Ayer asistí a la jornada sobre web 2.0 organizada por el Parc Sanitari Pere Virgili. Surgieron temas interesantes, como en otras ocasiones, relacionados con la utilización de las redes sociales con fines sanitarios. Uno de las cuestiones que surgió en diversas ocasiones, fue cómo debe el profesional compaginar su actividad institucional y la personal con su identidad digital.
Una de las cuestiones planteadas por uno de los asistentes me pareció de gran interés, al respecto de que si un médico manifiesta por ejemplo su oposición a la utilización de ciertas vacunas en su blog personal, la institución para la que trabaja debería tomar o no alguna medida. Se comentó que si se trataba de un blog personal podía opinar libremente sobre dicho tema.
Creo que la respuesta no es tan sencilla. Es cierto que las redes sociales nos permiten opinar libremente de los temas que nos preocupan o manifestar el apoyo o el rechazo a una determinada acción, hecho u opinión. Sin embargo, en el caso planteado (y en otros muchos), sobre el que quizás me siento especialmente vinculado por mi actividad en diversos grupos de trabajo sobre vacunas, creo que debe hacerse una reflexión más profunda al respecto. Aunque se trataría de una opinón personal vertida por un médico en su blog, es fácil pensar que pacientes y la propia institución a la que trabaja puedan leer dicha información y de ahí que surjan algunas preguntas:
¿Cómo puede explicar a sus pacientes que debe vacunarlos si opina de forma diferente tal como ha manifestado? ¿no creará confusión entre los usuarios y pacientes y desconfianza no sólo en el propio médico, sino en la institución a la que representa?
La institución en la que trabaja, ¿cómo debe interpretar dicha opinión con respecto al ámbito del trabajo que dicho médico puede estar desarrollando en la misma? ¿no puede dudar acaso del tipo de atención que está dando en sus consultas?
Está claro que las consecuencias (positivas o negativas) de "opinar" en las redes sociales (blogs, Facebook, Twitter, etc.) sobre un tema de salud relacionado directamente con nuestro trabajo, afectará la relación con los pacientes que atendamos, con la propia institución en la que trabajamos e incluso en este caso, en la propia forma de entender la prevención en salud en el que basa la aplicación de las vacunas.
Podemos imgaginar mil situaciones similares, entonces ¿hasta dónde podemos o debemos llegar con nuestras opiniones?
Friday 11 November 2011
Tuesday 11 October 2011
Social Networks and Medical Doctors and Students
In recent years social media has grown exponentially and there has been widespread use, amongst medical doctors and students, of platforms such as Twitter and Facebook. Several studies show that the use of social media by the medical profession is common and growing exponentially. Also, Internet forums and blogs are usual resources of medical information and participation. At the same time, there are intense debates about the complexities of ensuring medical professionalism in the digital age and there is little consensus among doctors on how interactions on these networks should be managed.
With all this in mind, Web Mèdica Acreditada (WMA) recently carried out a study trying to identify relevant guidelines and recommendations, in English and Spanish. First, we made a simple search in Google using diverse queries and their combination. Second, sixteen documents were selected based on their relevance and their content was analyzed comparing the statements and items in order to find agreements and differences. There are several professional organizations that have proposed some practical recommendations to guide doctors and medical students in using social media. This study was accepted in the 4th ICST International Conference on eHealth that will take place in Malaga (Spain) next 21-23 November 2011, where we will present it.
The main conclusions were the following: 1. There is a general consensus about the key role that medical doctors have in social networks. 2. Potential negative and positive consequences (professional, personal and in medical profession) are considered depending on their behaviour in these environments. 3. A Guidance of useful practices was proposed (see the presentation, slides 7 to 16):
With all this in mind, Web Mèdica Acreditada (WMA) recently carried out a study trying to identify relevant guidelines and recommendations, in English and Spanish. First, we made a simple search in Google using diverse queries and their combination. Second, sixteen documents were selected based on their relevance and their content was analyzed comparing the statements and items in order to find agreements and differences. There are several professional organizations that have proposed some practical recommendations to guide doctors and medical students in using social media. This study was accepted in the 4th ICST International Conference on eHealth that will take place in Malaga (Spain) next 21-23 November 2011, where we will present it.
