So this post follows on from one previous post about the spammy email practices of Docplexus, a networking site for doctors, and has been incited by a deluge of emails which kept pinging my inbox non-stop. I first noted that they were celebrating the achievement of a wonderful milestone – 250,000 medics signing up for their site – through a nicely made video on their LinkedIn page. Naturally, I aired my grievance about the spammy emails. It was quite a docile comment actually – which they ended up deleting, inducing me to rant about them on my blog! I also learned today that they have blocked me on their Twitterstream:

In the words of the inimitable Dr. Gregory House:

I was not happy that the Docplexus people were so actively trying to stifle the freedom of expression of their members, which was anyways a small, small minority, which seemed to be rather irritated by their spammy emails; however, on the plus side, the ruckus I created helped me get off their mailing list for good. So that was a win. And now, this time, the offender is a service called GoodMD, provided by Lybrate.

Lybrate is an online Practice Management portal, which seemed like a professional service, so I signed up with them (a few years back), when I received an email request to join them. They also seemed to have a premium service, including mechanisms for online consultations, all of which attracted me. Of course, after signing up, I toyed around with it for a few days before I forgot all about it… until today, when the whole stash of GoodMD emails cropped up in my inbox. I tried unsubscribing (as one does when they receive emails they did not sign up for!) after the first couple of emails, but the emails just kept on coming! I finally used their “Live Chat” feature to get a hold of a helpful responder, who offered to take me off the list. And when I asked him how to delete my account since I could not find any option for the same, he asked me to write in to their support email with a request to delete my account and a valid reason for the same.

Now, I am an early adopter when it comes to online platforms or social media tools for enhancing medical practice, awareness or disseminating verified information. However, since getting a bit burned on these two occasions, I decided that at least when it comes to signing up for professional social networking sites, I would like to verify a few things before signing up with them. Could be a helpful guide for those who, like me, get irked when the ethical norms for online behaviors are violated.

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1. Be sure who you are sharing personally identifiable information with

Some of the social networking sites ask for an official documentation to prove that you actually are who you say you are. While that is a good thing, as it verifies your credentials, it can be a bit of a dicey affair to share something as sensitive as your registration certificate or other such professional credentials without actually knowing who these people are. Get to know their funders. Get to their mission and vision in the long term. And above all, get to know their policies on withdrawal or deletion of any personal details that they force you to submit on sign up.

There is one point I am still slightly undecided on. About the professional profile of the leader of the service… do services which have physicians at the helm better understand our needs and purposes? Would platforms which are solely created, maintained and marketed by tech/engineering people be less sensitive to the needs of physicians – whether these needs be medical or technological or even socio-cultural? I have not had experience of working on too many platforms headed by doctors; and possibly, there are very few such platforms (Curofy comes to mind). But I would like to understand whether the professional background of the leadership makes a difference or not.

2. What are their profile deletion options?

It would be good to know what happens when one wants to delete their profile. Will they have to email them with a valid reason for asking for the deletion of one’s profile? Or can one simply delete their profile through the profile settings – almost as simply as they had signed on? And what happens to the content you generated while associated with the site when you finally do decide to delete your profile? Do they hold on to it? Can they reuse it? Will they attribute it to you or can they claim copyright over it? And most importantly, if they do all these, or actually, if they do anything besides deleting your data completely when you delete your profile, do they inform you about it explicitly? I know nobody, ever reads the Terms and Conditions before signing up for anything, but on this occasion, it could be worth spending the few extra minutes plodding through the tedium before hitting sign up. Your professional facade may depend on it!

3. Privacy options for you and your patients

This is becoming more and more important in the Indian setting. Although we do not have a formal and strong legal frame work like the HIPAA, emerging consensus about conducting online clinical encounters are indicative of some basic principles. While I realize that one may not have much control of these policies as a site user, yet, it would be a good thing to know how much one should engage in clinical interactions solely through the online media. The problem is that our medical curriculum on ethics (which is taught as a part of Forensic Medicine as well as in practice through Community Medicine) is a bit dated. To the best of my knowledge, it does not equip younger physicians-in-training on the nuances of the importance of medical information, and need to protect the patients’ confidentiality and privacy even when the patients themselves are not aware of their rights in this matter.

