I’ve been busy tweeting about ‘SoMe’ (social media for the uninitiated) guidelines this weekend, eliciting thoughts and suggestions for the development of a radiography-specific set of principles to facilitate the use of SoMe in professional practice. So this blog is not concerned with the ‘hazards’ of private SoMe networking but with the application of Twitter, Facebook, Linkedin, Pinterest and/or other platforms to carry out our professional business.
Before summarising what the twitter community shared let me explain why I think radiographers should/could be using SoMe to enrich their practice and what it is that is different about communicating on SoMe that means it’s important to have some explicit reference to SoMe within our codes of professional conduct.
First, there’s professional networking for CPD, educational and development. Although a recent systematic review into the use of SoMe for professional development conducted by Lawson & Cowling (2015) found no examples from the radiography profession (they had to look to other professional groups for evidence) very recently the excellent journal club medradjclub has emerged as an opportunity for radiographers around the world to share ideas and educate one another. The Facebook group, “I’m Not A Nurse…I’m A RADIOGRAPHER!” also exists. This less formal (and more private) networking space for radiographers is a mixture of social chat but also professional information sharing.
The literature is more fruitful in terms of SoMe in formal educational contexts. For example see Alexandra Partner’s article on the Society of Radiographers news web page in 2013 ‘Social Media for Learning and Teaching – Beyond Facebook’ . I also have undergraduate students using Whatsapp to support their Problem Based Learning and these students will be presenting their experiences at UKRC this year.
However, SoMe offers us a much more exciting opportunity to engage with the wider world; not just radiographers and other health professionals but patients and service-users. This has traditionally been tricky for diagnostic radiographers, because we just don’t have the luxury of time to be able to develop a therapeutic relationship with our patients. Consequently, our communication is often rushed and too late to be truly effective. Think about it, our patients want to know what to expect before they get to us. This need has traditionally been met with leaflets and nowadays on-line videos. But these sources are unidirectional; what if patients still have questions or they don’t understand this information? SoMe gives us the opportunity finally, to engage with patients before the examination using a two-way process. If we invested some time in re-thinking our working practices SoMe could be use to dramatically change the patient and radiographer interaction.
If you need some convincing here is an example of a Facebook exchange between some women on our WOMMeN (Word of Mouth Mammogram e Network). WOMMeN is a project which brings clients of the NHS Breast Screening Service together with mammographers to discuss experiences of breast screening. The aim is to allow the woman to ask questions, share her experiences and feel she is being heard. Out of this comes a mutual understanding (between practitioner and client) of what needs to take place. Discussions are shared on the site so other women can join in and support one another too. Names in the extract have been changed for anonymity and some editing for brevity’s sake, however the discussion can be read on the open page.
Pat: Personally found it unbelievably painful and I felt quite traumatised after the procedure. It did beg the question around the risks of having the most delicate tissue in the body squashed between two plastic plates, as hard as possible? There must be a less painful, less traumatic way of breast screening….. Or is it just me that thinks this?
[others respond, feeling the same]
Pat: Phew it’s good to know I’m not alone…. Thanks M and A!
Angie (Mammographer): I am sorry to hear that you had a terrible experience, but please don’t let it put you off! As a mammographer it is upsetting to us when ladies find it so uncomfortable, but there is a fine line between a good diagnostic mammogram and an inadequate one. It would be awful if you were to be recalled and have to go through it again due to insufficient compression or blurring. Sometimes it might be due to the time of month, the way the breast was positioned or that you genuinely have very sensitive breasts. Please ensure to let the mammographer know next time you go about your previous bad experience so that may, hopefully, try it make it easier. As an aside, try to avoid caffeine or cigarettes before you go and take an analgesic! Give anything a go
Pat: That sounds like really good advice, Angie! Thankyou!
Mandy: I believe it’s a very personal and subjective experience for all of us F. and it’s really good that we’re talking about it!
Pat: Preparation and education would be really helpful…. A friendly welcome and full explanation not just a leaflet… Sometimes the Nhs forget we are people who feel and not just numbers and statistics ….. Care and compassion…. It really does help !!!
Andy: Well said P. Facebook at its best, informing and allowing an inclusive debate.
