Matthew DeCamp

Social media and physicians' online identity crisis.

Recognizing this challenge and given reports of physician misconduct online, institutions, medical boards, and physician organizations worldwide have promulgated recommendations for physician use of social media. A common theme among these recommendations—with a recent example from the American College of Physicians and Federation of State Medical Boards4—is that physicians should manage patient-physician boundaries online by separating their professional and personal identities. In this Viewpoint, we contend that this is operationally impossible, lacking in agreement among active physician social media users, inconsistent with the concept of professional identity, and potentially harmful to physicians and patients. A simpler approach that avoids these pitfalls asks physicians not whether potential social media content is personal or professional but whether it is appropriate for a public space.

Ethical Review of Global Short-Term Medical Volunteerism

Global short-term medical volunteerism is growing, and properly conducted, is a tool in the fight for greater global health equity. It is intrinsically “ethical” (i.e., it involves ethics at every step) and depends upon ethical conduct for its success. At present, ethical guidelines remain in their infancy, which presents a unique opportunity. This paper presents a set of basic ethical principles, building on prior work in this area and previously developed guidelines for international clinical research. The content of these principles, and the benchmarks used to evaluate them, remain intentionally vague and can only be filled by collaboration with those on-the-ground in local communities where this work occurs. Ethical review must additionally take into consideration the different obligations arising from the type of institution, type of intervention, and type of relationship involved. This paper argues that frequent and formalized ethical review, conducted from the beginning with the local community (where this community helps define the terms of debate), remains the most important ethical safeguard for this work.

What are health-related users tweeting? A qualitative content analysis of health-related users and their messages on Twitter

Background Twitter is home to many health professionals who send messages about a variety of health-related topics. Amid concerns about physicians posting inappropriate content online, more in-depth knowledge about these messages is needed to understand health professionals’ behavior on Twitter. Objective Our goal was to characterize the content of Twitter messages, specifically focusing on health professionals and their tweets relating to health. Methods We performed an in-depth content analysis of 700 tweets. Qualitative content analysis was conducted on tweets by health users on Twitter. The primary objective was to describe the general type of content (ie, health-related versus non-health related) on Twitter authored by health professionals and further to describe health-related tweets on the basis of the type of statement made. Specific attention was given to whether a tweet was personal (as opposed to professional) or made a claim that users would expect to be supported by some level of medical evidence (ie, a “testable” claim). A secondary objective was to compare content types among different users, including patients, physicians, nurses, health care organizations, and others. Results Health-related users are posting a wide range of content on Twitter. Among health-related tweets, 53.2% (184/346) contained a testable claim. Of health-related tweets by providers, 17.6% (61/346) were personal in nature; 61% (59/96) made testable statements. While organizations and businesses use Twitter to promote their services and products, patient advocates are using this tool to share their personal experiences with health. Conclusions Twitter users in health-related fields tweet about both testable claims and personal experiences. Future work should assess the relationship between testable tweets and the actual level of evidence supporting them, including how Twitter users—especially patients—interpret the content of tweets posted by health providers.

An ethics curriculum for short-term global health trainees

BackgroundInterest in short-term global health training and service programs continues to grow, yet they can be associated with a variety of ethical issues for which trainees or others with limited global health experience may not be prepared to address. Therefore, there is a clear need for educational interventions concerning these ethical issues.MethodsWe developed and evaluated an introductory curriculum, “Ethical Challenges in Short-term Global Health Training.” The curriculum was developed through solicitation of actual ethical issues experienced by trainees and program leaders; content drafting; and external content review. It was then evaluated from November 1, 2011, through July 1, 2012, by analyzing web usage data and by conducting user surveys. The survey included basic demographic data; prior experience in global health and global health ethics; and assessment of cases within the curriculum.ResultsThe ten case curriculum is freely available at http://ethicsandglobalhealth.org. An average of 238 unique visitors accessed the site each month (standard deviation, 19). Of users who had been abroad before for global health training or service, only 31% reported prior ethics training related to short-term work. Most users (62%) reported accessing the site via personal referral or their training program; however, a significant number (28%) reported finding the site via web search, and 8% discovered it via web links. Users represented different fields: medicine (46%), public health (15%), and nursing (11%) were most common. All cases in the curriculum were evaluated favorably.ConclusionsThe curriculum is meeting a critical need for an introduction to the ethical issues in short-term global health training. Future work will integrate this curriculum within more comprehensive curricula for global health and evaluate specific knowledge and behavioral effects, including at training sites abroad.