I have, on numerous occasions, been a buzzkill when I protested the use of images which violate a patient’s privacy, on popular networking sites like Facebook. Recently, I earned the ire of a fellow physician, who had shared an image of a notice issued against a doctor by a state medical council, where the name of the physician, and his contact details, were clearly visible. At the cost of beating my own drum, on such occasions, I usually turn to an article I co-authored, about the digital indiscretions of medical care providers. The article is over six years old, but is still relevant with respect to the principles we outline about what not to do, in the least.

4. Liability for when Murphy’s Law strikes

The problem with the medical sciences is that even with the best of care and adhering to the highest ethical standards, sometimes, things fall through the cracks. Unfortunately, the human body is still an unraveling mystery, the workings of which sometimes defies the laws and axioms that we have devised. And Murphy’s Law still holds true… at least in my experience, life loves throwing googlies at me when I least expect them. Anyway. If one does undertake clinical consultations online, as is the case in Lybrate, there is at least theoretically a possibility that something will go wrong. If that does, then who bears the liability for that? It is a complex issue with no clear guideline. The problem in putting all the liability on the website is that it shall shackle the development of online economy for medical care; the problem of shunting it wholly on the consulting physician will allow fly-by-night websites to exploit physicians. Striking the legal and ethical balance is a task which medicolegal experts need to take up keeping in mind the myriad outcomes of their decisions.

This article on the India Medical Times website hints at some very interesting issues in this regard. Oh, and this also includes quotes from Saurabh Arora, the CEO of Lybrate, the company whose emails set off this rant of mine! Some interesting excerpts from this piece (if you have read this far, you should check out the IMT article as well):

According to the Medical Council of India (MCI) Code of Ethics Regulations, 2002, soliciting of patients directly or indirectly, by a physician, by a group of physicians or by institutions or organisations is unethical.

Dr K K Aggarwal, honorary secretary general, Indian Medical Association (IMA), told India Medical Times, “The real world rules also apply to the digital world. For example, I cannot be paid for referring a patient, as it is not allowed. If anybody sends me a patient for money, that is not allowed. Marketing on the internet as well as advertising is not permitted in the medical profession.”

“Such a claim made by a doctor or by the company with which the doctor associates itself is a false claim because there cannot be a substitute for actual face to face consultation and actual physical examination of the patient. Anybody who says that these can be dispensed with and induces patients to pay fee for such consultation is acting knowingly falsely and fraudulently and may be liable in law, including the Consumer Protection Act (CPA) – 1986 and the MCI Regulations – 2002,” said Dr Gupta.

5. Consider the benefits of using the platform

Every platform that I have mentioned in this post, or on Twitter rants, have their own importance. In an era when the foundations of trust between a doctor and her/his patients are eroding, these websites can go a long way in establishing trusted communication avenues. However, for that to happen, the platform itself has to be worth trusting. Personally, after my bitter experience with Docplexus, I am done with it. I will not use their services again until and unless they have had a major change of heart over their policies. Much to the credit of the Lybrate people (till now), they have not lashed out at me for my tweets or my position about their ridiculously difficult process of deactivating one’s account. The fact that they have been ignoring my concerns is also not very comforting, however, it is at least a bit better than blocking dissenting users on social media sites!

So personally, one has to make sure that there is some tangible benefit for signing up with the service. A lot of these services are startups and they need us to support them. Many of them are headed by young, tech-savvy doctors who need us to support their vision and mission. However, it should be a fair trade!

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As a self-declared early adopter for the use of social media  in medicine, I find that some of these above mentioned criteria can be a bit restrictive in that it is likely strictly adhering to them will discourage the use of professional networking sites. However, in my mind, until and unless a service gains my trust, and shows me a tangible benefit, as well as a clean “way out”, I shall not provide them with personally identifiable information again. I have made that mistake once and I am loathe to repeat it again. Comparing the poor experience I have had with Docplexus, and the complications I faced with Lybrate, with the absolutely stellar experience I have had with Figure1, on the whole, I would like to err on the side of participation in networking sites if my general worries can be assuaged.

What are your thoughts? Am I being too archaic in thinking of such safeguards before joining a network? Am I overthinking this non-issue? Or do you agree that it is better to be safe than sorry, or irritated by spam emails, when it comes to professional social networks?