The ethical dilemma of being a runner, doctor and journalist

Is it possible for a doctor to be a journalist? A journalist a doctor? A runner to be a journalist and a doctor? In trying to be all the above I walked (arguably crossed) a line which sparked disappointment amongst my co-workers, and criticism from the public.

When I started residency we had a lecture on the do’s and don’ts of social media. Don’t talk about patients, don’t post pictures of patients, don’t friend your patients. Don’t post pictures of yourself taking shots of flaming whisky, especially not with your patients.

Simple do’s and don’ts. We were now experts of navigating the social media kingdom.

Three years into residency I ran the 2014 Boston Marathon. I was convinced by the Boston Globe to take a selfie at every mile, creating a time lapse of the day. Multiple news outlets had also asked me to tweet every mile, capturing the rawness of the race. I was to be a journalist for 26.2 miles, delivering real time details through the eyes of a runner.

At mile 19 a runner went down. I stopped to help. Due to the quick response of volunteers and bystanders the man was saved. Once the ambulance arrived it was time to continue my race. I made a quick decision, snapping a picture I tweeted: “First responders saved a life. Thank you to those volunteers who save lives at every mile.”

Later that night when going through my tweets I realized I made a mistake. Part of the injured runner’s face was in the picture. I immediately removed the picture from my twitter account.

It was too late.

Boston.com had noticed the tweet, taken a screen shot and published an article. Even though I had deleted the picture, my Internet footprint was permanent.

The criticism of the public was harsh. Here is one of the comments:

“What’s so noble and admirable about stopping running so she can film this unfortunate individual and then tweet it out for his family and friends to possibly see? How is that ‘helping’? Is tweeting in that moment the most important thing to her?”

The unexpected came from my co-workers. One said the following:

“I believe that when we communicate on these forums as physicians we have to hold ourselves to the highest standards of privacy, respect, and dignity, and I worried that the picture of the man crossed a few of these lines.”

I felt sick knowing the unintentional consequences of my tweet had potentially caused harm.

Questions were racing: Had I violated this man’s privacy? Was he considered my patient? Did I do something unethical? Could I get fired for this?

The boundaries had become blurred at mile 19 on marathon Monday.

If I were just a runner, no big deal, unlikely the picture would have gained attention. If I were just a journalist, my job would have been to take the picture.

But I am a physician.

Am I held to a higher standard of moral conduct and professional responsibility, no matter the setting?

Curious about this intersection between social media and medicine I began to investigate.

One of the most famous cases of social media misconduct is the story of Dr. Alexandra Thran, a Rhode Island ER physician. She wrote about one of her patient’s injuries on Facebook. Although she did not reveal the patient’s name, a third party was able to identify the patient. She was fired from the hospital, reprimanded by the state’s medical board and forced to pay a fine.

I took a look at public Facebook posts. Here are some recent quotes from physicians:

“Trauma team couldn’t get back a 1 month old … May god bless you and keep you little baby.”

“Our ER is full of drunk morons who sleep on RVs.”

“Yeah. I’ll rank last night as a top three most disastrous night. Six MICU admissions. One death. One ECMO. Two other codes. Way to go out with a bang.”

Do these statements give away patient information? Should these physicians be fired for what they wrote? Are these unethical statements?

In 1847 (prior to Facebook) the American Medical Association gathered in Philadelphia and adopted the world’s first code of medial ethics. Much of it is not applicable to 2014 but one message prevails: “There is no profession, from the members of which greater purity of character, and a higher standard of moral excellence are required, than the medical.”

If you ask today, most doctors will still say they feel their profession requires the highest standard of moral excellence. But how does that moral excellence translate into social media, especially when we are out of uniform and not on duty, say on mile 19 of a marathon.

What I did on marathon Monday technically was not wrong, but ethically it was a mistake. As physicians we should be conscious of our actions and deliberate in our meaning in any setting, whether on Facebook, Twitter, radio, a blog, or while running a marathon. Facebook is not a place to vent feelings about horrible overnight shifts. Twitter is not a place to post pictures of those who are injured. Blogs are not places to distribute reckless information.

As I continue to explore what social media has to offer the world of medicine I may make more mistakes. But If I am deliberate, mindful and meaningful in my message perhaps no harm will come to those I vowed to protect.

Natalie C. Stavas is a pediatrics resident and can be reached on her self-titled site, Dr. Natalie Stavas, and on Twitter @nataliestavas.

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  • Steven Reznick

    You stopped as a Good Samaritan to provide help. I am not sure why anyone would want to snap a picture of a sick person on the street and put it on the internet but I do not believe that was your intention. stop beating yourself up for trying to help.

