Social Media – Control & Communication in Healthcare: Notes on a lecture

Busy playing catch-up with my notes (what are train rides for?), these notes come from a lecture I gave last week were the focus was on social media use in healthcare. I was (and am) excited about this subject as it touches on several sensitive difficulties like privacy, patient security, freedom of speech, professionalism and censorship like acts.

I chose to begin in an odd place – with planking. Remember planking? Wikipedia defines it as:

“an activity consisting of lying face down in an unusual or incongruous location. Both hands must touch the sides of the body and having a photograph of the participant taken and posted on the Internet is an integral part of the game. Players compete to find the most unusual and original location in which to play. The term planking refers to mimicking a wooden plank. Rigidity of the body must be maintained to constitute good planking.”

My point in beginning at this point was to show that there are many strange fads. These fads may be seen as silly – but are they harmful? Silly may be permissible but harmful acts may need to be controlled. Naturally planking wasn’t taken totally out of the blue but the in 2009 several members of staff at a UK hospital risked being fired for planking on the job.

From this point I showed several examples of Social Media & healthcare related acts that created a point of departure for the rest of the short presentation. My point was to widen the discussion from the bad apple theory to a wider group of neglectful individuals. Take for example the situation where a hospital worker has his picture taken with an anesthetized patient and posts this to Facebook.

The first error is to think of taking the picture, the second is asking someone else to take the picture, the third is to take out the camera, the fourth is that nobody else in the room reacted, the fifth is to post the image to Facebook, the sixth is all the positive comments people left on Facebook and the seventh is all the people who silently witnessed the process.

The question I want to explore is: WTF? How is this even possible? Then I put forward three ideas. (1) The people are ignorant of their acts and their consequences, (2) the people are stupid, (3) it was all an accident or mistake.

Obviously this story has too many stages to happen accidentally or by mistake. People doing stuff like this must obviously be stupid but are they really stupid people? I don’t think stupidity really covers these acts. If you ask healthcare workers about patient security or privacy I am sure they will be able to give a long and well-discussed answer to the topic. Can it be that people are ignorant of the consequences of their acts? This seems to be too odd, even people who only have a rudimentary understanding of social media will know the effects of their acts. So what’s left?

One of the interesting things about technology is the way in which it enables us to do things which we normally cannot do. But it is also interesting that technology encourages us to do things differently. For example there seems to be a change in the way in which we react today when we witness an accident or emergency.

1. Photograph the event
2. Tweet the photo
3. Update status on Facebook
4. Call emergency services

Naturally this is apocryphal but it has a sad ring of truth about it.

To this we must add the fact that bad news travels fast and is spread widely. This means that scandals spread faster than good news. To quote Winston Churchill “A lie can travel halfway around the world before the truth can get its pants on.”

So healthcare organizations are struggling to handle the situation where people are surrounded by sensitive information that if put online spreads faster and causes great harm to the individuals and damages the reputation of the organization. To handle this many organizations are creating policies. However, many of the policies are not really paying attention to the realities of the situation they attempt to regulate.

Many policies focus on protecting the organization rather than enlightening the individuals. The goal is to minimize any damaging effects of a damaging spread of information rather than helping individuals understand what social media is and how it should or could be used.

Social media very often leads to performance lifestyle where the individual works to present him or herself in an interesting way. As most individuals have ordinary lives the challenge is to present the ordinary as something extraordinary. In many cases this results in using superlatives. In social media we don’t (for example) just drink coffee but we drink excellent or horrible coffee. As social media demands activity of its users it does not work to help us to recognize or be aware of excessive or harmful spreads of information but rather encourages us to do more.

It is important to remember that on Facebook we are not customers or clients – we are the creators of the raw material (our data).

“If you’re not paying for something, you’re not the customer; you’re the product being sold”

So the design encourages us to share, the licenses limit the responsibility of the platform (for example Facebook) and a lack of social responsibility ensures we will not be interrupted in our sharing (even of harmful information). Basically we see that we are in a situation were local laws are not in control of the infrastructure we use to communicate and therefore its efficiency is eroded.

On the topic of social responsibility it noteworthy that the founder of Facebook, Mark Zuckerberg, has been quoted saying: privacy is no longer a social norm and “A Squirrel Dying In Your Front Yard May Be More Relevant To Your Interests Right Now Than People Dying In Africa”. It is ideas like these that shape one of the greatest information infrastructures ever devised. It’s obviously not about creating a more responsible world but about a radical new transparency were corporations mine us for our data.

In the light of this we must realize and remember two things: Firstly, policies are not enough – their focus is on protecting organizations in the face of human errors. Even if “everyone” in an organization knows things are being done wrong – the moment a major error occurs the policy may be used as a defense of the organization to the detriment of the user. The secondly, in a network silence is acquiescence. In other words by allowing information to be spread without comment is the same as passive agreement to the information.

What organizations need to ensure is that there is an ongoing discussion on the role and effects of social media.

Here are the slides I used for my presentation

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