I believe we should first as a medical community outline what is acceptable and not acceptable to be posted in social networks. I believe a lot of us are still not clear as nothing concrete has come out to my knowledge. As for patient privacy, with or without permission, it would be inappropriate until we have established specific guidelines on how to be using social media for health education purposes and where and what is acceptable to be posted. A textbook is for learning purposes so let's see if a day comes when we can define Facebook as a medical learning tool as well. Until then, it may be best to respect patient privacy and refrain from posting. Great question and looking forward to other responses. Thanks!

Thanks so much for your response to our responses Maurice. Thank you for the AMA guideline link as well. I did come across this a few weeks ago before I started teaching intro to social media to my physicians but as you mentioned, we are missing some specifics. Hopefully, we will generate more interest in the importance of physicians and other healthcare providers receiving clear guidelines so we all know how to proceed within social media. Look forward to more ehealth questions and discussions.

The issue of patient consent, Christine, either as an actual photograph of a lesion or the telling of a clinical scenario based on a patient's experience may be difficult or even impossible to obtain particularly if the event or photograph was obtained years ago or the patient's current address is unknown or is now deceased and family members are unknown. Does this mean that presentation of a photograph or scenario should be forbidden? Again, I am thinking about the intent of use: for education vs frivolous use.

Considering now the frivolous use such as what might be to display the body or organs of an unidentifiable human for the submitter's personal "gain" on Facebook or some other social media outlet, I would suggest that could be a different matter ethically compared with display for the constructive education of others. I would look at the intent and purpose of a display for these constructive educational purposes as meritorious with respect to the importance of preserving the dignity of all humans whether deceased or alive. I would consider frivolous use as unethical and rejection of such dignity. When those at the start or during the course of a medical career as some healthcare provider or as a hospital or clinic employee use a patient's story or image solely for self-gain then one should question the ethics if not additionally other serious aspects of this behavior. Right? ..Maurice.

[For your interest, I wanted inform those reading this Question that I posted this thread on my own Bioethics Discussion Blog

http://bioethicsdiscussion.blogspot.com/2011/02/should-non-identifiable-picture-of.html#comments

today (of course, without including the responses to my Question as written here) but also invited my Blog visitors to come to Medpedia to read here all your responses.]

Though the following is a bit off the main context of my question, nevertheless, I think it is important to remember that though we were discussing the public distribution of patient medical information (clinical body images) on the internet the ethical issue goes two ways. The second way is the searching online for patient information and the question as to whether that is ethical especially if that searching and use is being performed by a medical professional. The information including pictures could have been placed by the patient him/herself either intentionally or unintentionally or it could be a remark or picture placed there by some other person who has interacted with the patient. In any event a simple Google search might find the information but could this information lead the professional to providing a benefit for the patient or would it permit exploiting the patient?

This issue has been discussed in the medical literature and the summary
http://informahealthcare.com/doi/abs/10.3109/10673221003683861
of one recent article follows.:

Clinton BK, Silverman BC, Brendel DH. Patient-targeted googling: the ethics of searching online for patient information. Harv Rev Psychiatry. 2010;18(2):103-12

" With the growth of the Internet, psychiatrists can now search online for a wide range of information about patients. Psychiatrists face challenges of maintaining professional boundaries with patients in many circumstances, but little consideration has been given to the practice of searching online for information about patients, an act we refer to as patient-targeted Googling (PTG). Psychiatrists are not the only health care providers who can investigate their patients online, but they may be especially likely to engage in PTG because of the unique relationships involved in their clinical practice. Before searching online for a patient, psychiatrists should consider such factors as the intention of searching, the anticipated effect of gaining information online, and its potential value or risk for the treatment. The psychiatrist is obligated to act in a way that respects the patient's best interests and that adheres to professional ethics. In this article, we propose a pragmatic model for considering PTG that focuses on practical results of searches and that aims to minimize the risk of exploiting patients. We describe three cases of PTG, highlighting important ethical dilemmas in multiple practice settings. Each case is discussed from the standpoint of the pragmatic model."

In conclusion, it appears not only should there be guidelines regarding the presentation of potential patient information on the internet by healthcare workers but also guidelines about how patient information on the internet be ethically searched and used. Any suggestions? ..Maurice.

Intriguing question Maurice. I'll be uncharacteristically brief- No.

A fundamental part of the doctor patient relationship is fiduciary duty. While publication of such pictures for the educational value in reputable medical journals might generally be accepted no such circumstances would justify the degradation, denigration and intrinsically pejorative nature of posting such material to any social media site. For those reasons it's wrong to even make the request.

Doesn't anyone want to take on the question: was it ------------(whatever word you want to use) for those nursing students to publish a picture of them holding up a placenta? Of course, we don't know all the facts from the news article but based on what was written, do you think the students should have been kicked out of nursing school? ..Maurice.

For physicians, residents and even medical students; it is clearly unethical to post pictures (with or without identification) of patients without their permission. Even if unidentified, a picture of a body part, a tissue specimen or even a placenta is medical data; no different than an X-ray or medical history, and revealing this without permission is a breach in confidentiality. By extension, nurses or other health professionals or health professional students should abide by a similar code of ethics. If a hospital employee did this, this might not be an professional ethics violation, but likely an employee violation, since the hospital has the ethical obligation to protect the patient's privacy and subsequently has protective policies in place.

If the accident of the victim of the rebar piercing the abdomen in the original post took place in public, and a reporter or bystander took a picture of the horrible event and posted this on Facebook, it might not be morally right, but would not be ethically wrong; since the bystander or reporter had no obligation to the victim. If the bystander was a physician, and he snapped a photo of the rebar accident and posted this on Facebook, this would similaly be morally questionable but not ethically wrong, unless the physician went to aid the victim at the scene, thus establishing a doctor-patient relationship. Even if the patient was taken by ambulance to the hospital and the bystander physician who assisted the victim never saw the patient again, the doctor-patient relationship is still intact and the posting is unethical.

The bottom line is that any health care professional has an ethical obligation to ask for permission to share virtually anything about a patient outside the context of that patient's care.

kya hal hai ratul? mei bharat mei rehta tha bahut din se pehle, 1965 se 1967 tak. utter pradesh mei rehta tha, dehli se upper. shahar ka nam meerut, shanti sena sewak - peace corps volunteer. mei murghi palta tha.

(i do apologize for going off topic in another language and right after ratul asked for greater focus. ratul lives about 40 miles from where i raised chickens as a peace corps volunteer, 1965-67. great memories and the hindi was fun).