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Some thoughts on GMC social media guidance

On the 25th March – approximately a lifetime ago in internet terms – the GMC published guidelines for doctors’ use of social media. The guidelines come into effect later this month.

Publication of the guidelines caused something of a social media uproar, particularly around the anonymity clause. The brilliant Anne Marie Cunningham, who has written and spoken a lot about social media in medicine, has hosted a particularly fascinating conversation about this on her blog, with well made points on both sides.

With all the high-quality discussion and carefully thought-through points flying back and forth, I’ve taken a back seat on this one. I’m not sure that I have all that much that’s new to add, and I don’t blog all that much about medical matters any more. But a nagging feeling in the back of my head says that this is exactly the sort of debate I would once have jumped into with both feet, and the focus hasn’t been on the part of the guidelines to which I most object. So here goes.

In all guidelines, I’ve always been lead to believe that definitions are crucial. For a guideline to be effective, let alone for it to be enforced, it must be clear what it covers. And yet, the GMC’s definition of social media is absurdly wide:

Social media describes web-based applications that allow people to create and exchange content.

Later in the guidelines, it is clarified that this definition includes non-public, professional social networks too. As I’ve discussed this issue with tech friends and colleagues over the last couple of weeks, this definition has caused several to – literally – laugh out loud.

It, of course, includes all manner of things that are not social media, and essentially describes any form of cloud-based application. If we interpret this guidance as written, then from 22nd April patient-identifiable information can no longer be uploaded to web-based GP note systems, or to HPZone used by Public Health England to track outbreaks, or indeed transferred via NHSMail, the restricted-level security email system designed exactly for that purpose. Use of Choose and Book will be against the GMC’s rules. All of these are online applications which allow people to create and share content. All are clearly not supposed to be covered by this guidance.

It can be argued that even if the definition as written is unclear, it is perfectly clear to most people what it is supposed to refer to. I don’t buy that, for two reasons. Firstly, what’s the point in publishing the guidance at all if we aren’t to interpret it as written? Some might say that the definition has to be broad in a fast-moving environment, and that the guidance would quickly be outdated if it were too pinned down.

Which brings me to my second problem: you may understand it, but I don’t. I actually don’t know whether this guidance applies in edge cases. Office 365 and Google Drive are both web-based applications which allow the creation and exchange of content. Applications like these are almost certain to replace locally hosted applications like the Word and Excel of today within this decade. Indeed, some organisations have already made the switch.

Is use of these outlawed by the guidance? I can see arguments why it, perhaps, should be. There are inherent risks about patient confidentiality in these systems. But to ban their use for patient identifiable information is a big statement, and I suspect that they didn’t actually mean it. But I’m far from certain.

To me, the nub of the problem here is that this is guidance on using a particular medium – and one that is ill-defined, at that. Publication might feel relevant now, and everyone from the BMA to the RCGP is helping people to understand how to use this medium safely. But I don’t think this is the place of a regulator. I’m acutely aware that others will strongly disagree with this position.

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.

This 2,007th post was filed under: Health, News and Comment, Technology, .

Auditing emails

A couple of years ago, I was asked by one of the organisations I work with to do an “email audit” – “audit” in the accounting rather than quality sense – looking at how many emails I receive, and what I do with them. That specific project was trying derive what aspects of an email could be tweaked to encourage action, but I found it a useful experience to work out how efficiently I used email.

Every now and again I repeat the process, looking at the emails I receive in a typical week and what I do with them. Sometimes, this spurs action: unsubscribing from newsletters I never read, for example, or resolving to check email less frequently. Since I’ve just done one of these, from 22nd – 28th September, I thought that it might be interesting to share the results on here. I’ve really no idea where I sit in the continuum email recipients in a job like mine, and maybe this will encourage people to share.

So, some figures: over the week in question, which I’ve no reason to suspect was atypical, I received 1,010 emails across all my accounts. I haven’t included anything that my email providers marked as spam. These divided roughly 60% were personal – as in, not related to my main job in Public Health. That’s probably an overestimate, because I wasn’t very good at classifying emails, and tried to err consistently on the side of calling things “personal” rather than “work”.

I divided my actions into three mutually exclusive categories:

  1. Deleted without reading – These were emails that I either didn’t open (if using Gmail), or that I deleted at a glance if they happened to be opened in Outlook’s preview pane.
  2. Read – These were emails that I read and then deleted or archived. This category covers a multitude of sins, from those emails that I read and realised were nonsense, to those that I read closely as they included important information, but were ultimately not “actionable”.
  3. Read and acted – There were emails that I read and acted upon. Again, this covers a wide gamut of stuff, including emails in which I simply clicked on a link, emails I replied to, and emails which kicked off whole streams of work.

This pie chart shows how the proportions stacked up:

These varied slightly by the type of email: I read about 10% more of my work email than my personal email, but acted on 2% more personal mail. All told, I deleted about 62% of my work email and 69% of my personal email without reading it. Which is, I think, an appropriate response to receiving 1,010 emails.

So what does all of this mean? I’ve no idea. I don’t even know whether it means that email is a horrendously inefficient or wonderfully efficient communication method. With email, I can cut through ~65% of the things that don’t interest me in virtually no time; if these were letters or phone calls, I’d have no time to do any work. But, on the other hand, if email were unavailable, how many of these messages would ever bother transforming themselves into other media? Do I just get a load of emails because sending an email is relatively “costless” in terms of money, time, and energy? I certainly don’t feel like I’m drowning in email, and was a little surprised that the totals were so high – about 25% higher than the previous times I’ve done this. Having said that, I have come to rely on Gmail’s “Priority Inbox” feature more than I ever thought I would.

