Doctor reprimanded after patient privacy breached on Facebook, my take

Patient privacy and social media use in health care often go together when reported in mainstream media.

When physician blogs were a relatively new phenomenon several years ago, the majority of the media coverage focused on edge cases, where doctors inadvertently revealed patient information.

Only a minority of the headlines focused on the positive aspects, such as how social media could, and should, be used to guide patients to better sources of health information.

As social media has expanded past blogs, and into Facebook and Twitter, there’s more potential for negative press.

Consider the recent story about a physician in Rhode Island.

As reported in the Boston Globe,

[A doctor in Rhode Island] was fired from the hospital last year and reprimanded by the state medical board last week. The hospital took away her privileges to work in the emergency room for posting information online about a trauma patient.

Thran’s posting did not include the patient’s name, but she wrote enough that others in the community could identify the patient, according to a board filing. Thran, who did not return calls for comment yesterday, also was fined $500.

Several interesting points stem from the story. Note that I haven’t seen the offending post in question (it has been since deleted), so there’s some speculation here.

First, doctors run a risk posting clinical patient information online. The doctor did apparently omit identifying patient information, but not well enough. I read patient stories all the time online, and most provide a valuable window into how medicine is practiced today. Doctors must be more vigilant than ever when concealing identifying patient information. As this case shows, sometimes the clinical details is enough to violate HIPAA. Better to be safe and obtain written patient permission before posting a patient story online.

Next, this isn’t going to inspire confidence for hospitals to have their doctors to adopt social media. Westerly Hospital has now made national headlines, for the wrong reason. But instead of shying away from social media, a case like this makes it more imperative for hospitals get pro-active.

Westerly Hospital did not have a social media policy at the time. Every hospital needs one, and publicize it to their employees. It’s better to know what’s acceptable to post online beforehand, rather than dealing the aftereffects of a nationally publicized patient privacy breach.

As an aside, the hospital where I trained, Boston Medical Center, takes a social media-naive stance:

Boston Medical Center, for example, doesn’t have a policy. “It just doesn’t seem to have been an issue as of yet,’’ spokeswoman Gina DiGravio said.

Bad idea. Better to be pro-active now, rather than having it become an issue later on. Truly disappointing.

And, finally, I feel bad for the reprimanded physician. Her online persona will be forever linked to this episode. If she’s reading this, I would suggest getting more pro-active online, and take control of the online information associated with your name. She’s probably understandably stung by this episode, but instead of shying away, it’s all the more reason to get online, apologize, and tell your side of the story.  Take control of your personal narrative.

This episode isn’t going to endear doctors to use social media professionally. That’s a shame. But if we can use this as a valuable teaching point, rather than a reason not to use social media, perhaps physicians can embrace it in a more responsible way rather than shunning it completely.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • http://psychiatrist-blog.blogspot.com/2011/04/shrink-rap-survey-on-attitudes-towards.html Dinah

    Interesting post— a couple of weeks ago we had our annual mandatory departmental risk management meeting–the legal part was completely focused on warnings about social media and stories of doctors and nurses who were fired or sanctioned for putting patient information on Facebook–photos of themselves with patients, one doc who blogged about a large tumor, didn’t mention the patient’s name but did mention the surgeon’s name so that the patient was potentially identifiable. These “don’ts” seemed obvious.
    Our hospital has a policy: Don’t Friend your patients on Facebook. For psychiatrists this seems reasonable, I think the issues are more vague or troublesome in small towns where there are few psychiatrists and it’s hard to keep professional and social lives completely separate.

    Kevin, Could I ask you to post a link to our survey? Relevant to your post in that we include a couple of questions about blogs and their influence on getting care:
    http://psychiatrist-blog.blogspot.com/2011/04/shrink-rap-survey-on-attitudes-towards.html
    And please do take the survey, too!

    The issue of writing about clinical issues in any media (new or old) has been troublesome for psychiatrists for forever.

  • http://myheartsisters.org Carolyn Thomas

    Posting potentially identifiable details about your patient on Facebook is just plain stupid. What on earth are these doctors thinking?

    As a patient whose doctors might one day convince themselves that Facebook updates about my cardiac procedures are merely “guiding patients to better sources of health information”, I hope these cautionary examples serve to wake up docs who actually see nothing wrong with this disturbing trend. Alas, it’s the nature of the beast – Facebook encourages rattling on about both the important and the inane in equal measure. Recent Australian research published in the journal ‘Computers in Human Behavior’ found: “Facebook users have higher levels of total narcissism, extraversion, exhibitionism and leadership than Facebook non-users.” More on this at: “Why Narcissists Love Facebook” at: http://ethicalnag.org/2011/04/01/facebook-and-narcissism/

  • http://www.dialdoctors.com Dial Doctors

    Dr. Bailey was lucky all she got was the Chief on her case! This example shows how not to do social media. I agree that getting writtten consent is the way to go but I feel like removing her privileges is too harsh. There was intent to do harm and she did what she figured was correct (not disclosing personal information) even though it wasn’t enough. Hopefully other hospitals will quickly develop comprehensive policies on social media.

