The Doctor Will Tweet an Embarrassing Photo of You Now

What's to come?
Jan. 10 2014 11:08 AM

What Happens in the Hospital Doesn’t Stay in the Hospital

Some doctors and nurses use social media to share embarrassing photos of and information about patients.

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When online privacy breaches first began to occur, many institutions had no applicable rules governing the use of electronic content. At Stony Brook University Medical Center on Long Island, development of such a policy quickly became a priority in January 2010, when a photo began to circulate showing a medical student posing with a dissected corpse in the anatomy lab. (Federal privacy protection does, in fact, extend to deceased people under most circumstances.)

Lots of unauthorized disclosures can be attributed to technological naiveté or sheer carelessness. A piece in Clinical Obstetrics and Gynecology points out that many social media sites have followed the lead of Google Plus in simplifying privacy settings, allowing even techno-rubes to shield their conversations from public view. Yet a recent article in Teaching and Learning in Medicine laments that 62 percent of medical students and 67.5 percent of residents on Facebook neglect to modify the default visibility preferences.

Despite the flak over these and other indiscretions, a recent Harris Interactive poll indicates that 79 percent of Americans trust health care professionals to safeguard sensitive information. Providers will have to be more cautious than ever, though, as new crowdsourcing apps are introduced. The collaborative nature of popular platforms like Sermo may tempt clinicians to volunteer confidential details about their patients. Other apps use crowdsourcing to generate shared medical image databases. Figure 1 automatically detects and blocks out faces on uploaded images but relies on users themselves to obscure tattoos, moles, and other distinguishing features.

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Some doctors have misgivings about employing social media in the service of patient care: “What if one finds something that is not warm and fuzzy?” frets resident physician Haider Javed Warraich in a post this week on the New York Times’ Well blog. Despite his reservations, Warraich defends the practice, pointing out that doctors have used online intel to gauge suicide risk, discover relevant undisclosed criminal histories, and contact the families of unresponsive patients.

Social networking was also helpful on the day of the Boston Marathon bombing. Doctors near the finish line tweeted accounts of the attack to local emergency personnel six minutes before official announcements were made, giving staff critical time to prepare for the arrival of victims.

But until the utility of online sharing in health care contexts becomes obvious to hospital operatives, they’ll continue to view it the way the rest of us regard twerking—if we ignore it long enough, surely it will just go away. Nearly 60 percent of the health care professionals surveyed by InCrowd report having no social media access in clinical settings at work.

The American Nurses Association, American Medical Association, and other trade groups have tried to soften administrators’ hard line by setting standards for social media use in the workplace. They’ve published guidelines packed with nuggets like “Pause before you post” and “Be aware that any information [you] post on a social networking site may be disseminated (whether intended or not) to a larger audience.” These insights will undoubtedly be useful to CompuServe subscribers. In addition, the AMA urges its members to maintain separate personal and professional identities, a strategy that’s likely to work as well for doctors as it has for Anthony Weiner.

In 1999 the California HealthCare Foundation issued a report titled “The Future of the Internet in Health Care: Five-Year Forecast,” by Robert Mittman and Mary Cain of the Institute for the Future. Some of the authors’ predictions fell short—notably, they failed to anticipate The Google. (“Weaknesses in Web browser and search engine technologies,” they observe, “will limit the appeal of the Internet to health care providers.”) But overall, the forecast proved remarkably prescient. Its conclusions about online privacy foreshadow the equilibrium most contemporary patients and providers have reached: “[T]here will inevitably be several well-publicized incidents of people being harmed by public releases of their health care information—those exceptional cases will shape the debate,” the report predicts. “[I]n the end, people and organizations will have to learn to live with a less-than-perfect combination of technologies and policies.” Even health care executives must eventually relent and entrust doctors and nurses with the weighty responsibility of unfettered social media access. For now, their duties will be limited to saving lives.

This article is part of Future Tense, a collaboration among Arizona State University, the New America Foundation, and SlateFuture Tense explores the ways emerging technologies affect society, policy, and culture. To read more, visit the Future Tense blog and the Future Tense home page. You can also follow us on Twitter.

Melissa Jayne Kinsey is a medical writer and the owner of Nicholson & Stillwell. She blogs about the science of stardust at KinseyonCharisma.com.

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