Compared with the first time I did this exercise, the proportion of emails that I’ve deleted without reading has fallen considerably. I don’t remember the exact figures, but they were somewhere near 80%. That shows the effect of the remedial action I’ve taken, I suppose.

Anyway, I’ve no idea if this is of interest to anyone, but I find it a useful exercise, and wonder if you might too? Feel free to comment if you’ve any thoughts to contribute!

This 1,830th post was filed under: Technology, , .

Photo-a-day 258: Ceefax

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Tyne Tees is one of the few areas of the UK where Ceefax is still available… but not for much longer! In 12 days, this region will complete digital switchover and we’ll lose Ceefax forever.

The degree to which this really doesn’t matter to me personally is exemplified by the fact that it’s taken me about 10 minutes to work out how to get it on my current TV…! But I used to use it quite a lot, so I feel a little bit sad to know that it will no longer be there!

This 1,808th post was filed under: Media, Photo-a-day 2012, Technology.

Fundamentally changing what it means to go on holiday

It fundamentally changes what it means to go on holiday.

It seems it’s a day for hilarious quotes today: following on from this that I spotted a couple of hours ago, this ludicrous bit of hyperbole from Daniel Danker also made me laugh out loud. If, for you, being able to download BBC TV programmes to your iPhone or iPad genuinely changes what it means to go on holiday… well, I doubt we’d get on very well.

This 1,792nd post was filed under: Diary Style Notes, Quotes, Technology.

Review: Alan Turing: The Enigma by Andrew Hodges

Alan Turing is a fascinating subject for a biography: A leader in the fields of logical mathematics and computing, a war hero of a very different kind, and a social misfit. There’s so much to explore, and so much to learn. Yet, before turning to this definitive volume, I hadn’t read a proper biography of the man – although given the size of his standing in our cultural, intellectual and scientific past, I had a fairly good knowledge of many of the key moments in his story.

This comprehensive biography is certainly detailed. It is, perhaps, the most thorough biography I’ve read. This allows a great insight into the character and intelligence of Turing, but it did quickly become unnecessarily dense in parts, and felt like it was veering off at a tangent by placing Turing’s academic work in a wider context than was really necessary. I don’t think the book needed to explain some of the mathematical concepts in quite the detail it did, nor did it need to explain in fine detail the sequelae of those concepts as discovered by others.

I was also a little uncomfortable with the degree of subjectiveness in this description of his life. Clearly, it is impossible for any biography to be written from a totally objective stand-point, but it is clear that Hodges stands in awe of Turing, and constantly tries to explain and justify anything that could be seen as a fault in him. There were times when motives and opinions seemed to have been assigned to Turing’s actions without a clear explanation given as to how Hodges had derived these, which made me question their veracity. I’m also awed of Turing and think he’s a giant of our age, but even I found the warmth, bordering on sycophancy, of this book a little overbearing. I think the point would have actually been made more strongly had the reader been left to draw their own conclusions from a more objective description of the events.

I was disappointed with some of the omissions of this book. Turing was clearly a man with a strong sense of morality and ethics, and yet cryptography – perhaps his best-known skill – has inherent within it the ethical complexity of choosing when to act on intelligence, and when to ignore it and effectively sacrifice people in order to maintain the illusion that the code has not been broken. This, to me, is one of the most profoundly interesting parts of the work completed at Bletchley, and of cryptography, yet this is given relatively short shrift in this biography. I feel sure that Turing would have reflected on this point, and probably had interesting things to say about it, so it seems a shame that they aren’t discussed here. Perhaps this reflects a wider criticism of the book – it’s difficult at times to pick out Turing’s character amongst the reams of detailed mathematical and computational theory. That said, I think the story and an impression of the character of Turing does manage to shine through over the course of the book as a whole, even if it is hard-going in parts.

It’s really difficult to give this book a star-rating, because there are passages of five-star descriptive biographical brilliance, and passages of five-star mathematical or computational explanation, but the two cannot really happily co-exist in one volume. For a general reader like me, it leads to passages of tedium; the opposite passages would probably have the same effect for someone reading for the theory.

My head says, therefore, that this is a three-star read; but my heart, perhaps more because of the piquancy of the tale, says it’s a four-star read. So I’ll give it the benefit of the doubt.

Alan Turing: The Enigma is available now from amazon.co.uk in paperback, and also a special Centenary edition. There’s no Kindle edition available, which may well have frustrated Alan if he were alive today, and is really inexcusable when a new edition has only just been published.

This 1,783rd post was filed under: Book Reviews, Technology, , .

Desktop app of the week: ScanDrop

ScanDrop icon

I’ve mentioned on here previously that I’m a massive fan of Evernote, and ScanDrop is the main method by which I get paper stuff into my Evernote account. It’s another program which is brilliant for the fact that it just works. It scans and uploads directly to Evernote. I can specify which notebook I want the resulting note to appear in; I can tag them appropriately; I can even use the software to upload to other cloud services, or just save to my desktop.

ScanDrop doesn’t do anything that I can’t do manually. I could use my scanner’s proprietary software, or even OSX’s Image Capture, and then upload manually. But ScanDrop is an all-in-one solution that just makes life easier.

ScanDrop has a free version available, and works on Windows or Mac. Give it a go!

This 1,727th post was filed under: Favourite desktop apps, Technology, , , , .

Last in the “Mac apps” series; book reviews start next week

A little later this morning, I’ll be publishing the tenth and final review in a successful series of posts about my favourite Mac apps.

From next week, Wednesday mornings will feature book reviews: some original, some I’ve published elsewhere, and some a combination of the two. This series will continue pretty much indefinitely (read: until I get bored of it). I’ve even created a brand new skeuomorphic post template for this series, so you won’t want to miss that!

This 1,726th post was filed under: Diary Style Notes, Favourite desktop apps, Site Updates, Technology.

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