Takeaways from One Doctor’s Facebook Faux Pas

February 6, 2013

imgresOne St. Louis obstetrician drew attention for select Facebook comments posted last week.  Dr. Amy Dunbar posed the veiled threat to show up late for the induction of a patient who had been consistently late for her prenatal visits and ultrasounds.

It’s interesting that the public discussion and the response of her hospital, Mercy Hospital St. Louis, has been positioned around HIPAA.  We reach for HIPAA because we have no other way to frame the issue.  We train to HIPAA but spend little time thinking about a our commitment to patients which lies well above the law.

This situation would have been prevented by avoiding the public discussion of patient-specific matters.  Beyond that, here’s what I tell students and residents: In the event that a case must be discussed in a professional setting or for instructional purposes, we should keep in mind the sequence of privacy, respect, intent, perception (PRIP).  Privacy, of course, is a legal and moral mandate.  Our comments should be respectful.  We should always consider the intent of the discussion – why is the issue being raised.  Finally we want to think how our comment could be perceived by those listening, especially the patient.

What’s unfortunate is the Dr. Dunbar may be an amazing clinician.  But in the age of short-form commentary shared in near real-time, perception trumps reality.  Internet luminary Howard Rheingold has suggested, “Without tone of voice, facial expression, and body language, text-only online discussions strip a surprising amount of emotional context from the cues we use to surmise what other people really intend.”  What we see is all we know.

The truth is that thoughts like these run through the mind of every busy clinician from time to time.  Dealing with humans (doctors or patients) is tough business.  Having frustrating thoughts is one thing, but what we do with them is another.  In the days before doctors became publishers, comments like this would rarely go beyond earshot of the nursing station.  What’s different now is that our current spaces for dialog create the possibilities of what danah boyd has characterized as permanence, replicability, searchability and scale.

While patients and doctors may travel on the same path, patients get the right of way.  It’s challenging sometimes but that’s the way it is and should be.

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Carolyn Thomas February 6, 2013 at 10:34 pm

Okay, how can I say this charitably?

Dr. Dunbar is an idiot.

I know this because only an idiot would publicly post snark like this about one of her patients (even if all parties agreed that the patient was richly deserving of said snark).

Dr. D, alas, is not alone. Consider E.R. physician Dr. Alexandra Thran, who was fired from her Rhode Island hospital last year, and subsequently reprimanded by her state medical board, because she posted personal information online about one of her trauma patients. There are far too many examples like this; Mayo Clinic Center for Social Media actually used to run a column called “Friday Faux Pas” listing some of the juicier Facebook and Twitter culprits along with their ultimate punishments. Pretty sobering stuff that Dr. Dunbar and all other docs would do well to heed.

I’m merely a dull-witted heart patient, but honestly, I just don’t get it. Social media is not and never will be the same as muttering to a few of your colleagues around the nursing station no matter how tempting that surely is at times (but even there, I’ve been shocked to hear how careless and disrespectful docs and nurses can be when openly discussing patients or family members within earshot of strangers. What are they thinking?)

And it’s NOT just about privacy violations here. It’s about common sense and common courtesy and how you speak about patients in what you know is a public forum. As my mother used to warn when teaching us manners as little children:

“You just can’t TALK like that!”


Quackling February 7, 2013 at 7:13 am

I have been thinking a lot about what to say and not say regarding doctoring / hospital life on the internet. Thanks for sharing, I think it was helpful to point out the differences between what we say and what we write online. Especially what you mentioned about words without a face being easily misunderstood, and about the permanence of what is written online.

From the commenter’s side, I think the internet gives a somewhat false sense of freedom and anonymity too.

~R February 7, 2013 at 9:36 am

Just guessing the mad mom-to-be’s that exposed this did so more because of the snarkiness rather than the possible HIPPA reveal, but now because of all this, everyone posting on their FB group can see each and every post in their group, because it’s not a private group (guessing in order to make it easy for new potential patients to join). But, all the web can see all your posts now. Is that Ironic or Irony? I never learned to tell them apart.

Anthony Back February 7, 2013 at 11:40 am

This is more about a particular person’s emotional self-regulation than social media per se–but the social media channel exposes poor self-regulation relentlessly–every slip is sticky, visible to many others, and for a long time…

Cheryl Handy February 7, 2013 at 2:00 pm

There is a subculture of physicians who are becoming resentful and irritated at patients generally. Maybe these physicians feel overwhelmed by the onerous requirements of a bloated healthcare system. I read posts everyday written by frustrated physicians who seemingly have such a distain for their own patients.

I am absolutely not suggesting that Dr. Dunbar is resentful of her patients generally. But, as Dr. V sagely states “reality trumps perception.” If I were one of Dr. Dunbar’s patients, I would wonder what she is saying about me behind my back.

MS February 7, 2013 at 3:04 pm

Interesting post for me personally. I recently deactivated my FB account because I’m a person who is a physician. I have feelings, thoughts and opinions that even my wife doesn’t always agree with. I am afraid of how my private posts or “like”s could be misconstrued. Physicians are trained to be as nonjudgmental and accepting as possible, to the point of sacrificing our own feelings, thoughts or opinions. That is one reason physician suicide has increased significantly. FB used to be a source of creativity, humor, and community. Now, as a physician, I see it as a potential liability.

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