Confidentiality in the Era of Social Media

Grey’s Anatomy S07E13: Dr Miranda Bailey has a twitter feed which she uses to educate medical students across the nation about Dr Bailey’s cases and surgeries. The patients involved have given consent, but when the Chief of Surgery discovers it, his orders are to shut it down until he has been able to investigate possible ramifications.

Stellenbosch Medical School 2011: The MB.ChB.III. class starts their clinical rotations. For weeks, our Facebook newsfeeds are flooded by statuses of “firsts” – I caught my first baby, I did my first rectal exam, I assisted in my first appendectomy (etc, with many exclamation marks).

This matter was recently brought to light by an anonymous complaint, presumable a member of our class or course. We are requested (unofficially), not to talk about procedures we have performed on Facebook.

The pros and cons of social media in business, law and print media has been debated and discussed ad nauseum. But what are the implications of Facebook, Twitter and blogs to the confidentiality of our patients?

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Google-hypochondriasis aside, the internet-era offers a massive educational potential to students. Several times I have found images of real patients with real conditions on the blogs of MDs – these patients gave consent, of course, but not once were their eyes or any other distinguishing feature displayed in these pictures.

The other aspect of social media is more personal – for example, when I delivered my first baby earlier this year, I posted the news on Facebook. It is the status of mine that probably got the most “likes” and comments since I have been a member. I live very far from home; I was doing 24-hour calls and did not have much other time or opportunity for a kind-of “debriefing”. This was it, and (say what you want about loss of true communication because I might be inclined to agree) it was good for me.

On this blog I have written about some patients and some diagnoses. Never have I revealed any matter that may expose their identity – no name, no address, no distinguishing features or characteristics.

The Hippocratic Oath states,

Whatever, in connection with my professional practice, or not in connection with it, I may see or hear in the lives of men which ought not to be spoken of abroad I will not divulge, as reckoning that all such should be kept secret.

I have read and re-read this, and I have thought and spoken with others. I think it is clear that health care workers are to maintain confidentiality and protect our patients – I do not, however, think that this means we cannot refer to diagnoses, procedures or clinical experiences, as long as we protect the identity of our patients and preserve their dignity.

Simply abstaining from talking about things is what has allowed things like HIV to gain such massive stigma – if doctors won’t talk about it, who will???

[Admittedly, this is also the oath that states that we will not treat slaves and that we will offer free medical education to the children of our lecturers. Just saying.]

I have friends who are teachers and have changed their names on Facebook so their students do not get to view their statuses. One day when I am a fully-fledged doctor, will I do that? Perhaps a parent would not be very happy if I posted a status such as, “Diagnosed my first Kawasaki Disease patient today.” I would not mind, but then again, I am not a parent.

The other question: will patients feel comfortable being examined by me if they have read my blog?

I do not know. And while I do agree fully with doctor-patient confidentiality, I see no reason why one should abstain from making simple statements about your experience in the clinical set-up, provided you respect that confidentiality.

I do welcome all opinions, including disagreements. Feel free!