(Incidentally, we have ethics approval and patient consent to use the WOMMeN posts– supported by an excellent guideline from INVOLVE on the ways in which different types of social media are being used to involve the public in research)
So here is a great example of how SoMe is working to bring practitioners and clients/patients to a better mutual understanding. Furthermore, the demonstration of compassion and professional knowledge in this way can only raise the profile of the radiographer in the long term too. However, do the current guidelines on the use of SoMe encourage this innovative approach? Let’s return to what Twitter turned up this weekend.
Some tweeters felt there was sufficient guidance already provided in current documents such as the Radiographer’s Code of Professional Conduct (2013). Section 1 on Relationships with Patients and Carers would indeed appear to support WOMMeN’s aim to: empower patients to make decisions about their care, ensuring they have appropriate information to provide informed consent and being sensitive to the needs of vulnerable groups and those with culturally diverse needs. Making the most of on-line opportunities to have conversations with patients fulfills all these requirements. However, it also states “the use of social media such as Facebook™ or Twitter™ to publicise thoughts, actions and feelings can increase the risk of breaking patient confidentiality. You need to take extra care and act with absolute discretion at all times”. So whilst the Code does not prohibit the use of SoMe it misses a trick by failing to identify the opportunities afforded by SoMe for fulfilling the other requirements within the code.
Such encouragement is something which is evident in the Royal College of General Practitioners’ Social Media Highway Code however. Number 10 of their 10-step code is “Test out innovative ideas, learn from mistakes – and have fun!” This useful code therefore supports the vision to utilise SoMe to enrich practice.
Another tweeter provided a useful link to the SCoR. “Social media guidance for SCoR groups”. https://www.sor.org/about-radiography/media-centre/social-media-guidance-groups (You may not be able to see these unless you’re a member of the SCoR and logged in). So here are some specific SCoR guidelines on SoMe which is great however it turns out these are only aimed at SCoR groups not individuals. Furthermore, they are written in a prohibitive rather than enabling style. E.g.
You must ensure accounts using SCoR names/branding or affiliated with the SCoR do not bring the SCoR into disrepute (for example, by aggressively criticising or entering into personal arguments with individuals and/or organisations, making defamatory comments, posting or providing links to inappropriate content). (Quick aside – “whilst I’m a member of the SCoR Radiographic Informaticss group these are my own words and I am not representing the group in this blog!”)
You must not breach copyright (for example by using other people’s images/words without permission. Please note that using images found on Google can also breach copyright).
You must not post offensive or derogatory comments (including but not limited to posts about sex, gender reassignment, race, nationality, sexual orientation, age, disability, religion or belief).
The same guidance also says, “Please check your employer’s policies on social media and IT use, to ensure you are not in breach of any of their rules (especially about personal use/social media use during working hours)”. There are a couple of issues here. Firstly, this suggests that using Social Media in hours is problematic, which would not support the notion of radiographers embedding on-line patient communication as part of their daily working practice. Secondly, referring to local policies leads to non-uniform practice. For instance, the mammographers in the WOMMeN group found a range of guidance within the North West region which may result in them engaging differentially with the project.
Another Tweeter forwarded a useful link to NHS Employers Social Media Guidelines This links to guidelines from 10 professional bodies but excludes radiographers. However there is a link to the HCPC guidelines: “Focus on Standards: Social Networking Sites”. These include the statement,
“When you post information on social networking sites, think about whether it is appropriate to share that information. If the information is confidential and is about your service user, patient, client or colleague you should not put it on a site. This could include information about their personal life, health or circumstances”.
Again, this could discourage radiographers engaging in discussion with patient or clients since part of that discussion may result in patients sharing concerns and therefore disclosing personal information, albeit willingly.
So where does all this leave us? There are definitely codes of conduct which tell us how to communicate with those in our care, and the SCoR and HCPC have taken great care to protect radiographers in this regard. These codes also allude to social media. However, for the most part the tone is set so as to restrict practice rather than liberate it. In this brave new world there are amazing opportunities to change how we engage with others and present ourselves to the outside world. At the moment though, the standards, codes and guidelines do not go far enough to encourage us to take advantage of SoMe as a force for good. The exception to this is the RCGP Social Media Highway Code. We could adopt these easily for our profession but they do need to be adapted rather than adopted to ensure they capture the unique ‘relationship’ radiographers could have with their patients as facilitators of information and, in some instances, promoters of public health.