the values obtained in the three groups.

• .

Comparison between groups

SPSS19 for Windows

package was used for statiscal analysis

Significance level of 0.05 was used for all

tests.18

Medical Students

98% of the females and 100% of males

know and use Facebook.

Both male (87%) and female

(93%)frequently use Facebook to talk with friends, watch photos

and comment/see profiles.

Male subjects use Facebook more often

than female ones.

General Population

The same number of men and women

knows Facebook but females (61%) use it

more than males (56%).

The highlight is the use of Facebook to talk with friends on

both male and female inquired.

Male subjects use Facebook more often

than female ones.

Comparison Between SexesGroup 1 – Facebook Use

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In this group of questions, question

1.3.2. was the only one where we found

significant similarities between females (77%)

and males (73%)

Meanwhile, some women revealed that they had knowledge of cases of

clinical cases published on Facebook by doctors.

Medical Students

Both genders in general think that a certain doctor shouldn’t be punished just

for exposing a written clinical case

None of the inquired, both male and female, had knowledge of clinical

cases posted on Facebook.

General Population

Comparison Between SexesGroup 2 – Ethical Issues

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Comparison Between SexesGroup 3 – Other Important Questions

•Both male and females strongly thought (80% on males and 83% on women) that it is correct for a doctor to render health services on his/her Facebook page.

Medical Students

•There weren’t any particularly signifcant differences between answers of both genders

•Menwhile, men think religious feelings revealed by a doctor can influence physician-patient relationship more than women do.

•On the other hand, female medianly think that sexual tendicies revealed by a doctor on Facebook can influence physician-patient relationship more than men.

General Population

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Comparison Between SexesGroup 4 – Specific Question

Yes Don't Know0

10

20

30

40

50

60

70

80

90

100

Facebook is an instrument that promotes my academic success.

Male

Female

Yes Don't Know0

10

20

30

40

50

60

70

80

90

100

I would consent a clinical case of mine to be posted on Facebook so it could be discussed by health care

professionals.

MaleFemale

Valid %

Valid %

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Comparison Between Sexes

Other Conclusions There were not many significant discrepancies between

genders on the answers to the questions of our questionnaire. This may imply that the gender variable was not preponderant between the study groups which may somehow turn the following part of our study more reproducible on this population.

= Moreover, from our study results the conclusion that the use of

Facebook is somehow shallow to medical students due to the answers given by them to their questionnaire’s specific question.

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Comparison Between Groups

Yes0

10

20

30

40

50

60

70

80

90

100

I use Facebook.

Medical Students

General Population

Valid %

Conclusions:

The majority of people of the 2 groups knows Facebook , but medical students use it more than general population;

The frequency of use in a week is higher on general population than it is on medical students.

Group 1 – Facebook Use

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Comparison Between Groups

Yes Don't Know0

10

20

30

40

50

60

70

80

90

100

The doctor should be prosecuted for disclosing pictures without the patient

showing his/her face on Facebook.

Medical Students

General Population

Valid %

Can Should0

10

20

30

40

50

60

70

80

90

100

Can/should a doctor be punished by law if he/she publishes a

clinical case only using writting?

Medical StudentsGeneral Popula-tion

Valid %

"Patient consent, or if this is impeded, legal representative consent when the revelation does not harm third parties with interest in maintaining medical

confidentiality“.

~from Article 88 of Portuguese Medical Association Code of Ethics

"Confidentiality covers all facts of which the physician has become aware while exercising his professional duty or as a result of it and includes particularly: a) Facts revealed directly by a person, by

another at his request or by a third party with whom he had contact during provision

of care or as a result of it.” from Article 86 of Portuguese Medical Association Code of Ethics

Group 2 – Ethical Issues

25

0

10

20

30

40

50

60

70

80

90

100

The disclosure of pictures makes the attitude of the doctor ethically worse

than if the case was expressed only by write.

Medical Students

General Population

Valid %

Comparison Between GroupsGroup 2 – Ethical Issues

"Patient consent, or if this is impeded, legal representative consent

when the revelation does not harm third parties with interest in

maintaining medical confidentiality“.

~from Article 88 of Portuguese Medical Association Code of Ethics

"Confidentiality covers all facts of which the physician has become aware while exercising his professional duty or as a result of it and includes particularly: a) Facts revealed directly by a person, by

another at his request or by a third party with whom he had contact during

provision of care or as a result of it.”

from Article 86 of Portuguese Medical Association Code of Ethics

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Yes Don't Know0

10

20

30

40

50

60

70

80

90

100

The doctor should disclose information about a case of

domestic violence to the respective authorities.

