The following scenario is completely fictional although it is used to represent a real-life incident. All details have been changed.
“Hey – you’ll want to know about this – you’re into that twitter thing, aren’t you?” your consultant colleague Dan asks as you stroll, coffee in hand, into the office on Monday morning. There’s something about his tone; it’s more of a challenge than a question. But you’re interested. “Know what?” you reply, looking up from your smartphone screen.
“James, the ST4. He got a needlestick from a drug user. You’ll never guess what he was doing.” He pauses for effect. “He was using the ultrasound – and another needle – to remove a snapped off needle from the IVDU’s arm.”
“What? Had he x-rayed the arm?”
“Yep – he knew it was in there. He’d found it with the ultrasound too. Only, instead of referring to orthopaedics to remove it under the image intensifier like any normal doctor, he decided to fish around with another sharp to try to remove the thing himself! And he was going to use a scalpel afterwards to cut down, he says! Read it on the internet somewhere. Bloody dangerous if you ask me.”
“And how’s James?” you ask, with a sinking feeling, remembering a post you’d seen on a FOAM blog.
“He’s crazy! But he’s fine. He’s over in occupational health having his bloods taken now. IVDU thinks she’s HIV negative, which is lucky. It was a real job trying to get samples from her too. Why is it the ones who are covered in tattoos are always the ones who are needlephobic? Anyway, he’s learned his lesson now. You can’t believe any of that stuff you read online.”
You take a slow mouthful of your coffee as you think about what you are going to say next.
Where do we stand when FOAM goes wrong? How can we present the advice of our international colleagues – people we feel we know and interact with on a regular (maybe even daily) basis – to our peers who do not engage in social media? How can we hold up to scrutiny the practice of clinicians we respect but have never met?
I have found myself in a situation similar in principle (but entirely different in practice) to the one above, and struggled to rationalise my belief in the knowledge and wisdom of the people who seem to outsiders to be little more than “invisible internet friends”. What would you say to the colleague, eager to discredit all of the fantastic experience the FOAM movement brings because of one misunderstanding or misapplication?
I don’t know what the answer is – but I really hope this provokes some debate.
Disclaimer: it took quite some time (and a lot of discussion!) to find a plausible alternative example of something which might be adopted into practice from a FOAM blog but provoke a significantly negative reaction among UK clinicians when something went wrong. I do not mean to suggest that the tip alluded to in the example above is dangerous practice; it merely served to illustrate the point.