Facebook and the Rhode Island Doctor

April 21, 2011

As we work to get our fellow physicians to emerge from the shadows, the last thing we need is a social health horror story.  This week a Rhode Island physician was formally reprimanded for breaching patient confidentiality on Facebook.  You can get catch up with the core story on MSNBC or read KevinMD’s nice analysis.

Look for a screen grab of the MSNBC headline at a compliance lecture near you (pointer slapping against screen: “This is what happens when doctors use Facebook“).

A few thoughts of my own:

Don’t assume ill intent. While it’s never Kosher to disclose protected health information, we don’t know the nature of the dialog in this case. This may have been innocent mistake made while sharing a remarkable experience. On the other hand, it could have represented poor professional judgment.

Irony. The world clamors for doctors to be more engaged. But when (not if) we make a mistake our names are at risk of going viral.  And yes, the bar should be set higher for us.  I just wonder if news like this represents the best way to handle a profession’s social growing pains. This story represents one more reasons for doctors to hide under their exam tables.

It’s the medium, not the message.  Unfortunately disclosure of protected health information occurs more often than we’d like to admit. But when was the last time we saw MSNBC headline a patient privacy violation made on the radio?  Anything Facebook is newsworthy.  Ultimately this story’s more about the medium, less the transgression.

How do you define a jury of your peers? When it comes to the definition of unprofessional digital behavior, I’m concerned that early adopting doctors may not be given the benefit of the doubt when it comes to professional review. In fact, peer review by those who think that Twitter is something done by delinquent teens may not really represent peer review.  Expect physician transgressions on public platforms to evoke extraordinary consequences.

Could this be a teachable moment? With the blessing of her hospital’s compliance officer, a guest post on 33 charts or KevinMD, for example, would turn a negative into a positive. Think how an open dialog of this case could influence medical students and the discussion surrounding digital professionalism.  And everyone loves redemption. Westerly Hospital, you have my number.

Here’s an absolute: if you don’t talk about patients it’s impossible to commit a health privacy violation (or correct me if I’m wrong).

This is just one casualty of an evolving communication medium.  Expect more.


{ 14 comments }

Susan Giurleo April 21, 2011 at 12:50 pm

Bryan, I agree that the media exposure over this is unfortunate. I go into the elevator at a hospital and hear confidentiality breached often. And doctors are reprimanded and sued (rightly or wrongly) every day, too. It’s just this new fangled thing called social media is easy to point fingers at and use as an excuse to close rank.

I also agree we’ll see more of this and I think we’ll continue to need brave professionals to keep going forward.

And, yes, never talking about patient information protects us completely : ).

DrV April 21, 2011 at 8:13 pm

While the details in this case aren’t clear, it’s scary to think about the various ways we can trip. The case for health professionals can be made it’s just as easy to keep to yourself. Thanks for your insight, Susan.

Greg Smith MD April 21, 2011 at 1:10 pm

Bryan

Good look at this issue.
Hard sometimes to balance the power of emotion and passion in medicine with the restraint needed to have an ongoing online presence.
How do you try to do this on a daily basis for yourself?

Greg

DrV April 21, 2011 at 8:17 pm

Provocative question, Greg. I can always count on you to make me think. Will ponder and post in the next few days. And thank you.

Derek Warnick April 21, 2011 at 1:57 pm

To me, this issue highlights the need for continuing professional education in the realm of social media for physicians and other HCP’s. Sadly, the CME industry as a whole is a notoriously late adopter and there are few organizations in a position to provide the needed education (full disclosure: I work for a CME-certified med ed company).

We are making strides, though. Yes, I believe this can (and should!) be a teachable moment. Hopefully it will prove to be an opportunity for more conversation and education about HOW & WHY to use social media rather than an excuse for WHY NOT.

Derek

MJ Robinson! D.O. May 5, 2011 at 10:48 pm

It is not just CME thatnneeds to bring the issue up, but also this should be part of the professionalism/ ethics curriculum in medical school . As a curriculum chair I have been researching the issue for the last few days and find no schools have this or if they’d it is buried and an afterthought. this was on twitter today
http://www.freshwhitecoat.com/2011/05/almost-taught-us-nymc-iv-hcsm.html?m=1 from a graduating NYU student.

Matt Cyr April 21, 2011 at 2:50 pm

Dr. V,

Great take, as usual. Your line about the perils of being an early adopter are spot on. To the people who understand that this is the direction health care is heading (nay, that we’ve already arrived there), physicians like yourself—who do this for the right reasons and with the best intentions—represent an exciting refutation that things can’t and won’t change for the better in how we talk about health.

On the other hand, to your peers who probably see you and others as less-than-serious because of your efforts in social media, this is the ultimate “I told you so moment”.

Don’t listen to them (not that you would). Continue to prove the value of openness and keep taking on the inherent risks of the early adopter. Medicine itself is built on that spirit; communicating about it should be as well.

DrV April 21, 2011 at 8:23 pm

Thank you, @MattCyr. I have to say that these things are scary to hear. While I consider myself ‘safe’, I’m not immune to review. I always say the right people in power could easily find some of my views ‘unprofessional’ and make my life difficult. But to live with that over my head would be to impose a level of inhibition of thinking that would make it all pointless.

David April 21, 2011 at 6:27 pm

If the incident violated HIPPA then HIPPA rules. She was dismissed from the hospital. She was fined. She didn’t lose her license. She’ll find a new job.

Privacy under HIPPA is privacy, and the digital media revolution does not change the HIPPA message on privacy. Nor should it.

DrV April 21, 2011 at 8:30 pm

Yes, David, HIPPA rules. And I hope I made that clear.

With regard to your last comment, I might suggest that the digital media revolution will ultimately change the HIPPA message on privacy. The same patients who spurred HIPAA in the early days of AIDS want more open dialog. I sincerely believe that we will see a movement to ease the rigid restrictions that we live with. What began as a mechanism for protecting patients is evolving as one that holds patients and doctors from sharing their stories.

Lisa Fields April 22, 2011 at 10:47 am

Bryan,
As my friend Susan mentioned, I too have heard conversations about patients taking place in elevators and other public spaces within medical settings.

Is this a teachable moment? You Betcha!
This unfortunate case gives me the opportunity to further develop my own “elevator speech”explaining the benefits of social media for both health professional and patients.
Thank you,

Anthony Back April 22, 2011 at 1:52 pm

Re your last comment ‘here’s an absolute’: the issue here is that these kinds of issues rarely submit to absolutes–they are issues of balance. Agreed, the social media channel is a brave new world. But i think the real issue is, how should doctors make decisions here? What are the parameters? What do patients think?

Ann Becker-Schutte, Ph.D. April 25, 2011 at 10:47 am

Anthony,

So are you asking how health care professionals should make decisions about using social media as a tool for communication and teaching? Or asking under what circumstances practitioners should discuss patient information? Because I think those are different questions. If you’re speaking to the point made at the end of the article–that we can’t violate patient confidentiality if we don’t discuss patient information, I think we need to think about patient information in conservative terms. I’m a huge fan of social media for professional connection, and education.

I think that for now, HIPPA (and respect for our patients) means that our responsibility is clear. Just as I don’t talk about patient information when I’m out to lunch or at home with my family, I also don’t use *any* patient information in public social media. When patients use email, we discuss the limitations of confidentiality & use some clear guidelines about sharing personal information. I don’t think that we have much leeway in setting other parameters for now.

DrV April 25, 2011 at 11:27 am

My question, Ann (am I’m not sure I have a good answer), is whether we’re safe ‘de-identifying’ information. We have important stories to tell. Perhaps these stories need to be portrayed as fiction??

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