1. Introdução à Medicina II Ano lectivo 2011/2012 Turma 17 Professor regente: Altamiro Costa Pereira Professora supervisora: Cristina da Costa Santos 1

2. Introduction One-on-one contact virtual contact. (1) One-on-one contact virtual contact. (1) Is being replaced by 2 Medical students’ social networks overuse may lead to consequences (3) ; Medical students’ social networks overuse may lead to consequences (3) ; MEDICALMEDICAL PRINCIPLESPRINCIPLES

3. Principles of a good medical practice (4) 1.Primacy welfare; 2. Patient autonomy ; 3.Social justice. 3

4. 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.

5. 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

6. Studies Conclusions: (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

7. “Although the sample size of the study is small, the findings are certainly interesting enough to warrant further investigation.”(3) Studies 7

8. 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

9. Main Objective T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  T To evaluate their knowledge of laws in this issue. 9

10. 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

11. Methods 11

12. Target-populations Medical students of the “Faculdade de Medicina da Universidade do Porto”; General population. 12

13. Sampling Process Medical Students: Selection of students of 2 nd and 5 th years of college, who filled our questionnaire. Stratified Sampling Process QuestiQuestionnaire Questi 13

14. 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 QuestiQuestionnaire Questi 14

15. Study Design Application of a questionnaire to two population samples. 15 Several common groups of questions A specific group of questions

16. Variables of Study TThe o pinions of the two target populations about the role of Facebook on Medical Professionalism; TTheir knowledge about the P ortuguese 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.

17. 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

18. 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

19. 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 Sexes Group 1 – Facebook Use 19

20. 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 Sexes Group 2 – Ethical Issues 20

21. Comparison Between Sexes Group 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

22. Comparison Between Sexes Group 4 – Specific Question Valid % 22

23. 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

24. Comparison Between Groups 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

25. Comparison Between Groups "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

26. Comparison Between Groups Group 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

27. 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

28. Comparison Between Groups "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

29. 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(…)“ from Artigo 4 - DIÁRIO DA REPÚBLICA—I SÉRIE-A Nº 18— 26 de Janeiro de 2005 Lei Nº 12/2005 de 26 de Janeiro Comparison Between Groups Group 3 – Other Important Questions 29

30. Comparison Between Groups 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

31. Comparison Between Groups 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.

32. Comparison Between Groups Group 3 – Other Important Questions The most important question of our questionnaire revealed that generally, people think Medical Profissionalism is moderately threatened by Facebook. 32

33. 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

34. 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

35. 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