Introdução à Medicina II Ano lectivo 2011/2012 Turma 17 Professor regente: Altamiro Costa Pereira...
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Transcript of Introdução à Medicina II Ano lectivo 2011/2012 Turma 17 Professor regente: Altamiro Costa Pereira...
Medical studentsand Facebook:
threatened professionalism?
Introdução à Medicina IIAno lectivo 2011/2012Turma 17
Professor regente: Altamiro Costa PereiraProfessora supervisora: Cristina da Costa Santos 1
Introduction• One-on-one contact virtual contact.(1)
Is being replaced by
2
• Medical students’ social networks overuse may lead to consequences(3);
MEDICAL
PRINCIPLES
Principles of agood medical practice (4)
1. Primacy welfare;
2. Patient autonomy;
3. Social justice.
3
Studies
4
Online information shows lack of professionalism: (5)
Photos of behaviors that are
not morally correct;
Discussion of clinical cases
between medical
students;
Offensive
language;
Racism statements;
Sexism comments.
Irresponsible postings on
social networks
physician-patient relation
may affect
Disrespect patients;Lead the profession into disrepute;Diminish confidence in the doctor;Expose patients’ personal lives;Influence a doctor’s career;Lead to a health student dismiss;Result in denial for a job applicant(6).
Ethical Issues
5
StudiesConclusions: (5)
The use of social networks is more frequent amongst medical students than it is on residents;
The majority keep their profiles widely open to the general public.
6
“Although the sample size of the study is small, the findings are certainly interesting enough to
warrant further investigation.”(3)
Studies
7
What is potential patients’ and medical students’opinion about the influence of
Facebook on medical professionalism and if there are valid reasons to think that
medical professionalism is threatened?
Research Question
8
Main Objective
To evidence the opinion of potential patients
and medical students about the influence of the
use of Facebook amongst health care
professionals and students on medical
professionalism through concrete questions
based on the Portuguese Constitution
To evaluate their knowledge of laws in this
issue.9
Objectives To study if the patients had knowledge of cases of
disclosure of personal information by doctors on
Facebook;
To compare the opinions of the two populations in
study and evidence their similarities and differences;
To evaluate the possible positive and/or negative
aspects of Facebook’s utilization on medicine students’
academic itinerary.
10
Methods
11
Target-populations• Medical students of the “Faculdade de
Medicina da Universidade do Porto”;
• General population.
12
Sampling Process
• Medical Students: Selection of students of 2nd and 5th
years of college, who filled our questionnaire.
Stratified Sampling Process Questionnaire
13
Sampling Process• General population
Delivery of 40 questionnaires to different people of “Hospital S. João” who are not busy and sick (in different places at different times and dates)
Stratified Sampling
Questionnaire14
Study Design
• Application of a questionnaire to two population samples.
15
Several common groups of questions
A specific group of questions
Variables of Study
The opinions of the two target populations about the role of Facebook on Medical Professionalism;
Their knowledge about the Portuguese Laws that are related to professionalism on the health care services.
16
Outcome variable: if there are motives to be concerned about the effects of overuse of Facebook by medical students and young doctors on medical professionalism.
Limits of Our Conclusions
×Geographically limited space;
×Other people’s opinions could differ of those opinions on which our conclusions will be based on, (differences on cultural and social status);
×Our sample contains some biases of selection;
17
Statistical Analysis• For the closed item
questions, the chi-square test was used when the expected values lower than 5 for cells were less than 20%. When that did not happen, to analyze the relation between two categorical variables, Fisher's Exact Test was performed, considering the answers "I do not know" as Missing Values .
• For the scaled item questions, median and range were used as description measures because the sample did not follow a normal distribution. For comparisons, it was used Mann-Whitney test.
• .
Comparison between sexes
• For the closed item questions, it was used the chi-square when we could.
• For the scaled item questions was also used median and range as descriptive measures. Kruskal-Wallis test was used to compare the values obtained in the three groups.
• .
Comparison between groups
SPSS19 for Windows
package was used for statiscal analysis
Significance level of 0.05 was used for all
tests.18
Medical Students
98% of the females and 100% of males
know and use Facebook.
Both male (87%) and female
(93%)frequently use Facebook to talk with friends, watch photos
and comment/see profiles.
Male subjects use Facebook more often
than female ones.
General Population
The same number of men and women
knows Facebook but females (61%) use it
more than males (56%).
The highlight is the use of Facebook to talk with friends on
both male and female inquired.
