Ethical Doctor Blogging

PalMD (of the White Coat Underground) tweeted a link to a 2008 post calling for a code of ethics for MD blogging. A study under review showed:

17% of the blogs include enough information for patients to identify themselves or their physicians

I occasionally blog stuff inspired by my patients. I never worry that they will identify me- if they don’t, I would be really worried! I use my real name and image, after all.

Most of the time I am blogging a condition, such as volume overload or neonatal hypertension. While these posts may have been inspired by one or more in my care, the posts reviewed the conditions; no patient data of any sort were shared!

Could my patients identify themselves from my posts? A number of parents of hypertensive neonates probably believe their child inspired me to put fingertips to keyboard, but they cannot tell from that post. Only one post comes to mind in which the patient concerned would know for sure it came about because of him: the post on Page kidneys. Given the date of the post, the few vague items presented, and the fact that this patient knows he has the honor of being the first and only patient I have treated for this condition, he would figure it out.

I do not feel this post is unethical. Only someone who knows this person’s diagnosis and that I am his doctor can identify the patient. If they already know that much about him, they will learn nothing new from the post! The pathophysiology of Page kidneys, not the patient, remains the focus of the blog.

I would never try not to moan about inappropriate or inconvenient patients in a public forum. All physicians have “war stories” that we share; this blog is not the time or place. Occasionally I write about colleagues when either (1)I do not care if they read it and know it is about them; or (2) I have no clue who it is. Either way, no ethical issues apply. These situations are like complaining about jerks in traffic.

I have to go see a patient now. I am not going to say who, where, or what, though. And this kid will never know s/he inspired my closing today!

Image above is my daughter about 20 years ago. No patients were compromised in the creation of this post.

HIPAA Meets Politics Via Twitter

The following story hit my mailbox yesterday, courtesy of HIT News. Seems a worker in Mississippi has lost her job by getting a little snarky with protected health information via twitter:

A simple tweet has sparked a HIPAA compliance and public relations mess at Mississippi’s University Medical Center, and an administrative assistant is out of a job as a result, reports a local TV station.

The controversy began when Mississippi governor Haley Barbour posted this tweet on his Twitter page: ”Glad the Legislature recognizes our dire fiscal situation.  Look forward to hearing their ideas on how to trim expenses.”

“Schedule regular medical exams like everyone else instead of paying UMC employees over time to do it when clinics are usually closed,” tweeted UMC administrative assistant Jennifer Carter. She had heard that the governor had come into UMC for a physical one Saturday three years ago, and that the clinic had to be staffed up with 15-20 workers just for his visit.

Next: Carter paid dearly …

Two days later, Carter was in UMC’s compliance office for violating HIPAA’s privacy provisions. The Compliance Department told her the Governor’s Office had tracked her down and told them to deal with her,” according to WLBT.

Carter says she was suspended without pay for three days and “strongly encouraged to resign,” which she did. She says she ”wasn’t really jabbing” at the governor.  ”That’s just what people do on Twitter.”

I explored a number of the links provided on the site, yet I have one big unanswered questions about the event:

Did the governor publicly acknowledge his physical or its results at the time of this appointment? Those in the public eye, especially in an election year(Barbour is up for re-election in 2011, so this event took place during his last quest for office), often have their physicals and then assure the public that they are in great health. If it was public knowledge that he had the physical, then I am confused about where the break in protected information occurred. Carter said nothing about his health, merely commented on the “unnecessary” costs the state may have incurred. Given security issues with a prominent government official, the situation described may have been the least disruptive for the medical center’s other patients. It could even have been a cost-effective measure when all other factors were considered.

If the appointment was not publicly acknowledged, then Carter’s tweet was clearly a violation of HIPAA, since knowing the date and circumstances of a medical procedure can compromise one’s privacy. Her defense- she ”wasn’t really jabbing” at the governor- seems silly. Clearly, she was questioning the governor’s judgment and priorities. Such “jabbing” would be protected speech… if a healthcare appointment weren’t involved.

Social media, like twitter, allow us to find our audience as never before. We all must remember our legal and moral responsibilities, and use these freedoms wisely.