A twenty-year-old nursing student had finally realized her dream and was caring for patients on her pediatric oncology rotation. She fell in love with the courage of her young patients. One patient, in particular, captured her heart. She took a picture of the three-year-old boy grinning from ear-to-ear despite his chemotherapy. When she posted the picture to her Facebook page, she put the following caption: “This is my 3-year-old leukemia patient who is bravely receiving chemotherapy. I watched the nurse administer his chemotherapy today and it made me so proud to be a nurse.” In the photo, the child’s room number was clearly visible.
Three days later, the nursing student was called into the office of the dean of the nursing program. Another nurse had seen the Facebook post and reported it. Although the student did not identify the patient by name, it was clear that he was a cancer patient in an identifiable academic facility and his room number was in the photo. After a hearing, the student was dismissed from the nursing program. Even worse, the nursing program was barred from having its students rotate on the pediatric oncology service. In this real life example, a seemingly innocent expression of pride led to serious consequences.
This story illustrates the danger that social media can pose to medical professionals, who have a strict duty to maintain patient confidentiality. The problems posed by social media are complex and growing. Facebook posts, comments on blogs or other social media, online forums, and even texting all raise opportunities for violations of patient privacy. In a recent survey, 26 of 33 state boards of nursing reported taking disciplinary action for breaches of patient privacy through social media. Many organizations have now published member guidelines for the use of social media. A few tips are commonly repeated in these guidelines:
- Do not accept friend requests from patients or their families. While it is common for health care professionals to become close to their patients, particularly during long hospitalizations or in the NICU setting, professional boundaries must be maintained.
- Do not photograph patients or their families with personal devices. Many of the disciplinary actions cited above involved the dissemination of photos of patients via social media.
- Do not identify patients by name or post information that may lead to the identification of a patient. The use of online forums has become a valuable means for health care professionals to share information and problem solve in a collaborative way. However, great care must be taken that patient specific information not be shared. As in the example above, a violation of patient privacy can occur even without using the patient’s name.
- Do not post photos of yourself engaging in unprofessional conduct. One study found that the social networking accounts of 70% of medical students and residents included images containing alcohol, racially toned language, misogynistic statements, or foul language. These images not only reflect poorly on the profession (and thus can be the basis for discipline), but they can affect your prospects for employment.
- Report any potential breach of patient privacy or confidentiality.
- Be aware of your employer’s policy regarding the use of social media and follow it to the letter.
The incidence of employee discipline and even licensing actions will undoubtedly increase with the prevalence of social media and smart phones. It is important to always remember your obligation to protect patient privacy when using these technologies.