The main conclusions were the following: 1. There is a general consensus about the key role that medical doctors have in social networks. 2. Potential negative and positive consequences (professional, personal and in medical profession) are considered depending on their behaviour in these environments. 3. A Guidance of useful practices was proposed (see the presentation, slides 7 to 16):
Friday 23 September 2011
Is Wikipedia reliable when talking about health information?
According to a recent study that was published in the Journal of Oncology Practice last week (the 15th September released online in advance), the information about cancer in Wikipedia is, in general, reliable but it was difficult to understand in terms of readability (Wikipedia is written at a college level with complex information and hyperlinks that hinder its understanding).
I would like to mention that last year we also carried out a study of the information in Wikipedia about vaccines, that we presented in the European Family Medicine Conference (WONCA, Málaga, October 2010). In that study we found out that the articles in Wikipedia about vaccines were quite good but at the same time, there was a lack of information about the authors' profile of the articles (in very few cases was the author a health professional) and there were no clues to determine the country or scenario of the immunization schedules of vaccines recommended. This last point is a very important matter because each country has different schedules (there are countries such as Spain with several schedules depending on the region where the vaccine has to be applied) and therefore the recommendations may change a lot depending on where we are.
I think that we need more studies to determine the real usefulness and applications of Wikipedia as a source of health information, for instance thinking of educational and Public Health purposes. Finally, it is very interesting to know that there are several health initiatives to promote the improvement of the medical information in Wikipedia such as Wikiproject Medicine.
I would like to mention that last year we also carried out a study of the information in Wikipedia about vaccines, that we presented in the European Family Medicine Conference (WONCA, Málaga, October 2010). In that study we found out that the articles in Wikipedia about vaccines were quite good but at the same time, there was a lack of information about the authors' profile of the articles (in very few cases was the author a health professional) and there were no clues to determine the country or scenario of the immunization schedules of vaccines recommended. This last point is a very important matter because each country has different schedules (there are countries such as Spain with several schedules depending on the region where the vaccine has to be applied) and therefore the recommendations may change a lot depending on where we are.
I think that we need more studies to determine the real usefulness and applications of Wikipedia as a source of health information, for instance thinking of educational and Public Health purposes. Finally, it is very interesting to know that there are several health initiatives to promote the improvement of the medical information in Wikipedia such as Wikiproject Medicine.
Thursday 22 September 2011
Medicina Basada en la Evidencia en las consultas de AP
La atención sanitaria en los centros de salud de Atención Primaria (AP) exige satisfacer unas necesidades de información entre sus profesionales, amplias, diversas y continuas, para asegurar una asistencia de calidad, así como favorecer el desarrollo de actividades docentes y de investigación.
El acceso a fuentes de información de calidad y de Medicina Basada en la Evidencia (MBE) ha de considerarse una prioridad y debe ser facilitada en los centros de salud. Un estudio que fue realizado por Alonso et al. (BMC Health Serv Res 2009; 9:80) así lo ponía de manifiesto, señalando la inaccesibilidad a las fuentes de información de calidad, falta de tiempo y la necesidad de mayores conocimientos en la evaluación crítica de las publicaciones por parte de los médicos de AP.
Desde el grupo de MBE de semFYC hemos elaborado la "Declaración sobre el acceso a las fuentes de información científica para el médico de familia" (acceso al artículo en prensa) señalando la importancia de solucionar estos problemas y de proveer acceso a recursos MBE desde los propios centros de Atención Primaria.
El acceso a fuentes de información de calidad y de Medicina Basada en la Evidencia (MBE) ha de considerarse una prioridad y debe ser facilitada en los centros de salud. Un estudio que fue realizado por Alonso et al. (BMC Health Serv Res 2009; 9:80) así lo ponía de manifiesto, señalando la inaccesibilidad a las fuentes de información de calidad, falta de tiempo y la necesidad de mayores conocimientos en la evaluación crítica de las publicaciones por parte de los médicos de AP.
