Social Networking and Patient Confidentiality

ConfidentialityDo you ever think it is appropriate to discuss a patient online, even if identifying details have been changed? What about posting pictures?

A New York Times ethicist recently answered a question from a medical student concerned about her classmates who post “de-identified” photos of their patients as punch lines to jokes – in this specific context, a 5’9 Hispanic man who had been impaled by a bar. The student was worried that this violated patient privacy. The ethicist explained that when putting such information in the public sphere, it is important to ensure not only that the patient is unidentifiable to others, but also that the patient could not recognize himself online. If the patient came across this photo, he would likely know it was him and be embarrassed – not to mention hurt or angry that his doctor treated him like a punch line.

Cell phones with cameras, email, Facebook profiles, Twitter accounts all offer new opportunities to accidentally disclose confidential patient information. HIPAA forbids disclosure of “individually indentifying patient information,” and violators can be penalized with up to $250,000 in fines and 10 years imprisonment.

What you think is vague may be completely obvious to someone else. For example, even if you change identifying details, descriptions or photos of gruesome injuries and freak accidents may give away the subject of your case. And if you live in a small town and refer to, say, a female ER patient from the night before, this description may apply to only one person. To keep your patients’ identity safe, and, more broadly, to represent your profession responsibly, remember to keep your work and personal life separate when you log on.

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