Friday, June 14, 2013

Social Media and Patient Confidentiality

I'm motivated to blog about this after a recent posting I read in one of the social media sites. With how fast things are evolving, it's pretty common these days to get a 'curbside' from colleagues via the internet.
Either emailing, or posting clinical challenges, lab results, radiologic or physical exam findings. After all, it's good for patients for us to be able to reach out to experts elsewhere, and it's good education for us doctors too to share cases.
However, with the ease of sharing these diagnostic dilemmas, comes the potential for misuse or downright abuse. A few recent events I read on a certain website comes to mind. The first was a series of pretty graphic pictures of the genitalia showing some pathology. Though this was not identifying of the patient, many doctors who belonged to that group was unprepared to see those images in such a public forum and found it offensive. And while I imagine the doctor who took the pictures had asked for the patient's permission, I'm pretty sure it was not exactly proper informed consent: "Please let me take a picture of your genital for me to post on Facebook..". The second incident was an image of a test result; the person who posted that image in all its glory conveniently forgot the patient's name and DOB was listed for all to see. I am also reminded of a blog of a medical student who some years ago started to post pictures of his pediatric patients with their faces clearly visible. Though permission was "obtained", these were children who were not able to legally able to provide proper consent.
As physicians, we are in a priviledged position, of being privy to a person's deepest, darkest secrets. We leave a person with very little remaining modesty as we poke and prod and push and percuss and auscultate and do other unmentionables, while they lay there vulnerable. We have taken the Hippocratic Oath, which among other things, to "respect the secrets that are confided in me, even after the patient has died..." (OK, to be accurate that was the Declaration of Geneva version).
And so, it's easy to forget that in a brisk click of the mouse, we may be revealing more than we should, and that we might be betraying the trust given to us. Even if it was done with no malice but with total beneficence for the patient. It's easy to think, "Hey, this is a really cool MRI, let me share this" without realizing the patient name is clearly visible. Or that picture of the goiter also happens to reveal a person's face.
We owe it to our patients to be more discreet about these things. The truth is, in some parts of the world people are fired or sued if they are found to have done some of these things. So, before you share your pictures, or X-ray images or whatever it might be, do take a moment to ask- is this suitable for social media? Am I overstepping the scope of the consent the patient has given me?