I’m a doctor and so it’s not surprising that I have many doctors on my list of Facebook friends. Not often but not as rare as I would want it to be, I’ve seen various photos I’d rather not see on my Facebook feed: a dismembered hand reattached, a humongous ovarian tumor, an eye socket with a knife sticking out of it, a patient unconscious on an operating table, patients in the background at the emergency room, and hands in bloodied surgical gloves around a draped boy’s body at circumcision missions.
I haven’t lost a friend, though it’s been a near miss a couple of times, because when I see photos like these I send a polite private message in this vein –
Please don’t take this the wrong way, but I think the photo you posted violates patient’s privacy and confidentiality. Although it is nearly impossible to identify the patient based on your photo, I do know you and the hospital where you are (there’s a logo of the hospital on the linen), and with due diligence it would not be impossible to find out the name of the patient because of the unusual nature of this case. Did you ask the patient’s consent to post this picture?
Some take down the picture and thank me for the reminder. Some confirm that they have the patient’s permission and amend their post to reflect “Posted with permission.”
But the question has come up quite often. What is acceptable behavior?
There is a paper on this subject! The Ethics of Clinical Photography and Social Media by Cesar Palacios-Gonzalez (Med Health Care and Philos 2015 Feb;18(1):63-70). Let me discuss some highlights.
First, some definitions.
PRIMARY use of clinical photography. For patient’s care.
SECONDARY use. For medical education and research.
For primary use of clinical photos on social media, the author advises to weigh
the direct benefits that publishing a patient’s picture on social media can have to the patient’s treatment.
The example given was that of being the only doctor in a remote clinic and getting a patient with a spider bite. The photo of the bite can be posted online in a tropical medicine Facebook group for possible identification. The author posits however that surely there are other safer options to share clinical images. I’m thinking aloud – email? MMS?
The second argument against primary use put forth by Palacios-Gonzales is that of having inadequate information as to the terms of use and privacy settings of social media platforms by both patients and doctors. This would preclude giving an informed consent. To partly solve this, the author recommends that
- The patient be told that the doctors do NOT know the terms of use and privacy settings and see if the patient still gives consent.
- The doctors should explain to the patient “possible harms that disseminating a clinical image on social media may have.”
- The doctors should erase the clinical photos as soon as possible.
Frankly, I think it’s too risky to use social media for sending clinical photos for treatment or patient care. The issues with secondary use are more interesting to me. As always, informed consent is needed. But the author is definitely correct when he says –
Any image that is published on the internet can be copied and redistributed without the knowledge of the person that uploaded it… healthcare providers would not be able to retrieve or delete all the patient’s clinical images if she recants her consent.
The second point that the author raises is the interaction between the uploaded content and the social media users. Remember that secondary use of clinical photos is for medical education and research. This imposes a responsibility on the doctor that uploaded the photos –
… they should moderate the comments, and other interactions, in order to avoid derogatory remarks about the clinical images or the patients depicted.
What this paper does not answer is the ethics of healthcare providers taking selfies in a clinical environment. This calls to mind the case of the Chinese doctors who were punished for ‘surgery selfies’. Should doctors not be allowed to Instagram in the hospital? A question for another post, another day.
#Day2
Thank you for this article. My question though is about us clinicians. How should we react if we caught a patient’s relative recording us (audio or video) during outpatient consultation or hospital rounds? Do we also have the same privacy privilege?
Thanks for the question Catherine! We did a #HealthXPh tweet chat a few weeks back about this very question. I’ll try to summarize some points raised then in another blog post. A quick answer for now – yes. Most clinicians agree that consent from the physician is still needed.