  • BeckyDO

    I have set up a “professional page” on facebook. I use this page to post articles about health and wellness with my patients. I don’t post any personal comments at all. I work in a critical access hospital and when patients are transferred to a larger place they often post updates on themselves. It’s amazing how it has improved my ability to follow-up on my patients.

    I am interested in anybody’s comments on using facebook this way. I am very vigilant about not even commenting on my patients’ posts. Overall, I think I’m fairly safe, but maybe there are issues I haven’t considered.
    Thanks.

  • Max

    That’s all we read. Physicians must learn to embrace social media, yadda yadda yadda.. What do they get for ‘embracement’? Fired. Fined. Stay off social media, physicians. Get your Facebook for friends and family. Don’t comment. Don’t discuss medicine. Stick with the weather or your picnic or the baseball game or the cruise. Patients won’t choose you because you’re hip and on facebook. They will still go to their insurance book and see who is in their plan. Period. $$ wins, not how cool you are.

    • pj

      For the most part, Max is (sadly) correct.

  • http://drpauldorio.com Paul Dorio

    Privacy regulations, public scrutiny and good common sense and decency should be enough for anyone to stop them from typing comments such as “Dr so-and-so cut out X from Mrs. Y. How interesting.” Obviously, most posts are not this blatant. But variations abound and people continue to get in hot water for (what I consider) obtuse additions to the online flora: photos of patient parts, comments of patient behaviors, etc. These things are inappropriate. Many of my colleagues refuse to use social media because they are concerned that their words will be (overly?) scrutinized. I don’t have a problem with that. I think it’s simple: if you can’t figure out that what you are writing may come back to haunt you…don’t.

    • http://Www.twitter.com/alicearobertson Alice

      But Paul….it is so helpful when doctors like you post under your real name…your real thoughts….and allow a patient to converse in a manner a quick office visit doesn’t provide. I communicate really well with our doctors…but I think most people are too anxious or intimidated to do what I do and email doctors absurd emails that entertain amidst what is often a tension filled day.

      I found this site during a dark period of uncertainty in my life…I term this our dark medicinal abyss. My correondence with doctors I have met online actually is a bit healing. There is plenty online to make patients cynical, but to see decent, good, empathetic doctors writing….explaining what I consider the dark side of medicine…helps. Sure it has risks…but I wanted you and others to know that I am glad you give your to me online.

      My doctors read my blog posts, and we discuss social media. You will not find them posting online. They want to continue working:). And, yet, they have so much to offer.

      What do patients gain when good doctors become silent?

  • http://www.healthcaremarketingcoe.com/health_care_social_media/ Simon Sikorski, M.D. Twitter @medmarketingcoe

    It’s a shame indeed that these kinds of stories ALWAYS makes it to the news, and the really compelling stories how social media positively bridges the gap between health care organizations, practitioners, and patients… never does.

    • http://myheartsisters.org Carolyn Thomas

      Dr. S – It’s hardly “a shame” – it’s actually a darned good thing these cautionary tales DO hit the headlines as long as there are so many medical professionals out there who seem to need a smack upside their collective heads when it comes to appropriate use of social media.

      • http://www.healthcaremarketingcoe.com/health_care_social_media/ Simon Sikorski, M.D. Twitter @medmarketingcoe

        For every “cautionary tale” like this … hundreds of health care providers back out of getting involved in social media. I run workshops & seminars for docs on marketing and social media. Every workshop starts the same way… doctors raise concerns about recent articles first. Sometimes an hour-long debate ensues about the mistakes, rather than spending the time on learning how to use social media appropriately.

        In the media there are many examples of Mistakes in Social Media. There are no guidelines that educate.

        “Funny” enough, most of the younger doctors already have Facebook, LinkedIn, Twitter profiles. During the workshops we usually find lots of examples of what NOT to do. But we correct them, learn from them. Firing doctors, who could be great doctors, for something they did not know how to do right… that’s a mistake in itself.

  • http://SteinWellness.com Sara Stein MD

    I’m with Simon. I am one of those doctors who embraces social media in all forms. I educate, I interact, I post a few music videos, occasionally I lobby. I blog, I link, I FB, I tweet.

    In the tradition of see one, do one, teach one…the method of teaching and the definition of who is a student has changed. These days students are anyone who wishes to be informed and empowered by health care information, not just those who paid tuition to sit and watch slides. The most effective reach is social media. And, social media is the most effective reach toward the uninsured.