Medical Students

General Population

Valid %

Yes Don't Know0

10

20

30

40

50

60

70

80

90

100

This doctor should be prosecuted for disclosing that

information.

Medical Students

General Population

Valid %

Comparison Between Groups

“If it is absolutely necessary to the defense of the physician’s or the patient’s dignity, honour and legitimate interests, the physician shall not in any of these cases reveal more than is necessary nor

without prior authorisation from the Medical Association." from Article 88 of Portuguese Medical Association Code of Ethics)

Group 2 – Ethical Issues

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Comparison Between Groups

Yes Don't Know0

10

20

30

40

50

60

70

80

90

100

The doctor should tell his best friend that his wife is secretly using contraceptive methods while the couple was trying to

have a baby.

Medical StudentsGeneral Popula-tion

Valid %

"Confidentiality covers all facts of which the physician has become aware while exercising his professional duty or as a result of it and

includes particularly: a) Facts revealed directly by a person, by

another at his request or by a third party with whom he had contact during provision of care

or as a result of it;b) Facts appreciated by the physician,

stemming or not from clinical observation of the person or third parties;

c) Factors stemming from knowledge of patient’s ancillary diagnostic exams and

treatment;d) Facts communicated by another physician or health professional sworn to confidentiality on

them.“

from Article 86 of Portuguese Medical Association Code of Ethics

Group 2 – Ethical Issues

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Yes Don't Know0

10

20

30

40

50

60

70

80

90

100

The Portuguese Constitution allows the creation of those groups on Facebook

(exclusive for doctors).

Medical Students

General Population

Valid %

The percentage of people who doesn't know the Portuguese Constitution is very high and common on the study groups.

"A informação de saúde só pode ser utilizada

pelo sistema de saúde(…)“

fromArtigo 4 - DIÁRIO DA REPÚBLICA—I SÉRIE-A Nº 18—26 de Janeiro de 2005 Lei Nº 12/2005 de 26 de

Janeiro

Comparison Between GroupsGroup 3 – Other Important Questions

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Comparison Between Groups

Median and Range0

2

4

6

8

10

12

14

Degree of agreement on the sentence: "Doctors are very

influenced by Facebook".

Medical StudentsGeneral Popula-tion

Median and Range0

2

4

6

8

10

12

14

16

Degree of influence that sexual tendencies revealed by doctors on Facebook have on the physician-

patient relationship.

Medical StudentsGeneral Population

Globally, both study groups had the same opinion on this question sexual tendencies

revealed by a doctor on Facebook has impact on the relation physician-patient.

Group 3 – Other Important Questions

Generally, General Population thinks that doctors are influenced by Facebook more than Students

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Comparison Between Groups

Yes Don't Know0

10

20

30

40

50

60

70

80

90

100

It's correct for a doctor to render health services to a patient that has

access to his/her Facebook page.

Medical Students

General Popu-lation

Group 3 – Other Important Questions

Valid %

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Conclusions:

Both sample groups think that it is correct for a doctor to render health services to a patient that has access to his or her Facebook page (82% of medical students and 72% of general population) when, by law, it should be impossible to a physician to do so.

Comparison Between GroupsGroup 3 – Other Important Questions

Median and Range0

1

2

3

4

5

6

7

8

Degree of agreement on the sentence: "Health Care

Professionalism is being threatened by the use of social networks as

Facebook".

Medical StudentsGeneral Population

The most important question of our questionnaire revealed that

generally, people think Medical

Profissionalism is moderately

threatened by Facebook.

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Conclusion Despite incomplete, our study accomplished all

his objectives:

The main objective was almost completely fullfiled:

We evidenced the opinion of the two target populations about the influence of Facebook on Medical Professionalism amongst doctors and medical students with the application of the questionnaire.

The statistical analysis of the questionnaires revealed that Medical Professionalism is moderately threatened by the overuse of Facebook. This means, responsable entities must be prepared and prevent future negative events and install Facebook optimally amongst Medicine or separate them eficiently.

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Conclusion

Our secondary objectives were completely fullfiled:

• People of the two target populations revealed not to have knowledge of disclosure of information by doctors on Facebook

• We successfully compared the opinions of the 2 already studied target populations and presented those comparations througout the presentation.

• The majority of medical students didn’t find Facebook to be of any use to promote their academic success, but those who did find it useful, used it to discuss academic affairs with their colleagues.

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In the Future…

Facebook, a company that captivate and worth millions and millions, should always be treated carefully when it is mixed with such delicate area as Medicine is..

The conclusions of our study, despite limited geographically, may have the power to stimulate other higher researchers to study this complex theme and come up with new ideas and conclusions that complement ours thus helping to give a more solid view of this emergent reality and, if necessary, present some solutions.

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