One 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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