Patient privacy, MySpace and Facebook

Don’t post patient pictures on your MySpace or Facebook page. Employees who do something that foolish deserve to be fired.

Until hospitals get a grasp of the Web 2.0 era, it’s probably best not to blog about patients as well. Despite the efforts bloggers take in masking patient identity, I see hypersensitive administrators erring on the side of overreaction and start banning employees from blogging.

Comments

halfmd
I’m still not seeing what was so bad about taking pictures of the patients. According to the article, the employees removed all identifying data and only posted pictures of the injuries themselves. This behavior happens all the time in the form of published case reports. As far as I can tell, the hospital is overreacting by firing the two employees. Perhaps posting these photographs to a publicly accessible website was in bad taste, but the general public and just as easily access JAMA and the New England Journal of Medicine, too.
Anonymous
According to the story, what they were actually disciplined for was violating hospital policy regarding picture-taking with cell phones.
IMO, there is a huge difference between a medical journal and MySpace.
Some years ago, I had a surgeon take photographs of a medical injury I sustained. My permission was asked first. I would have no objection if the photos were published in a medical journal about how to treat this type of medical injury, but I think I would be rather upset to find them posted on some private site such as MySpace.
It’s a question of professionalism and the patient’s ability to trust that you aren’t going to exploit them just to sensationalize their injuries and garner more hits on your Web site.
Not to be harsh on you, halfmd, but the fact that you can’t tell the difference is a little alarming.
Noel Hastings
As a medical blogger for several years and a recent "compliance" project of my own hospital I have a lot of opinions on this. Personally, I feel that the firing of the employees may or may not have been justified.
There are specific criteria necessary to remove identifying patient information and if those are met the patient data can be used for educational purposes. I agree, MySpace is not really an educational website, but many blogs and websites are designed as such. I believe many hospitals are firing people only out of fear of legal repercussions, not out of concern for patient privacy. Since someone cannot be sued directly for HIPPA violations but the hospital that they work at can be fined thousands of dollars, it is in the hospitals best interest to simply fire anyone that puts them at risk. This is in effect censoring the worker's and their ability to educate the public and peers.
The foundation of the healthcare provider & patient relationship is trust and we as bloggers need to make efforts to assure our readers that as we write, educate and entertain the public with our involvements in the human experience we will always do so with respect and anonymity such that people do not fear going to their doctors or hospitals because of concerns over their own privacy.
I would like to see those of us in the trenches of healthcare retain the ability to relate our experiences to the public in an effort to bring the humanity BACK to the MD/patient relationship. I also feel that the internet can be an amazing teaching tool and education could greatly benefit from this medium.
It is sad to see fear and ignorance already taking a toll on this medium, both by aggressive administrators AND by clueless bloggers (we both need to set a high standard).
Noel Hastings
Both anonymous and halfMD have good points, but the key is that the hospitals have all the power. They cannot write any policy they wish simply to fire people out of convenience. There are first amendment issues here as well as patient privacy and HIPPA issues. They both need to be respected.
There needs to be a process in which concerns can be raised and that questionable articles or pictures can be evaluated. If you just allow hospitals to fire whoever they like whenever they like because they are afraid of legal repercussion then you create a community of fear.
I write to restore the human experience both for myself and for those that feel the humanity has been leeched from healthcare. I don’t do it to garner hits, get comments or somehow shock those that read my blog. I simply try to give some human insight into the life I lead and I should not be afraid to tell my story. I also agree that I cannot tell my story to the exclusion of the patient’s right to privacy and that I need to be aware and respectful of those rights. But if I tell my story in a journal, my blog, a magazine or a best-selling book, it is my choice.
We need to regulate this AS A COMMUNITY or the legal world will take this over too, just like everything else in medicine…. If we can’t regulate ourselves in this regard then we are giving the lawyers and administrators our permission to disregard our own rights to tell our stories or to educate our peers. We need to prove we have the ethical, moral and intellectual insight to regulate our own behavior or else they will have an argument to start making our decisions for us.
What happened to the value of our word and reputation as physicians. How has it become so tarnished? Why have we *allowed* it to become so tarnished?
Anonymous
I suspect the hospital fired the employees either to avoid a public relations fiasco or to CYA in case someone filed suit. Maybe both.
You would really have difficulty defending this particular action as a first amendment violation. The hospital’s first duty is to protect the privacy of its patients, and the people who took those pictures, as employees, were agents of the hospital. They opened the institution to possible litigation.
I really don’t see how you can defend such poor judgment on the employees’ part. As anonymous 12:39 pointed out, it’s one thing to obtain the patient’s permission to use photographs for publication or teaching purposes, and quite another to publish them without permission on a social networking website.
Anonymous
Really, people, we don’t know enough about the situation to be able to argue the firings weren’t justified.
We don’t even know whether the patients were aware their pictures were being taken, let alone gave permission to publish them on MySpace.
For all we know, this may have happened multiple times. It may have involved patients who were unconscious, or it may have involved sensitive parts of the anatomy. It may have involved employees who weren’t directly involved in the patient’s care and had no business even being in the patient’s room.
No employer is going to divulge all the details, especially to the media. Personnel issues have the same level of confidentiality as patient information. So most likely, there is more to the story than what we’re hearing.
I appreciate Dr. Hastings’s concern for the First Amendment, but it seems the more important consideration here is the relationship of trust and confidentiality to which patients are entitled when they seek medical care. Patients are the vulnerable ones in this relationship, so these employees had a duty to put the relationship first.
I have a hard time believing that a so-called health care professional would take a photo with a cell phone (!) and publish it on a social networking site solely for the educational value. I mean, let’s not be naive here.
Although the U.S. Constitution protects freedom of speech, it also protects the individual’s right to privacy. So don’t go cloaking yourself in the mantle of First Amendment self-righteousness, all in the name of defending someone’s bone-headed behavior.
Noel Hastings
Perhaps hospitals would consider creating a secure website with the technology and resources for professionals to securely share such information. Right now the only places we have are ones such as Google, Blogger and social networking sites. They have the easy to use, easily managed systems in place for photos and writing so we are forced to use these mediums.
Perhaps rather than fighting one another the hospitals and healthcare workers could come up with a moderated, professional and secure system for this type of communication? I bet it would be cheaper than the legal and administrative costs that are starting to go into these issues now.
I agree that social network sights sounds bad, but let’s face it, just because some people use this technology poorly does not mean it is inherently unethical. It is merely the only method we have currently. I am open to better solutions for this writing and education and perhaps a standard HIPPA web form or release that works universally?
I have had hour long phone calls with patients with ENTHUSIASTIC support for my writing and their permission and have still been forced to pull it off my site because of hospital concerns and fears of the “gray area”.
Anonymous
Dr. Hastings,
I think “moderated, professional and secure” are the operative words here.
This particular incident which we are so hotly discussing… well, this isn’t any of those. There’s no indication that the photos had any educational purpose whatsoever or that there was any professionalism involved or any employer/moderator oversight.
I do agree we need to figure out where the line should be drawn. As usual, the rapid development of new technology is outstripping our ability to learn how to use it wisely.

Patient privacy, MySpace and Facebook

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