    The plus sides are numerous, but two come to mind. One is that I can enmasse provide accurate medical information that will compete in the virtualsphere with all the fake berry pushers. The other is that I meet amazing people from all walks of life, and have a great time. We all end up enriched.

    Having made my case FOR docs in social media, I now make my case against being an idiot. If you wouldn’t say it in a crowded hospital elevator, don’t post, tweet, blog it. Just because you’re home in your jammies after a long call weekend doesn’t mean no one is listening.

    Join the conversation!
    http://twitter.com/sarasteinmd
    http://www.facebook.com/SaraLSteinMD

    • http://www.womeninpainawareness.ning.com carol

      I think this is part of the problem. There are now signs in hospital elevators reminding docs and other hospital staff while in elevators, and other public places not to talk about patients. Why do you need a sign? It should be ingrained in you from the moment you start training.

  • http://minochahealth.typepad.com doc

    This case clearly illustrates the double edged sword that social media is as far as health care providers are concerned. Since technology is moving fast, it would be hard to have clear policies governing physician participation in this tech wonder. Physicians are likely to be at the receiving end since the the “right or wrong” of the conduct is likely going to be determined by others’ interpretation of what is correct conduct.

  • http://onsurg.com/about Chris Porter MD

    Dr Thran may have been fired for violating hospital policy, but, from the Boston Globe article it’s not clear to me that HIPAA was violated. (It’s a stretch, but maybe the patient gave written consent.) I don’t defend the doctor’s actions, not knowing the details, but I am curious: was something revealed besides the injury which identified the patient? The Globe article falls short in explaining the offense.

    “I treated the Mayor for a dog bite,” is obviously inappropriate, without consent. But, “I treated the woman who was bit outside Safeway,” doesn’t identify her to anyone except those who already know the person bit outside Safeway. Thus nothing is revealed except who was the treating provider and hospital. Can we get a HIPAA ruling on this?

    Regardless, it doesn’t inspire patient confidence.

    Last thought: maybe professional misuse of social media is a *missing child* story – statistically rare, but compelling enough to be common in headlines.

  • http://ethicalnag.org/2011/04/01/facebook-and-narcissism/ Carolyn Thomas

    Doctors and nurses, pleeeeease let me help you out here.

    Last summer, five California nurses were fired from Tri-City Medical Center in Oceanside after discussing patients on Facebook (without identifying them by name). The year before, two Wisconsin nurses were fired after they took photos of a patient’s x-ray and posted them to Facebook. U.K. hospital staff faced unspecified “appropriate disciplinary action” because of a now-famous hospital staff food fight photo collection posted on Facebook from Stafford Hospital. These disciplinary actions were not so much due to the Facebook postings, but rather because hospital staff decisions to post this stuff on Facebook in the first place confirmed their status as idiots.

    And let’s face it, nobody wants to be treated by a health care professional who’s an idiot. Some professionals, like Dr. Thran apparently, seem genuinely unable to separate the inane but acceptable “Just back from spin class and wondering what to make for dinner” banalities of constant Facebook updates from inappropriate postings about life on the job. Despite the questionable implied urgency here that somehow all doctors MUST now be Facebooking and Tweeting, the nature of social media in essence appeals to those who believe that their frequent stream-of-consciousness updates – yes, even about patients – are just too fascinating to resist posting. News flash: they’re not! And those who honestly cannot tell the difference between what’s “correct conduct” or not have no business being on social media.

  • Ajay Bharadwaj

    I am completely with Dr Simon Sikorski on this. Sharing information always does 10x (may be 100x) more good than bad sand I think we need to completely rethink privacy paradigm. I can understand that some people are sensitive about sharing anything about them but that has to taken as exception and not norm.

    • http://www.myheartsisters.org Carolyn Thomas

      I’m curious, Ajay, about why you would believe that a patient’s sensitivity about privacy concerns “has to be taken as exception and not norm”?

    • http://drpauldorio.com Paul Dorio

      Ridiculous – with all due respect. Privacy is privacy and it is an essential component of being human in a world where everyone wants to know your business but no one wants to share theirs. Though you and I may feel that everyone should be willing and able to share their lives and be “open books,” most people don’t feel that way. The exception, as you put it, is a person’s ability to share and not care about privacy. But there are many arguments for judicious privacy – not the least of which is that it’s nobody’s business whether you went to the emergency department for X ailment last week.

    • http://warmsocks.wordpress.com/ WarmSocks

      With all due respect, I think you have the privacy issue backwards. It should be taken as the NORM that people expect their information to be private. It is an exception to the normal standard when patients are okay with their private information being exposed to others. Quite frankly, I find it appalling that you’d think otherwise.