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

      “I am not sure why anyone would want to snap a picture of a sick person
      on the street and put it on the internet but I do not believe that was
      your intention.”

      Based on results, that was entirely the intention of Dr. Stavas: to post a photo (without permission) of a sick person lying on the street. If doctors are ever in even the tiniest doubt about how appropriate this decision is, try to put yourself in the shoes of that person lying on the street: as a longtime former distance runner, how would I feel if I “went down” at mile 19, hurting, frightened, embarrassed, surrounded by emergency medical personnel – only to find out that the passing physician who stopped to help me has posted my FACE all over Twitter without my permission? You can’t just take the MD on and off your name when you choose to make such decisions.

  • JR

    You should never take someone’s photo with express permission from that person, even if that person can’t be identified from the photo. Certainly publishing them is even worse. I’ve seen blogs where ER people post pictures of injuries of unconscious patients, I’m sure they took them without consent and published without consent and I think it is completely unethical.

    (Journalists are doing something entirely different, they are taking news worthy photos, and have more leeway with what kinds of photos they can take. They generally can only take photos of people in public, they don’t have access to patients receiving medical care.)

    • Anne-Marie

      Journalists do have access to patients receiving medical care, usually with the consent of the patient and/or family and sometimes with the doctor, nurses and whoever else as well, depending on the situation. It’s similar to prison inmates – the right to talk to the media is not automatically waived once you’re a patient or an inmate.

      There;s a lot of debate in newsrooms right now about how the social media is creating new ethical questions, often with no clear answers. Dr. Stavas has plenty of company.

      Legally speaking, she didn’t invade anyone’s privacy. The Boston Marathon is a public event taking place on public streets in front of thousands of spectators. Participants have no expectation of privacy. That said, even the mainstream media usually tends to be careful about showing faces in the kinds of situations that Dr. Stavas encountered. Some media outlets might have published the exact same photo; others might not have.

      There are no absolute answers here. I hope Dr. Stavas can consider it a lesson learned and try to move on without beating herself up over it.

      • JR

        Let me restate that: Journalists generally have access to people in public, where they could snap a picture without asking permission, but they can’t waltz into an exam room and start snapping pictures without permission.

        Traditionally, medical personnel have been required to get signed documentation to take photos of patients.

        In a social media age, doctors need to remember that they have access to places and situations where photos shouldn’t be taken without consent.

        • azmd

          Did you even read what Dr. Stavas wrote? She did not “waltz into an exam room and start snapping pictures.”
          She took a picture IN PUBLIC during an interaction in which she was participating as a PRIVATE CITIZEN. That is the entire point of her article, which you appear to have missed in your rush to berate her for supposedly unprofessional behavior.

          • JR

            I shall restate my position again, as you didn’t understand it.

            You should never take someone’s photo without express permission from that person.

            This is my personal ethical judgement and it applies to everyone – not just doctors.

            Of course, even those in emergency rooms are taking pictures and publishing it in their online journals – which is wrong.

            Comparisons to journalists aren’t justified, as journalists are specifically taking photos of “news worthy events.”

            Of course, I don’t think celebrities going about their daily business should be considered “news worthy” and it’s unethical to follow them around and photograph them as well.

          • JR

            BTW – I do believe experience is the best teacher and the writer of this article had a lapse in judgement. It’s brave of them to bring this up now and post it as a learning experience for others.

            But I still personally believe anyone photographing anyone should have permission.

  • guest

    I personally think your co-workers may be missing some nuances here. Unless you were running the marathon in some sort of medical capacity, or reporting on your participation in some sort of medical capacity, you were engaging in both of those activities (running and reporting on your experience) as a private citizen, not as a physician.

    Certainly the conventional wisdom is that we should not take someone’s photo without their express permission. However, in today’s society, with cellphone cameras and videos as ubiquitous as they are, people have their pictures taken all the time by total strangers.

    On this very blog, I have seen a senior physician weigh in with commentary on how marvelous it was for a medical student to use his cell phone to take video of a patient experiencing a seizure.

    As physicians of course we should never photograph or film our patients without their (written and consented) permission. I think for a private citizen who happens to be a physician to accidentally post someone’s picture in the course of reporting on a marathon does not seem so egregious, and the outcry from your colleagues seems a little hypocritical, given the widespread admiration for the notion of using Google Glass as a physician assistive device.

  • wiseword

    If you want to display your private parts on Facecrap and Twitcrap,you’re certainly entitled to do so. Have fun. But you’re not entitled (You’re not? Gee whiz!) to talk about or photograph or otherwise use other people.

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