Remember that one of the defining features of the public physician is that we are out in public. Social networks put doctors and patients in the same places at the same time. Public life brings new rights for the public physician. With those rights come new responsibilities.
So this calls for a readjustment in how we connect and relate to patients.
Social networks don’t change our conversations
But the adjustment shouldn’t be such a big deal because social networks don’t change our conversations.
It’s important to remember that, if you live in the same community where you work, you probably have interactions with patients outside your clinic all the time. It may be as a parent at a school open house. Perhaps you go to the same church or volunteer to monitor junior high school cross-country meets. Your relationship in these situations is different, however, and your dialogue concerns different things.
When you see them in this setting, would you talk to them? How about in a restaurant or a grocery store? Would you try to hide or avoid contact? Or can you even avoid public spaces where your patients are found?
Of course you would talk to them, and you can’t avoid your patients when you live where you work. But would you discuss a treatment plan for a rectovaginal fistula? Probably not.
So just as we have always done, the types of conversations we have with patients should be tailored to the context and medium of interaction.
Things to keep in mind regarding patients and your public presence
There are some good rules to keep in mind when you step out of the clinic and into the virtual world.
1. Avoid public discussion about patients
Remember that most concerns about doctors and their conversations online center on two issues: privacy and professionalism. Professionalism is a little more elusive (our medical cyberculture is a little different from our IRL culture). Privacy, on the other hand, is more black-and-white. It’s simple, actually: don’t talk about patients or patient-specific issues in public places.
Stick to that little bit of advice and you’ll go far in avoiding problems. The only time you should publicly discuss patient stories outside of the clinic is when you have the permission of the patient or family. That should be done through a signed release. If you’re interested in publicly sharing a patient’s story, you should seek the input of your hospital or institution’s office of public affairs.
A good general guideline is that patient-specific issues should be avoided in any place where the privacy of that conversation isn’t secure (e.g., the frozen food section of your grocery store or the comment area of your blog). Dialogue should be issues unrelated to an individual’s treatement.
Here are a couple of examples of how doctors engage with patients without involving patient-specific issues:
- A family practice Facebook page may offer information regarding the availability of flu vaccine.
- A post on your blog about vaccines and autism may stimulate important and instructive discussion about controversies.
- A patient may tweet a link to a new, gluten-free restaurant that you share with your followers or other patients with celiac disease.
Again, what we should or shouldn’t do in public isn’t too much different in real or virtual life. The medium doesn’t change our standards.
2. Keep patient information off of your smart phone
Despite its remarkable capacity to organize, capture, and collect, your smartphone and the details of your patient’s medical history don’t mix.
As a general rule, keep patient information off of your phone. If your smartphone is managed by your hospital’s IT department and there are approved applications for patient management, that’s one thing. Otherwise, stay clear.
Remember that your smartphone is like an airplane’s black box. Anything you do and any communications you have represent a record that could come back to haunt you. Text messages, emails, and other sundry bits of stored information could not only endanger a patient’s privacy, but are subject to discovery in the event of legal action.
Forbidden places where doctors sometimes park clinical information
These forbidden digital spaces should be obvious to modern doctors. Students and trainees sometime forget. So these applications worth a quick mention:
- Google Drive. While this may seem like a great place to store the list of patients on the surgery service, Google’s servers are not designed for patient privacy. Until a better option emerges, use paper. Oh, and by the way, don’t set the paper down anywhere.
- Evernote. Evernote is a cloud-based note application and like Google Drive, its servers don’t meet legal standards for protecting patient privacy.
- SMS text messaging. Despite the fact that nearly forty percent of physicians use text messaging in the management of patients, it is considered an unsafe medium for protected health information. Information, patient names, and diagnoses are not protected from the cell service’s prying eyes.
- Email (non-encrypted). Email is a great way to communicate with patients, but it has to live on a server that is specially managed to be compliant with health privacy laws. While few students and residents use email to communicate with their patients, it should only be done on encrypted email servers. This does not include Gmail and Yahoo.
Platforms for illegally and unsafely organizing patient information are growing faster than this site can keep up. The safest policy is to assume that everything’s out of the question until proven otherwise.
3. Remember that your obligation to patients goes above the law
Since federal law made it illegal to share protected health information (via the Health Insurance Portability and Accountability Act (HIPAA)), hospitals and institutions are preoccupied with making sure everyone is up to snuff on health privacy law. This is a good thing since the penalties for transgressions can be costly both in terms of money and damage to an institution’s reputation.
But the problem with all the HIPAA training is the accompanying belief that, if something is HIPAA-compliant, we’re good. And this is why lawyers can’t teach us how to be doctors.
Let’s say, for example, that you are in the neonatal intensive care unit (NICU) consulting on a new case of neonatal hemochromatosis (a rare neonatal condition of iron overload). It’s an interesting condition and something not seen very often.
Excited and pumped, you decide that you want to share your enthusiasm with your followers on Facebook with something along the lines of, “I saw an amazing case of a baby with neonatal hemochromatosis today. Crazy but interesting disease.”
By definition, this public posting wouldn’t represent a violation of health privacy law, and according to what many of us are taught, if it doesn’t break the letter of the law, we’re good.
But not so fast. While there are no specifics regarding the patient in question, is there a chance that the mother, who happens to follow you on Facebook, could see your post? Of course. What would she think and how would she feel if she believed you were publicly commenting about her daughter?
Some patients would find it kind of cool. Others wouldn’t.
There are plenty of other examples where a family could put two and two together despite your best de-identification. Don’t leave this to chance and always assume that the public sharing of even vague details is something that wouldn’t be okay with the patient or family.
Our obligation to patients goes above anything defined by the law.
Some good reading
Should Doctors Write About Patients? | Anna Reisman | The Atlantic
When Doctors Write About Patients | 33 charts
To learn more about talking about patients online check out the ultimate guide for doctors online. Visit The Public Physician landing page.