Confidentiality
Example 1:
You are working in a rural hospital and make a comment on a social networking site about an adverse outcome for one of your patients. You are careful not to name the patient or the hospital. However, you mentioned the name of the hospital you are working at in a post last week.
A cousin of the patient searches the internet for the hospital’s name in order to find its contact phone number. In the search results, the patient’s cousin is presented with your posting mentioning the hospital. The cousin then sees the subsequent posting regarding the adverse outcome involving the patient.
Doctors have an ethical and legal responsibility to maintain their patients’ confidentiality. This still applies when using any form of online tool, regardless of whether the communication is with other doctors, a specific group of people (eg, ‘friends’ on social networking sites), or the public (eg, a blog). The anonymity potentially afforded online is no excuse for unprofessional behaviour.
Before putting patient information online, think about why you are doing it. You should inform the patient and gain their express consent, and acknowledge that consent has been obtained in any online posts. If you feel it is appropriate to discuss a patient case—for example, to further that patient’s care or the care of future patients who present with a similar condition—care must be taken to ensure that the patient is properly de-identified. Using a pseudonym is not always enough; you might have to change case information or delay the discussion. The accessibility and indexability of online information means that although a single posting on a social networking website may be sufficiently de-identified in its own right, this may be compromised by other postings on the same website, which are just a mouse click away.
In maintaining confidentiality, you must ensure that any patient or situation cannot be identified by the sum of information available online.
Breaching confidentiality can result in complaints to your medical registration authority (with potential disciplinary action, including loss of registration), involvement of the Privacy Commissioner, or even legal action (including civil claims for damages). In Australia, Medical Boards have already investigated doctors for patient-identifying information posted on social networking sites.9,10 Moreover, breaching confidentiality erodes the public’s trust in the medical profession, impairing our ability to treat patients effectively.
Defamation
Example 2:
Dear Emergency Registrar,
Thanks a million for misdiagnosing my patient’s perforated bowel as constipation and treating aggressively with laxatives. I’m sure she appreciated the subsequent cardiac arrest and multiorgan failure. Don’t worry, she just needs a new set of kidneys and a liver and she’ll be right.
And with that kind of performance, I’m sure you can help her acquire them.
Kind regards,
Lowly intern
(based on an actual posting on a social networking site)
Another potential risk of inappropriate online comments is defamation. Defamatory statements:
- are published to a third person or group of people
- identify (or are about) a patient/colleague/person (‘subject’); and
- damage the reputation of the subject.
Professional codes of conduct specify that doctors should not engage in behaviours that can harm the reputation of colleagues or the profession.11 Be mindful about comments made about colleagues (medical or otherwise), employers, and even health departments. Defamation cases are civil claims, in which substantial monetary compensation can be awarded.
References
9 Pow, H. Doctors Caught Revealing Secret Patient Information on Facebook Posts. The Sunday Telegraph [internet], September 25 2010 [cited September 2010]. http://www.news.com. au/technology/doctors-caught-revealing-secret-information-on-facebook/story-e6frfrnr- 1225929424789
10 Brill, D. Social Networking: Facing the facts. Medical Observer [internet], May 2010 [cited October 2010]. http://www.medicalobserver.com.au/news/social-networking-facing-the-facts
11 Ibid 3.
