PCM Lecture 2 PDF

Level 1 - Semester 1 PCM LECTURE (2) E-PROFESSIONALISM & TELEMEDICINE DR ZIAD MAHANA  FAMILY MEDICINE Gynecology - 1 0 Tele-medicine &...

Level 1 - Semester 1 PCM LECTURE (2) E-PROFESSIONALISM & TELEMEDICINE DR ZIAD MAHANA  FAMILY MEDICINE Gynecology - 1 0 Tele-medicine & e-professionalism D EFINITION OF E- PROF ESSI ONALISM  Attitudes and behaviors reflecting traditional professionalism paradigms that are manifested through digital media (some of which may occur in private setting). The intersection between medical professionalism and social media has been termed also as online professionalism or digital professionalism. D EFINITION OF S OCIAL M EDIA  A group of online applications that allow for the creation and exchange of content generated by users.  There is a considerable growth in social media use:  In linking patients and health care professionals.  AND For communication among health care professionals.  The popularity and use of social media has increased substantially in the past few years:  Despite controversy around privacy - hacking - fake news and all other negative aspects of online life.  With a million new people worldwide coming online every day. Dr. Ziad Mahana 1  PCM LECTURE - 2 Types of social media      Collaborative Content Social networking Virtual gaming or Blogs / Microblogs projects Communities sites (SNSs) social worlds ▪ Blogger ▪ Wikipedia ▪ YouTube ▪ Facebook ▪ Second life ▪ Twitter Benefits of social media on E-Professionalism of Health Care Professionals ❶ PROFESSIONAL NETWORKING… ① Providing the opportunity for connecting with others and sharing experiences. ② Enables the creation of communities for support. ③ Enables students to help each other in:  Studying.  Interacting with faculty who can provide advice, encouragement, and virtual mentorship. ④ Provide for students, residents, and faculty a good discussion medium and an engaging way to get high-quality current information. ⑤ The speed of access to information and the ease of communication provided by social media platforms allows for: faster feedback Therefore increasing interactivity and learner engagement (as well as confidence and student satisfaction) Which in turn positively influenced learner outcomes. Dr. Ziad Mahana 2  PCM LECTURE - 2 ❷ PROFESSIONAL EDUCATION AND TRAINING… ① Use of social media for acquiring knowledge to gain access to information: o From experts with whom they otherwise would not be able to connect with. o OR for creating communities that can then be used as means for supportive, professional, and social learning. ② Use of technologies in the provision of health services improves professional knowledge. ③ Social media can be a useful tool by which physicians may promote their services. ❸ PATIENT EDUCATION AND HEALTH PROMOTION…  Using Social networking sites in health care services are suitable tools for patient education and raising public health awareness. Dangers of Social Media on E-Professionalism of Health Care Profession THERE ARE 5 RECOGNIZED DANGERS OF SOCIAL MEDIA ON E-PROFESSIONALISM OF HCPS ❶ LOOSENING ACCOUNTABILITY…  Loosening accountability can be seen as a danger to e-professionalism due to: ① Eroding public trust by providing poor quality of information on social media. ② Damaging to the professional image  Potential damage to the professional image has been depicted by students as concerns about repercussions of their posts on career development or future employment  Since employers are checking social media profiles of candidates. ❷ COMPROMISING CONFIDENTIALITY…  Being both an ethical and potentially legal issue.  Taking pictures - recording video & audio clips of patients & of clinical interactions involving patients, & posting this information on social media looking for a higher level of self-esteem, a greater number of Facebook friends, and a higher frequency of signing into Facebook is considered a breach of confidentiality. Dr. Ziad Mahana 3  PCM LECTURE - 2 ❸ BLURRED PROFESSIONAL BOUNDARIES…  Blurred boundaries between professional and personal spheres of social media use with concerns about exposure of one’s private life or separating private and professional.  DEPICTION OF UNPROFESSIONAL BEHAVIOR…  Most frequently associated it with online content pertaining to o Alcohol intoxication; substance or illegal drug use. o Nudity, and sexuality. o Demeaning content about patients, peers, educators, clinical sites, or the profession as a whole. o Discriminatory Content. o Profanity - aggressive/bullying content toward coworkers.  Posting pictures from holidays, moments in nightclubs, and photographs wearing swimwear or underwear have been reported.  Alcohol consumption and smoking were also published.  LEGAL ISSUES…  Unprofessional behavior on social media of health care professionals can have legal consequences, potentially affecting credibility and licensure.  A controversy has been raised of whether medical regulatory bodies should monitor the social media activities of health care professionals. Barriers to using social media for Health Care Professionals ❶ LACK OF : ① Time or time constraint. ② Knowledge or technical skills. ③ Previous education. ④ Supportive institutional social media policies - ignorance to existing social media policies.  PROBLEM DEVELOPING AND SUSTAINING MUTUAL TRUST ON SOCIAL MEDIA. Dr. Ziad Mahana 4  PCM LECTURE - 2 D EFINITION OF T ELEMEDICINE  Practicing medicine over a distance… in which diagnoses and subsequent treatment recommendations are based on patient data, documents and other information transmitted through telecommunication systems or video-conferencing tools. TELEMEDICINE TELEHEALTH  Can refer to remote non-clinical services, as: 1) Tele-training. Refers specifically to remote clinical services 2) Tele-education. 3) Tele- monitoring. 