Male subjects use Facebook more often
than female ones.
Comparison Between SexesGroup 1 – Facebook Use
19
In this group of questions, question
1.3.2. was the only one where we found
significant similarities between females (77%)
and males (73%)
Meanwhile, some women revealed that they had knowledge of cases of
clinical cases published on Facebook by doctors.
Medical Students
Both genders in general think that a certain doctor shouldn’t be punished just
for exposing a written clinical case
None of the inquired, both male and female, had knowledge of clinical
cases posted on Facebook.
General Population
Comparison Between SexesGroup 2 – Ethical Issues
20
Comparison Between SexesGroup 3 – Other Important Questions
•Both male and females strongly thought (80% on males and 83% on women) that it is correct for a doctor to render health services on his/her Facebook page.
Medical Students
•There weren’t any particularly signifcant differences between answers of both genders
•Menwhile, men think religious feelings revealed by a doctor can influence physician-patient relationship more than women do.
•On the other hand, female medianly think that sexual tendicies revealed by a doctor on Facebook can influence physician-patient relationship more than men.
General Population
21
Comparison Between SexesGroup 4 – Specific Question
Yes Don't Know0
10
20
30
40
50
60
70
80
90
100
Facebook is an instrument that promotes my academic success.
Male
Female
Yes Don't Know0
10
20
30
40
50
60
70
80
90
100
I would consent a clinical case of mine to be posted on Facebook so it could be discussed by health care
professionals.
MaleFemale
Valid %
Valid %
22
Comparison Between Sexes
Other Conclusions There were not many significant discrepancies between
genders on the answers to the questions of our questionnaire. This may imply that the gender variable was not preponderant between the study groups which may somehow turn the following part of our study more reproducible on this population.
= Moreover, from our study results the conclusion that the use of
Facebook is somehow shallow to medical students due to the answers given by them to their questionnaire’s specific question.
23
Comparison Between Groups
Yes0
10
20
30
40
50
60
70
80
90
100
I use Facebook.
Medical Students
General Population
Valid %
Conclusions:
The majority of people of the 2 groups knows Facebook , but medical students use it more than general population;
The frequency of use in a week is higher on general population than it is on medical students.
Group 1 – Facebook Use
24
Comparison Between Groups
Yes Don't Know0
10
20
30
40
50
60
70
80
90
100
The doctor should be prosecuted for disclosing pictures without the patient
showing his/her face on Facebook.
Medical Students
General Population
Valid %
Can Should0
10
20
30
40
50
60
70
80
90
100
Can/should a doctor be punished by law if he/she publishes a
clinical case only using writting?
Medical StudentsGeneral Popula-tion
Valid %
"Patient consent, or if this is impeded, legal representative consent when the revelation does not harm third parties with interest in maintaining medical
confidentiality“.
~from Article 88 of Portuguese Medical Association Code of Ethics
"Confidentiality covers all facts of which the physician has become aware while exercising his professional duty or as a result of it and includes particularly: a) Facts revealed directly by a person, by
another at his request or by a third party with whom he had contact during provision
of care or as a result of it.” from Article 86 of Portuguese Medical Association Code of Ethics
Group 2 – Ethical Issues
25
0
10
20
30
40
50
60
70
80
90
100
The disclosure of pictures makes the attitude of the doctor ethically worse
than if the case was expressed only by write.
Medical Students
General Population
Valid %
Comparison Between GroupsGroup 2 – Ethical Issues
"Patient consent, or if this is impeded, legal representative consent
when the revelation does not harm third parties with interest in
maintaining medical confidentiality“.
~from Article 88 of Portuguese Medical Association Code of Ethics
"Confidentiality covers all facts of which the physician has become aware while exercising his professional duty or as a result of it and includes particularly: a) Facts revealed directly by a person, by
another at his request or by a third party with whom he had contact during
provision of care or as a result of it.”
from Article 86 of Portuguese Medical Association Code of Ethics
26
Yes Don't Know0
10
20
30
40
50
60
70
80
90
100
The doctor should disclose information about a case of
domestic violence to the respective authorities.
Medical Students
General Population
Valid %
Yes Don't Know0
10
20
30
40
50
60
70
80
90
100
This doctor should be prosecuted for disclosing that
information.