      As a patient-blogger, I post quite a bit of personal information online. When I post, it’s my choice. I choose which details to reveal and which to keep private. I also choose which details to change to protect the privacy of others: maybe that “he” is really a “she” and maybe an event I said was “last week” was really “two months ago.” I also blog anonymously without ever using names or specific locations. There is a huge difference between this information I post about myself and something that another posts about me.

      There is huge benefit to patients being able to read doctors’ writings in social media. Just use some common sense and make very certain that patients can’t be identified.

  • Ajay Bharadwaj

    To answer your question, Carolyn, one has to dig deeper and ask why would one want to keep something private and address those core issues. And I am not suggesting that “X went to emergency” is anybody’s business..I believe that sharing of knowledge has many times more benefits and once everybody appreciates it, than we may get to a stage where one can keep only those things private which need to be private.

    • http://drpauldorio.com Paul Dorio

      I don’t disagree with your sentiments, Ajay. And I too believe that people tend to be overly suspicious and inadequately forthcoming/honest. But the current topic, that of inadvertent/inappropriate exposure of facts that shouldn’t be revealed, is really about HOW those comments are made as opposed to the fact that they were made at all. An individual choosing to communicate private personal details is a whole lot different from someone else choosing to communicate the same details. I think that is the crux of the issue.

      • http://Www.twitter.com/alicearobertson Alice

        I think HIPPA went too far. And I do not understand why a nameless case cannot be discussed. Patients scream that doctors are not empathetic enough, yet defend patients having a doctor sued for an anonymous post. How is that helpful when doctors are bound and gagged, yet we can go online and run them down by name? Each side has the potential to ruin a life, so caution is necessary…but anonymous cases not being discussed? Patients are starting to look like bullies.

        I was contacted by an Ombudsman because an employee posted about my daughter’s misdiagnoses that was posted on an employee only bulletin board. It was deleted immediately, then maybe four months later I was contacted. A post with no names…not the doctor…not my child and the employee was getting fired at the doctor’s request…ironic that he ended up cited.

        Sometimes our outrage is misplaced and it comes from both sides. I just think we need a better…more level playing field.

        • http://www.myheartsisters.org Carolyn Thomas

          Hi Alice – being sensitive about another person’s privacy rights is not being “bound and gagged”. It’s plain old common courtesy and common sense. At our hospital, all employees sign a confidentiality agreement upon hiring – standard practice in many occupations. Personal information – medical, legal, financial, educational, you name it – by definition belongs to the individual “person” – who is free to disclose as much or little as desired. It’s only when third parties (doctors, nurses, lawyers, accountants, teachers) start sharing others’ information they are privvy to that the line is crossed.

          Trouble is, many professionals don’t seem to get where that line is.

          • http://Www.twitter.com/alicearobertson Alice

            Carolyn…when it is anonymous it is an unfair binding. I learn from these stories. I do not even want a patient’s name…but I desire to understand both sides. How can that happen if we mute doctors from the discussion? Nameless entities forbidden? Don’t we want doctors at the table? Or do we want them under it….to kick?

  • http://psychiatrist-blog.blogspot.com shrinkraproy

    “I treated the woman who was bit outside Safeway” may sound lacking in identifying information, unless you happened to see a woman get bit outside Safeway within a short time period before reading this statement (or be that woman or her family). In that case, this could be seen as a violation of privacy. HIPAA violation? I don’t know.

    Better to wait a month or two, then talk about “a person got bit outside of a store”. That is more general. No gender. No specific store. The more specific the details, the more likely they are identifiable.

    • http://www.myheartsisters.org Carolyn Thomas

      Why would it be necessary to even mention a location?

      • pj

        WHy is it “necessary” to mention most of the things most of us do in our daily lives????

        You seem to be applying a VERY high standard to Dr Thran’s (and Docs in general ) conduct, with what little info seems to be available about that case…

        She may have acted inappropriately but sheesh, you dont think her punishment was a bit harsh at all???

        • http://www.myheartsisters.org Carolyn Thomas

          Unlike her employers, we don’t know the specific details of what she posted about her patient on Facebook – clearly her employers felt the punishment was appropriate.

          • pj

            Your point being, what, employers are always right???

          • http://Www.twitter.com/alicearobertson Alice

            I think employers often overreact, in an effort to serve themselves…not the patient or customer. They may be a scapegoat to send a loud message to other doctors to shut up. What hospital wants truthful doctors online sharing things they prefer to never cross sealed lips!

            I surmise the reprimanded doctor’s case sent a resounding message to every employee in not only that hospital, but all across the land. Much louder than an internal memo. I would not assume a doctor is guilty just because of a reprimand, nor would I assume a doctor is innocent just because a patient’s complaint was buried. There is a much larger agenda going on and it is not about patient protection.