Desde el grupo de MBE de semFYC hemos elaborado la "Declaración sobre el acceso a las fuentes de información científica para el médico de familia" (acceso al artículo en prensa) señalando la importancia de solucionar estos problemas y de proveer acceso a recursos MBE desde los propios centros de Atención Primaria.
Monday 8 August 2011
Analysing social networking for Public Health measures
It is well known that the Internet can be useful in monitoring disease outbreaks as different approaches have shown in recent studies, for instance based on the use of search engines (e.g. Google Trends) and Web 2.0 channels such as blogs, Facebook and Twitter.
I would like to focus on the use of Twitter in this fashion. Recently, Paul MJ et al. have published a paper ("You are What You Tweet: Analyzing Twitter for Public Health") where the messages of social media users are analysed in order to find out information to be useful for Public Health. The idea is to aggregate millions of messages to generate relevant knowledge, in that case, trying to get diverse public health measures, taking into account that Twitter (and social networks in general) may be a new Internet-surveillance method characterized by an important message volume, frequency and public availability. One of the problems I see is the fact that these messages and people behind them may represent a certain reality that could not be applied to the majority of cases or scenarios in terms of Public Health (probably many unknown factors play role in this environment). Nevertheless, I'm sure it's a very interesting line of research that needs to be more studied in depth.
I would like to focus on the use of Twitter in this fashion. Recently, Paul MJ et al. have published a paper ("You are What You Tweet: Analyzing Twitter for Public Health") where the messages of social media users are analysed in order to find out information to be useful for Public Health. The idea is to aggregate millions of messages to generate relevant knowledge, in that case, trying to get diverse public health measures, taking into account that Twitter (and social networks in general) may be a new Internet-surveillance method characterized by an important message volume, frequency and public availability. One of the problems I see is the fact that these messages and people behind them may represent a certain reality that could not be applied to the majority of cases or scenarios in terms of Public Health (probably many unknown factors play role in this environment). Nevertheless, I'm sure it's a very interesting line of research that needs to be more studied in depth.
Monday 11 July 2011
Puntuando a los médicos en la web
Cada vez es más frecuente (también en España), webs que incluyen listas de profesionales de la salud y su lugar de actividad profesional, y en las que los usuarios pueden aportar opiniones sobre dichos profesionales y la experiencia personal que se haya podido tener con la atención sanitaria recibida.
Lo positivo está en que es importante facilitar la comunicación entre los diferentes protagonistas, poder expresar libremente opiniones tanto favorables como no, pero siempre con un objetivo, mejorar el sistema en general y la atención médica en las consultas.
Lo negativo, y desafortunadamente tan importante como lo positivo o más, es el hecho de que estas plataformas no pueden asegurar (tal como suelen indicar) quién eres realmente (desde el punto de vista profesional) y lo que es todavía más preocupante, tampoco sabemos quiénes están opinando sobre un profesional, hospital o servicio. ¿Cuáles pueden ser las consecuencias de una o muchas opiniones falsamente vertidas (con buena o mala intención) en estos foros, positivas o negativas, que pueden influir sobre la decisión de otros usuarios, creyendo que la atención médica ofrecida es la mejor en el primer caso, o rechazándola de pleno al leer la pésima calidad asistencial del profesional calificado en el segundo caso?
Si queremos la bien deseada transparencia, ésta debe ser exigida a todos, no sólo a los profesionales, sino también a las plataformas y a los que opinan, así ganamos todos. Mientras tanto, podemos estar ante una peligrosa farsa basada en una buena idea, utilizada sin la mínima seguridad y ética exigibles.
Lo positivo está en que es importante facilitar la comunicación entre los diferentes protagonistas, poder expresar libremente opiniones tanto favorables como no, pero siempre con un objetivo, mejorar el sistema en general y la atención médica en las consultas.