Medical Students
General Population
Valid %
Comparison Between Groups
“If it is absolutely necessary to the defense of the physician’s or the patient’s dignity, honour and legitimate interests, the physician shall not in any of these cases reveal more than is necessary nor
without prior authorisation from the Medical Association." from Article 88 of Portuguese Medical Association Code of Ethics)
Group 2 – Ethical Issues
27
Comparison Between Groups
Yes Don't Know0
10
20
30
40
50
60
70
80
90
100
The doctor should tell his best friend that his wife is secretly using contraceptive methods while the couple was trying to
have a baby.
Medical StudentsGeneral Popula-tion
Valid %
"Confidentiality covers all facts of which the physician has become aware while exercising his professional duty or as a result of it and
includes particularly: a) Facts revealed directly by a person, by
another at his request or by a third party with whom he had contact during provision of care
or as a result of it;b) Facts appreciated by the physician,
stemming or not from clinical observation of the person or third parties;
c) Factors stemming from knowledge of patient’s ancillary diagnostic exams and
treatment;d) Facts communicated by another physician or health professional sworn to confidentiality on
them.“
from Article 86 of Portuguese Medical Association Code of Ethics
Group 2 – Ethical Issues
28
Yes Don't Know0
10
20
30
40
50
60
70
80
90
100
The Portuguese Constitution allows the creation of those groups on Facebook
(exclusive for doctors).
Medical Students
General Population
Valid %
The percentage of people who doesn't know the Portuguese Constitution is very high and common on the study groups.
"A informação de saúde só pode ser utilizada
pelo sistema de saúde(…)“
fromArtigo 4 - DIÁRIO DA REPÚBLICA—I SÉRIE-A Nº 18—26 de Janeiro de 2005 Lei Nº 12/2005 de 26 de
Janeiro
Comparison Between GroupsGroup 3 – Other Important Questions
29
Comparison Between Groups
Median and Range0
2
4
6
8
10
12
14
Degree of agreement on the sentence: "Doctors are very
influenced by Facebook".
Medical StudentsGeneral Popula-tion
Median and Range0
2
4
6
8
10
12
14
16
Degree of influence that sexual tendencies revealed by doctors on Facebook have on the physician-
patient relationship.
Medical StudentsGeneral Population
Globally, both study groups had the same opinion on this question sexual tendencies
revealed by a doctor on Facebook has impact on the relation physician-patient.
Group 3 – Other Important Questions
Generally, General Population thinks that doctors are influenced by Facebook more than Students
30
Comparison Between Groups
Yes Don't Know0
10
20
30
40
50
60
70
80
90
100
It's correct for a doctor to render health services to a patient that has
access to his/her Facebook page.
Medical Students
General Popu-lation
Group 3 – Other Important Questions
Valid %
31
Conclusions:
Both sample groups think that it is correct for a doctor to render health services to a patient that has access to his or her Facebook page (82% of medical students and 72% of general population) when, by law, it should be impossible to a physician to do so.
Comparison Between GroupsGroup 3 – Other Important Questions
Median and Range0
1
2
3
4
5
6
7
8
Degree of agreement on the sentence: "Health Care
Professionalism is being threatened by the use of social networks as
Facebook".
Medical StudentsGeneral Population
The most important question of our questionnaire revealed that
generally, people think Medical
Profissionalism is moderately
threatened by Facebook.
32
Conclusion Despite incomplete, our study accomplished all
his objectives:
The main objective was almost completely fullfiled:
We evidenced the opinion of the two target populations about the influence of Facebook on Medical Professionalism amongst doctors and medical students with the application of the questionnaire.
The statistical analysis of the questionnaires revealed that Medical Professionalism is moderately threatened by the overuse of Facebook. This means, responsable entities must be prepared and prevent future negative events and install Facebook optimally amongst Medicine or separate them eficiently.
33
Conclusion
Our secondary objectives were completely fullfiled:
• People of the two target populations revealed not to have knowledge of disclosure of information by doctors on Facebook
• We successfully compared the opinions of the 2 already studied target populations and presented those comparations througout the presentation.
• The majority of medical students didn’t find Facebook to be of any use to promote their academic success, but those who did find it useful, used it to discuss academic affairs with their colleagues.
34
In the Future…
Facebook, a company that captivate and worth millions and millions, should always be treated carefully when it is mixed with such delicate area as Medicine is..
The conclusions of our study, despite limited geographically, may have the power to stimulate other higher researchers to study this complex theme and come up with new ideas and conclusions that complement ours thus helping to give a more solid view of this emergent reality and, if necessary, present some solutions.
35