Physician, monitor thyself: professionalism and accountability in the use of social media

The recent report of the AMA Council on Ethical and Judicial Affairs (CEJA), "Professionalism in the Use of Social Media," describes the types of social media medical professionals use, outlines ways in which existing AMA policies address issues of online professionalism, and makes a list of recommendations for physicians to maintain online professionalism. CEJA recommends directed efforts towards educating physicians about the benefits and pitfalls of social media and, in particular, underscores the difficulties of maintaining professional boundaries in the digital age. In this commentary, we highlight issues introduced by the report and suggest some specific ways that the recommendations of the committee can be implemented by medical schools, residency programs, and practicing physicians.     

Online and offline social networks: Use of social networking sites by emerging adults

Social networking sites (e.g., MySpace and Facebook) are popular online communication forms among adolescents and emerging adults. Yet little is known about young people's activities on these sites and how their networks of “friends” relate to their other online (e.g., instant messaging) and offline networks. In this study, college students responded, in person and online, to questions about their online activities and closest friends in three contexts: social networking sites, instant messaging, and face-to-face. Results showed that participants often used the Internet, especially social networking sites, to connect and reconnect with friends and family members. Hence, there was overlap between participants' online and offline networks. However, the overlap was imperfect; the pattern suggested that emerging adults may use different online contexts to strengthen different aspects of their offline connections. Information from this survey is relevant to concerns about young people's life online.     

Conducting Exposure-Based Groups via Telehealth for Adolescents and Young Adults With Social Anxiety Disorder

The rapid spread of COVID-19 and subsequent social distancing measures posed unprecedented challenges in providing mental health care and a swift transition of services to telehealth platforms. Social distancing measures create unique concerns for young people with social anxiety disorder who already struggle with social connection and isolation; therefore, the continuation of care via telehealth platforms is especially important for this population. To date, there is little literature regarding use of telehealth groups for this population and the current commentary aims to fill in this gap in the literature while also providing general guidelines for telehealth groups. The commentary discusses the delivery of an exposure-based cognitive behavioral therapy group for adolescents and young adults via telehealth and provides considerations, challenges, and benefits of conducting a group through a telehealth platform. In conjunction with clinically relevant examples and in-depth exposure discussions, we aim to provide guidance for youth-focused practitioners who are considering conducting groups in a telehealth format for a range of presentations.     

Report of the AMA Council on Ethical and Judicial Affairs: professionalism in the use of social media

Although many physicians have been using the internet for both clinical and social purposes for years, recently concerns have been raised regarding blurred boundaries of the profession as a whole. In both the news media and medical literature, physicians have noted there are unanswered questions in these areas, and that professional self-regulation is needed. This report discusses the ethical implications of physicians' nonclinical use of the internet, including the use of social networking sites, blogs, and other means to post content online. It does not address the clinical use of the internet, such as telemedicine, e-prescribing, online clinical consultations, health-related websites, use of electronic media for clinical collaboration, and e-mailing patients (some of which are already covered in the AMA's Code of Medical Ethics).     

青少年线上积极自我呈现与幸福感的关系:线上积极反馈与自尊的作用

采用社交网站自我呈现问卷、社交网站积极反馈问卷、牛津幸福感问卷和整体自尊量表对1804名中学生进行调查,探讨了社交网络使用中的积极自我呈现与幸福感的关系,以及线上积极反馈在二者关系间的中介作用和自尊对这一中介模型的调节作用。结果发现：（1）线上积极自我呈现、线上积极反馈、自尊与幸福感两两均呈显著正相关;（2）线上积极自我呈现不仅能直接正向预测青少年的幸福感,还能通过线上积极反馈的中介作用对幸福感产生作用;（3）自尊不仅能调节线上积极自我呈现对幸福感的直接效应,还能调节线上积极自我呈现经由线上积极反馈预测幸福感的中介作用的前半路径。研究揭示了青少年线上积极自我呈现与幸福感关系的作用机制,有助于引导青少年通过社交网络使用促进积极心理品质的发展。     