Lo negativo, y desafortunadamente tan importante como lo positivo o más, es el hecho de que estas plataformas no pueden asegurar (tal como suelen indicar) quién eres realmente (desde el punto de vista profesional) y lo que es todavía más preocupante, tampoco sabemos quiénes están opinando sobre un profesional, hospital o servicio. ¿Cuáles pueden ser las consecuencias de una o muchas opiniones falsamente vertidas (con buena o mala intención) en estos foros, positivas o negativas, que pueden influir sobre la decisión de otros usuarios, creyendo que la atención médica ofrecida es la mejor en el primer caso, o rechazándola de pleno al leer la pésima calidad asistencial del profesional calificado en el segundo caso?
Si queremos la bien deseada transparencia, ésta debe ser exigida a todos, no sólo a los profesionales, sino también a las plataformas y a los que opinan, así ganamos todos. Mientras tanto, podemos estar ante una peligrosa farsa basada en una buena idea, utilizada sin la mínima seguridad y ética exigibles.
Friday 8 July 2011
Beyond e-patients
New Communication and Information Technologies (ICT) are no longer new, they are totally integrated into our lives, in our personal, social or professional relations, there is no turning back. For that reason, some terms which have made complete sense up to now are not necessary any more and should be given up.
E-patients and e-physicians turn back into patients and physicians, at present they have integrated twitter and facebook or other social networks into their day to day work, and they are using Google searches, as much as to be better informed in the case of the former and better trained in the latter and also clarify their doubts, their illness or concerns, to get support from others like them, sharing their knowledge and experience, to make an appointment, to get medical advice online and so forth.
Now the previous patient-doctor relationship in the current e-scenario is a simple reality and fortunately it is a renewed relationship and it isn't an "e-" any more. The Electronic Health Record (EHR) is shared between patients and medical doctors and the possibility to gain access to them is a fact, to recommend high quality websites is usual and it seems that online support groups and social networks will soon be incorporated in the EHR.
From now on, we may and we have to give up talking about "e"-patients, we reinvent o.s. time and again but now as "patients".
E-patients and e-physicians turn back into patients and physicians, at present they have integrated twitter and facebook or other social networks into their day to day work, and they are using Google searches, as much as to be better informed in the case of the former and better trained in the latter and also clarify their doubts, their illness or concerns, to get support from others like them, sharing their knowledge and experience, to make an appointment, to get medical advice online and so forth.
Now the previous patient-doctor relationship in the current e-scenario is a simple reality and fortunately it is a renewed relationship and it isn't an "e-" any more. The Electronic Health Record (EHR) is shared between patients and medical doctors and the possibility to gain access to them is a fact, to recommend high quality websites is usual and it seems that online support groups and social networks will soon be incorporated in the EHR.
From now on, we may and we have to give up talking about "e"-patients, we reinvent o.s. time and again but now as "patients".
Friday 1 July 2011
Personal Health Records (PHR) versus Electronic Health Records (EHR)?
Personal Health Records (PHR) are essentially patient-centered services with the aim of offering a space on the Internet, where people could have access to their personal health information. Google Health and Microsoft HealthVault are the outstanding exemples of this kind of service.
On the other hand, eventually it seems that Electronic Health Records (EHR) have been adopted in western countries, although with different speeds and difficulties among them. Surely, there are diverse reasons to decide to retire Google Health, but I'm sure one reason that may explain the low success of PHR services is the fact that the EHR, at least apparently, is made with an open-minded vision of the medical-patient relationship in the current ICT scenario. In my view, that means the EHRs are "for" and "by" patients, with the promise of an open access and shared management with medical doctors. So why do you need an external service in the cloud if it is included in EHR, and which is reliable, secure and shared?
