Patient Confidentiality and Social Media

In the last decade, social media has changed the face of medicine. There are physicians who live their lives on social media and update their social media status q4h.  In the midst of a physician’s personal photographs, we often come across a patient’s clinical encounter with detailed description, ECG/Radiology Imaging displaying the name of the patient. We need to remember that any information posted on social media could end up on the front page of a newspaper. Posting patient photographs, meticulous description of hospital encounters can certainly put us at risk of litigation.

Breach of patient confidentiality on social media is a legitimate concern and as Health Care Professionals, it is our responsibility to ensure patient privacy. These issues can be extremely sensitive as patients share vital bits of information with physicians (sexual, psych, recreational drug use etc.). Violations in these regards expose us to liability under various privacy laws. 

On one hand, the western countries are extremely cautious about "patient confidentiality" issues whereas in developing nations, the concept of patient confidentiality remains unknown to many medical students, residents, practitioners and as well as the patients. It is not uncommon in third-world countries to find residents and even physicians openly discussing patient details, prognostication in elevators and hospital cafeterias. Conversely, personal information is not released to a patient's spouse without prior patient consent. 

Social media potentially improves health outcomes, facilitates developing a professional network, increases personal awareness of news and discoveries and also aids in providing health information to the community. And the intent behind information sharing on social media is knowledge dissemination and having discussion for the overall betterment of patient care. Nevertheless, this should not be done at the cost of breaching patient confidentiality. Here are a few suggestions that can provide a useful framework before posting any patient related information on Social Media:

• Avoid writing about specific patients: It is reasonable to generalize things when discussing about a patient rather then referring to someone in particular. This shields identification to some extent without loosing the point of discussion.
• Obtain patient consent when required: If you are going to post a photograph on a social media platform such as patient’s ECG or Radiological imaging, make sure you crop the image or take explicit patient consent before posting such information online. If done in the right manner, it is rare to find a patient who will refuse to share his details.
• De-identification: De-identification is the process used to prevent a person’s identity from being connected with information. Common strategies for de-identification include deleting or masking name and DOB, Age, ZIP code. Adding hypothetical points to a patient’s story is another way to de-identify but without loosing the crux of the matter. The Health Insurance Portability and Accountability Act defines data as de-identified if it “does not identify an individual and with respect to which there is no reasonable basis to believe that the information can be used to identify an individual is not individually identifiable health information.”
• Use a respectful tone when discussing patients: Social Media is accessible by everyone. Many patients do not appreciate the fact that majority of medical decisions are based on a physician's past experiences, opinions, local practices and comfort level rather than mandated rigid protocols. Beware of this whenever you are involved in an online discussion accessible by patients  Also, be courteous and demonstrate utmost respect towards a patient. Even when the outcome is going to be dismal, be sensitive while expressing your opinion.
• Have a separate personal and professional account
• Know your local/national laws and policies: If you medical licensing body or hospital has a social media policy, then give it a thorough read. 

Further Reading:

Ventola CL. Social media and health care professionals: benefits, risks, and best practices. Pharmacy and Therapeutics. 2014 Jul;39(7):491.