Facebook as a Site for Inter-religious Encounters: A Case Study from Finland

The aim of this article is to analyse the social networking site Facebook as a possible platform for inter-religious dialogue. Building on a case study—an attack on a Buddhist temple in Turku, Finland, and the consequent interaction that took place online immediately following the attack—the article investigates the strengths and limitations of social networking sites such as Facebook for encountering and connecting with religious others. The ethnographic material—consisting of both Internet material and interviews with concerned parties—is discussed in close connection with current research on religion, social media, and discussions online. Themes that are highlighted include stereotypes and superficiality as assumed aspects of online conversations, the role of power in dialogue—both offline and online, and symbolic communicative actions and social networking sites.     

Medical professionalism: a tale of two doctors

The AMA's social media guidelines provide physicians with some basic rules for maintaining professional boundaries when engaging in online activities. Left unanswered are questions about how these guidelines are to be implemented by physicians of different generations. By examining the issues of privacy and technological skill through the eyes of digital natives and digital immigrants, the challenges associated with medical e-professionalism become clear.     

Things online social networking can take away: Reminders of social networking sites undermine the desirability of offline socializing and pleasures

People are beginning to develop symbiotic relationships with social networking sites (SNSs), which provide users with abundant opportunities for social interaction. We contend that if people perceive SNSs as sources of social connection, the idea of SNSs may reduce the desire to pursue offline social activities and offline pleasures. Experiment 1 demonstrated that priming with SNSs was associated with a weakened desirability of offline social activities and an increased inclination to work alone. Felt relatedness mediated the link between SNS primes and reduced desire to engage in offline social activities. Experiment 2 showed that exposure to SNS primes reduced the desirability of offline socializing and lowered the desire for offline pleasurable experiences as well. Moreover, heavy users were more susceptible to this detrimental effect. We provide the first experimental evidence that the idea of online social networking may modulate users’ engagement in offline social activities and offline pleasures. Hence, online social networking may satisfy the need for relatedness but undercut the likelihood of reaping enjoyment from offline social life.     

Friending, IMing, and hanging out face-to-face: overlap in adolescents' online and offline social networks

Many new and important developmental issues are encountered during adolescence, which is also a time when Internet use becomes increasingly popular. Studies have shown that adolescents are using these online spaces to address developmental issues, especially needs for intimacy and connection to others. Online communication with its potential for interacting with unknown others, may put teens at increased risk. Two hundred and fifty-one high school students completed an in-person survey, and 126 of these completed an additional online questionnaire about how and why they use the Internet, their activities on social networking sites (e.g., Facebook, MySpace) and their reasons for participation, and how they perceive these online spaces to impact their friendships. To examine the extent of overlap between online and offline friends, participants were asked to list the names of their top interaction partners offline and online (Facebook and instant messaging). Results reveal that adolescents mainly use social networking sites to connect with others, in particular with people known from offline contexts. While adolescents report little monitoring by their parents, there was no evidence that teens are putting themselves at risk by interacting with unknown others. Instead, adolescents seem to use the Internet, especially social networking sites, to connect with known others. While the study found moderate overlap between teens' closest online and offline friends, the patterns suggest that adolescents use online contexts to strengthen offline relationships.     

Treating Social Anxiety in an Era of Social Distancing: Adapting Exposure Therapy for Youth During COVID-19

The novel coronavirus (COVID-19) pandemic has caused widespread disruption to our traditional way of life and mental health therapy has not been spared. A combination of increased anxiety, diminished social opportunities, and the shift to telehealth service provision presents particular challenges for the treatment of social anxiety in youth, which relies heavily on exposures to social situations with peers, adults, or other feared social stimuli. The objective of this commentary is to provide guidance to clinicians working with youth with social anxiety on how to maintain ethical, evidence-informed provision of exposure therapy in light of these unusual circumstances. We first present an overview of how COVID-19 may uniquely impact youth with social anxiety and highlight the importance of continuing to provide exposure-based treatments during this time. We then discuss guiding principles for delivering exposure therapy during COVID-19. We focus on providing practical examples of how common social anxiety exposures can be adapted and delivered successfully through telehealth while abiding by COVID-19 social distancing guidelines. Finally, we discuss key recommendations to assist clinicians in moving treatment forward while considering changing safety guidelines pertaining to COVID-19.     