On the other hand, eventually it seems that Electronic Health Records (EHR) have been adopted in western countries, although with different speeds and difficulties among them. Surely, there are diverse reasons to decide to retire Google Health, but I'm sure one reason that may explain the low success of PHR services is the fact that the EHR, at least apparently, is made with an open-minded vision of the medical-patient relationship in the current ICT scenario. In my view, that means the EHRs are "for" and "by" patients, with the promise of an open access and shared management with medical doctors. So why do you need an external service in the cloud if it is included in EHR, and which is reliable, secure and shared?
Monday 27 June 2011
Más allá de los e-pacientes
Las nuevas tecnologías de la información y comunicación ya no son nuevas, están integradas totalmente en nuestras vidas, en nuestras relaciones sociales, personales y profesionales, no hay vuelta atrás. Algunos términos que tenían todo su sentido comienzan a no ser necesarios y deben ser abandonados.
Los e-pacientes y los e-médicos, vuelven a ser pacientes y médicos, han integrado desde hace tiempo en el día a día, en twitter y facebook o en otras redes sociales y en sus búsquedas en Google para estar mejor y más informado los primeros, y mejor formados los segundos, sus dudas, su enfermedad o su preocupación, el apoyo de otros como ellos, su ciencia y su experiencia, la petición de citas y consultas médicas, etc.
La que era una relación médico-paciente en un e-escenario hace un tiempo, simplemente es ahora y por fortuna una relación renovada que ya no es necesario llamar e-. La historia clínica electrónica es compartida con los pacientes y el acceso a ella es una realidad, es usual la recomendación de webs y se incorporarán pronto en este entorno las redes sociales de apoyo. La relación médico-paciente tampoco tiene "e"s.
Podemos y debemos dejar de hablar de los "e"-pacientes, somos "pacientes".
Los e-pacientes y los e-médicos, vuelven a ser pacientes y médicos, han integrado desde hace tiempo en el día a día, en twitter y facebook o en otras redes sociales y en sus búsquedas en Google para estar mejor y más informado los primeros, y mejor formados los segundos, sus dudas, su enfermedad o su preocupación, el apoyo de otros como ellos, su ciencia y su experiencia, la petición de citas y consultas médicas, etc.
La que era una relación médico-paciente en un e-escenario hace un tiempo, simplemente es ahora y por fortuna una relación renovada que ya no es necesario llamar e-. La historia clínica electrónica es compartida con los pacientes y el acceso a ella es una realidad, es usual la recomendación de webs y se incorporarán pronto en este entorno las redes sociales de apoyo. La relación médico-paciente tampoco tiene "e"s.
Podemos y debemos dejar de hablar de los "e"-pacientes, somos "pacientes".
Monday 6 June 2011
Web 2.0 and doctor-patient relationship
I read an article published in 2010 in the Journal of Law, Medicine & Ethics about how Web 2.0 is changing the doctor-patient relationship (Bernard Lo et al). Web 2.0 offers a way to be in touch with other peolple with a particular condition. At the same time, now it's possible to improve the access to health services and it even seems that Web 2.0 may give patients and people in general, a more active role in decision making.
Web 2.0 is evolving quickly in Health Care Services and how patients are using it so at the moment we have enough time to reconsider and work on different ethical, legal and organizational issues in the present doctor-patient relationship scenario to make the most of these tools in health care.
Web 2.0 is evolving quickly in Health Care Services and how patients are using it so at the moment we have enough time to reconsider and work on different ethical, legal and organizational issues in the present doctor-patient relationship scenario to make the most of these tools in health care.
Sunday 27 February 2011
A new stage and a new beginning
After a long time in silence on this Blog (nearly two years), I've decided to begin once again and the first thing I thought I had to do was to change both the blog URL and name. The idea is to move on to new subjects and related ideas, that I see, is the new era of Medicine we are witnessing, that is "personalized medicine". From my point of view, basically that means to be able to manage the huge amount of health information we are facing in the service of patients and general public. In the next posts and months I will try to go more deeply into issues such as the emerging biomedical informatics science, electronic health records (EHR) and personal health records (PHR), standards of communication in medicine, ehealth and social changes, the new scenario in patient-physician relationship, web 2.0 and web 3.0 and its application in biomedicine and so forth.
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