4) Tele-support. BENEFITS OF TELE-MEDICINE TO HEALTHCARE PROFESSIONALS PATIENTS ❶ Improved diagnosis and better treatment ❶ Early diagnosis and treatment. strategies. ❷ Early detection of disease. ❷ Continued education and training. ❸ Access to expertise of medical specialists ❸ Quick and timely follow up of discharged ❹ Access to specialized health care services to patients. under- served rural and remote areas. ❹ Access to computerized comprehensive ❺ Reduced travel expenses. data of patients, both offline and Realtime. ❻ Reduced visits to specialty hospital. ❼ Reduced burden of morbidity. Dr. Ziad Mahana 5  PCM LECTURE - 2 Types of Telemedicine Types of Telemedicine is classified according to: ❶ According to timing of information transmitted  Interactive services (videoconferencing) can provide immediate advice to patients who require medical attention. REAL-TIME  A medical history and consultation about presenting symptoms can be (TWO-WAY) ❶ INTERACTIVE undertaken, followed by assessment like those usually conducted in SERVICES face-to-face appointments.  Tele neuropsychology is an example of this type. STORE AND FORWARD REMOTE MONITORING (SELF-MONITORING OR SELF-TESTING)  Surpasses the need for the  Uses a range of technological medical practitioner to meet in devices to monitor health and person with a patient. clinical signs of a patient remotely.  Instead… data such as medical images or bio signals can be sent to the specialist as needed ASYNCHRONOUS when it has been acquired from EXCHANGE OF ❷ RELEVANT the patient. INFORMATION COMMONLY USED IN  This practice is common in the  This is extensively used in the medical fields of: management of chronic ▪ Radiology. diseases such as: ▪ Pathology. ▪ Cardiovascular disease. ▪ Dermatology. ▪ Diabetes mellitus. ▪ Asthma. Dr. Ziad Mahana 6  PCM LECTURE - 2 ❷ According to the Mode of Communication ❶ VIDEO  Telemedicine facility - Apps - Video on chat platforms. ❷ AUDIO  Phone. TELEMEDICINE CHAT-BASED ▪ Specialized telemedicine smartphone Apps, ❸ TEXT BASED APPLICATIONS Websites, other internet-based systems etc. ASYNCHRONOUS ▪ Email/ Fax etc. ❸ According to the purpose of the consultation FOR NON-EMERGENCY CONSULT EMERGENCY CONSULT  FIRST CONSULT for diagnosis/treatment/health  Telemedicine consultation should be education/ counselling: limited to:  Either first contact between physician and ▪ First aid. patient. ▪ Life-saving measure.  OR The patient consulted the physician ▪ Counselling and advice on referral. previously, but more than 6 months have lapsed since the previous consultation.  FOLLOW-UP CONSULT:  Patients may use this service for follow up consultation on his ongoing treatment with the same physician who prescribed the treatment in an earlier in- person consult. ❹ According to the individuals involved ① Patient to physician. ② Caregiver to physician. ③ Physician to physician. ④ Health worker to physician. Dr. Ziad Mahana 7  PCM LECTURE - 2 ⎚ Telemedicine should be employed primarily in situations in which a physician cannot be ❶ physically present within a safe and acceptable time period. ⎚ The patient-physician relationship must be based on mutual trust and respect… ❷  It is therefore essential that the physician and patient be able to identify each other reliably when telemedicine is employed. ❸ ⎚ An informed consent must be obtained from the patient. ⎚ The physician must aim to ensure that patient confidentiality, privacy, and dataintegrity are not compromised.  Data obtained during a telemedicine consultation must be secured to prevent ❹ unauthorized access.  Electronic transmission of information must also be safeguarded against unauthorized access. ❺ ⎚ The physician must ensure that the patient has understood the advice and treatment. ⎚ A physician should not violate the local rules and regulations set by the local health ❻ institution when participating in telemedicine service. Dr. Ziad Mahana 8  PCM LECTURE - 2  Face to face consultation is preferred over telemedicine in the following conditions: ① High risk patient with complex presentations. ② Do not have access to the patient`s medical records. ③ You need to examine the patient. ④ Unsure about the mental capacity of the patient ⑤ You are prescribing high risk drugs. ❶ Patient`s fear and unfamiliarity. ❷ Financial unavailability. ❸ Literacy rate and diversity in languages. ❹ Government support. ❺ Perspective of medical practitioners. ❻ Lack of basic amenities. Elements to be considered before any telemedicine consultation ❶ Identification of Physician and Patient. ❷ Mode of Communication. ❸ Consent. ❹ Patient Evaluation. ❺ Patient Management. Dr. Ziad Mahana 9  PCM LECTURE - 2 ❶ Identification of Physician and Patient 1) Patient identification by: Name - age - address - email ID - phone number - registered ID or any other identification. 2) A physician should begin the consultation by informing the patient about his/her name and qualification. ❷ Mode of communication ❶ Text. ❷ Audio. ❸ Video : skin - eye or tongue examination. ❸ Patient consent  An Explicit patient consent is needed. ❹ Exchange of information for patient evaluation 1) Gather patient information required to be able to exercise proper clinical judgement as: ▪ History - examination findings - Investigation reports - past records. 2) Telemedicine has its own set of limitations for adequate examination…  If a physical examination is critical information for consultation, physician should not proceed until a physical examination can be arranged through an in-person consult.  Wherever necessary, he/she shall recommend: ▪ Video consultation. ▪ Examination by another physician. ▪ In-person consultation. ❺ Patient Education and management 1) Provide appropriate health education. 2) Prescribe medications. ❻ Write and Communicate prescription  How you well tell your patient about the therapy? Dr. Ziad Mahana 10