医学专业精神的初步研究

由于历史和社会文化的差异,中西方对医学专业精神有着不同的理解。在中西不同语境下,分析了“Profession”和“Professionalism”这两个核心概念的涵义,并从中西对比的视角,对中西方医学专业精神所面临的几个共同问题进行了初步研究,包括医学专业核心道德价值观念、利益冲突、行业自治等。在此基础之上,还对我国医学专业精神的发展提出建议。     

Online professionalism: social media, social contracts, trust, and medicine

The AMA Council on Ethical and Judicial Affairs (CEJA) has initiated an important discussion on medical professionalism and the use of social media by issuing thoughtful and practical guidance for physicians and medical students. The implications of online activities for trust in the profession, as well as for trust between patient and doctor, however, will need further exploration as digital life expands and evolves.     

错失焦虑与大学生被动性社交网站使用的交叉滞后分析

为探讨大学生错失焦虑与被动性社交网站使用间的准因果关系,采用错失焦虑量表和被动性社交网站使用量表对403名大学生进行间隔8个月的两阶段追踪调查。结果发现：(1)错失焦虑和被动性社交网站使用的自回归路径系数显著,存在风险累积效应。(2)错失焦虑与被动性社交网站使用在8个月内能够互相预测,存在强化螺旋效应。(3)错失焦虑与被动性社交网站使用的交叉滞后效应性别差异不显著,存在跨性别趋同效应。结果支持了强化螺旋模型,表明错失焦虑与大学生被动性社交网站使用能够交互影响。     

被动性社交网站使用与错失焦虑症：压力知觉的中介与乐观的调节

本研究为考察被动性社交网站使用对移动社交媒体环境下大学生错失焦虑症的预测,以及压力知觉的中介作用、乐观的调节作用与性别差异,选取443名大学生进行问卷调查。结果表明：（1）被动性社交网站使用通过直接预测与压力知觉的中介作效应两种方式作用于错失焦虑症;（2）乐观调节中介模型的直接路径,在低乐观水平下,被动性社交网站使用对错失焦虑症的预测作用显著;在高乐观水平下,该预测作用不显著;（3）中介效应与调节效应存在性别差异：在女生群体中,压力知觉的中介效应大于男生群体;而乐观的调节效应仅存在于男生群体中。     

Between Thanatos and Eros: Erich Fromm and the psychoanalysis of social networking technology use

Social networking technologies have become a ubiquitous framework for social interaction, serving to organise much of the individual’s social life. Such technological structuring affects not merely the individual’s psyche (as a psycho- technics), it also affects broader aspects of society (as a socio-technics). While social networking technologies may serve to transform society in positive ways, such technologies also have the potential to significantly encroach upon and (re) construct individual and cultural meaning in ways that must be investigated. Erich Fromm, who psychoanalytically describes humans as a product of their society and the economic systems within that society, may provide insight into the influence of social networking technologies in contemporary society. He sees the relationship between the individual and society as being in a constant state of dynamic change. Utilising Fromm’s psycho-societal insight, social networking technologies are shown to conflate and confuse the relation between Thanatos and Eros – the Thanatos of a lifeless and consumerist agenda-filled mechanisation, and the Eros associated with social engagement. Thanatos and Eros are tied together via social networking technologies. This results in, firstly, social networking technologies functioning predominantly to further capitalist agendas through the monetisation of these technologies – particularly in terms of linking commodity fetishism and the foundational social drive of the individual. Secondly, social networking technologies mechanise human action according to predictable behavioural paths through the use of these technologies, especially in terms of how socialisation is possible via these technologies (shaping how platonic and romantic relationships may take place in the contemporary world). Such a mechanisation of interpersonal engagement contrasts with Erich Fromm’s assertion that interpersonal relations (vis-à-vis love) are not “mere emotion”, but rather represent an interpersonal creative capacity and interplay. Fromm’s psycho-societal insights will show how contemporary individuals may take independent and responsible rational action to establish accountable and psychologically beneficial ways of engaging with others through social networking technologies.     