Chemotherapy Drug Shortages in Pediatric Oncology: A Consensus Statement

Shortages of essential drugs, including critical chemotherapy drugs, have become commonplace. Drug shortages cost significant time and financial resources, lead to adverse patient outcomes, delay clinical trials, and pose significant ethical challenges. Pediatric oncology is particularly susceptible to drug shortages, presenting an opportunity to examine these ethical issues and provide recommendations for preventing and alleviating shortages. We convened the Working Group on Chemotherapy Drug Shortages in Pediatric Oncology (WG) and developed consensus on the core ethical values and practical actions necessary for a coordinated response to the problem of shortages by institutions, agencies, and other stakeholders. The interdisciplinary and multiinstitutional WG included practicing pediatric hematologist-oncologists, nurses, hospital pharmacists, bioethicists, experts in emergency management and public policy, legal scholars, patient/family advocates, and leaders of relevant professional societies and organizations. The WG endorsed 2 core ethical values: maximizing the potential benefits of effective drugs and ensuring equitable access. From these, we developed 6 recommendations: (1) supporting national polices to prevent shortages, (2) optimizing use of drug supplies, (3) giving equal priority to evidence-based uses of drugs whether they occur within or outside clinical trials, (4) developing an improved clearinghouse for sharing drug shortage information, (5) exploring the sharing of drug supplies among institutions, and (6) developing proactive stakeholder engagement strategies to facilitate prevention and management of shortages. Each recommendation includes an ethical rationale, action items, and barriers that must be overcome. Implemented together, they provide a blueprint for effective and ethical management of drug shortages in pediatric oncology and beyond.

Providing Price Displays for Physicians: Which Price Is Right?

Price transparency is gaining momentum as one way to address the cost crisis in U.S. health care. Attention frequently focuses on patients’ awareness of prices.1 Less attention has been given to initiatives designed to increase physicians’ awareness. Recent research demonstrates that displaying prices to physicians reduces expenditures2,3 and is well-received by physicians.3 Price displays are also being used to teach cost-consciousness in medical education.4 However, prices are notoriously variable, and “price” can have multiple potential meanings (e.g., cost of service provision, cost plus profit, charges, or expected reimbursement, among others). To illustrate, consider three general sources that might be considered for displaying the “price” of certain tests (Table). In this example, potential displayed amounts vary as much as tenfold. Table Examples of possible prices (rounded to the nearest dollar) Which “price” is right? Implementing price displays requires more than knowing only whether doing so effectively decreases expenditures. In this Viewpoint we suggest that several ethical values should be considered to guide the design and implementation of providing price displays to physicians. While recognizing its sometimes ambiguous use in this context, we refer simply to “price” throughout; our goal is to offer ethical clarity on choosing an amount to display.

Ethical issues when using social media for health outside professional relationships

Abstract Social media have the potential to revolutionize health and healthcare, but fulfilling this potential requires attention to the ethical issues social media may raise. This article reviews the major ethical issues arising when social media are used for research, public health, mobile health applications, and global health. It focuses on social media use outside fiduciary relationships between healthcare professionals and patients. Emphasis is given to the potential of social media in these contexts, the ethical issues relatively unique to each, and where possible how existing ethical principles and frameworks could help navigate these issues. In some cases social media create the circumstance for particular ethical issues but also facilitate managing them, such as in informed consent for research. In other cases, disagreement exists about whether social media – despite their potential – should be used for certain purposes, such as in public health surveillance (where confidentiality represents a significant ethical concern). In still others, ethical uncertainty exists about how social media will affect ethical issues, such as inequality in global health. As social media technologies continue to develop, identifying and managing the ethical issues they raise will be critical to their success in improving health while preserving fundamental ethical values.

Ethics in global health outreach: three key considerations for pharmacists.

The objective of this article is to explore three key ethical tenets that pharmacists should consider prior to participating in global health outreach.

Navigating Ethical Tensions in High-Value Care Education

Enthusiasm for high-value care is increasing throughout health care, including in the education of medical students, residents, and fellows.1 Until recently, there were few examples of educational programs that equipped future physicians with the tools required to practice high-value care or even consider the cost of care they deliver. In fact, future physicians were encouraged to provide care that could be considered as quite the opposite—academia often instilled excess over restraint, celebrating trainees who generated (and tested for) the broadest differential diagnosis. Because physicians who train in high-spending regions subsequently provide more costly care than those who train in low-spending ones,2 medical school and residency are critical times to teach high-value care. Despite the enthusiasm, inherent to the concept of value are potential ethical tensions between patient and societal interests, and different approaches to increasing value may be controversial. In this Viewpoint, we describe this tension in the context of highvalue care education and suggest that physicians’ primary commitment to patient welfare and the process

Ethics and high-value care

High-value care (HVC) is en vogue, but the ethics of physicians’ roles in the growing number of HVC recommendations demands further attention. In this brief report, we argue that, from the standpoint of individual physicians’ primary commitments and duties to individual patients, not all HVC is ethically equal. Our analysis suggests that the ethical case for HVC may be both stronger and weaker than is ordinarily supposed. In some cases, HVC is not merely a ‘good thing to do’ but is actually ethically obligatory. In others, it is merely permissible—or even ethically suspect. More importantly, we suggest further that understanding HVC as ethically ‘obligatory, permissible, or suspect’ has implications for the design and implementation of strategies that promote HVC. For example, it questions the use of adherence to certain HVC recommendations as a physician performance metric, which may already be occurring in some contexts. Properly construed, ethics does not threaten HVC but can instead help shape HVC in ways that preserve the fundamental values of the medical profession.