Ethical Considerations when Employing Fake Identities in Online Social Networks for Research

Online social networks (OSNs) have rapidly become a prominent and widely used service, offering a wealth of personal and sensitive information with significant security and privacy implications. Hence, OSNs are also an important—and popular—subject for research. To perform research based on real-life evidence, however, researchers may need to access OSN data, such as texts and files uploaded by users and connections among users. This raises significant ethical problems. Currently, there are no clear ethical guidelines, and researchers may end up (unintentionally) performing ethically questionable research, sometimes even when more ethical research alternatives exist. For example, several studies have employed “fake identities” to collect data from OSNs, but fake identities may be used for attacks and are considered a security issue. Is it legitimate to use fake identities for studying OSNs or for collecting OSN data for research? We present a taxonomy of the ethical challenges facing researchers of OSNs and compare different approaches. We demonstrate how ethical considerations have been taken into account in previous studies that used fake identities. In addition, several possible approaches are offered to reduce or avoid ethical misconducts. We hope this work will stimulate the development and use of ethical practices and methods in the research of online social networks.     

孤独感对青少年问题性移动社交网络使用的影响：人际困扰和积极自我呈现的作用

摘 要：为探讨孤独感与青少年问题性移动社交网络使用的关系,以及人际困扰和积极自我呈现在孤独感与问题性移动社交网络使用行为间的作用机制。采用孤独感量表、人际关系综合诊断量表、社交网站自我呈现量表和青少年问题性移动社交网络使用行为评估问卷,按照年级整群分层取样方式选取2872名青少年为研究对象,采用SPSS18.0、Amos以及偏差校对非参数百分位Bootstrap置信区间法进行统计分析。结果发现,孤独感、人际困扰、积极自我呈现和问题性移动社交网络使用两两间均存在显著正向相关,孤独感、人际困扰和积极自我呈现对问题性移动社交网络使用行为均具有显著正向预测作用,人际困扰和积极自我呈现在孤独感与问题性移动社交网络使用关系间分别起中介作用,同时孤独感对问题性移动社交网络使用的影响通过人际困扰→积极自我呈现的链式关系发生作用。     

Therapist Utilization of Online Social Support for Parents of Premature Infants

Using a qualitative framework to capture the voices and stories of parents of premature infants, this study explored the role of online social support through the use of the March of Dimes, Share Your Story site. Given the growing trend of computer mediated communication usage in the lives of individuals and family members experiencing medical challenges, this study adds to the broad array of research on online social support, while specifically contributing to the limited literature on the parental experience of premature birth and online social support. The research also connects marriage and family therapists and other family practitioners to the role of online social support opportunities for families.     

Using online social media,Facebook, in screening for major depressive disorder among college students

This study explored the feasibility of using Internet social networking media in an online program for Major Depressive Disorder (MDD) screening and psychoeducation targeting college students. A Facebook advertisement targeted students at five colleges in the United States to complete a mental health research survey that screened for MDD using the Patient Health Questionnaire-9 (PHQ-9). Students who screened positive for MDD were offered an eightweek follow-up survey. Of the 259 students who consented to participate in the study, 26.7% screened positive for MDD, while only 14.2% were receiving treatment. The use of Facebook to advertise for online screening for MDD required very little start-up time, and the average cost was $11.45 per subject recruited. It is feasible to use online, commercially available social networking media such as Facebook for online screening for MDD among college students. However, conducting online screening and offering treatment resources alone did not increase treatment rate in this population.     

Medical Education for Social Justice: Paulo Freire Revisited

Although social justice is an integral component of medical professionalism, there is little discussion in medical education about how to teach it to future physicians. Using adult learning theory and the work of Brazilian educator Paulo Freire, medical educators can teach a socially-conscious professionalism through educational content and teaching strategies. Such teaching can model non-hierarchical relationships to learners, which can translate to their clinical interactions with patients. Freirian teaching can additionally foster professionalism in both teachers and learners by ensuring that they are involved citizens in their local, national and international communities.