Are You Sharing Too Much Online?

Internist and cardiologist Westby Fisher, who blogs under the moniker Dr. Wes, writes daily about his life in practice. He’s mused on healthcare reform, shared humorous items from around the Web, and expounded on issues in his field.

What you won’t find on his blog? Personal information about his patients.

“There is no question a blog is a wonderful release for trying to talk about the daily struggles,” he says. However, Fisher adds, it’s important not only to respect the laws regarding patient confidentiality, but also to be careful not to damage the trust established between doctor and patient.

“I know many, many of my patients read my blog,” Fisher says. “I would hate for them to ever feel like they were having their confidence violated by what I write.”

As more and more physicians delve into the blogosphere and social networking world, dishing their views on everything from the flu vaccine to federal legislation, the potential lurks to violate patient confidentiality.

Sure, it can be tempting to deliberate online on a particularly vexing or unique case. You may want to solicit advice from colleagues or just get your thoughts written down. But it’s exactly this type of clinical discussion that can land you in hot water.

It’s more than just following privacy laws that clearly state what information is protected. Most physicians wouldn’t dream of sharing a patient’s name, age, or any other explicit identifying information.

“Doctors in general are so terrified of violating HIPAA, and we have been so frightened about this for so long, that I think we are not going to violate it very easily,” says Val Jones, a physician and CEO of Better Health, a medical blogger community.

But, it’s not enough to follow the letter of the law. Even if you are writing about a patient in a way that her identity could be guessed, you’ve crossed the line, Jones says.

All of her bloggers follow the Healthcare Blogger Code of Ethics, five guidelines that ensure their blogs’ integrity. Second on the list of guidelines is confidentiality. Blogs are peer reviewed for their accuracy and transparency before they are given the seal of approval.

Bryan Vartabedian, a pediatric gastroenterologist and author of the blog 33charts.com, agrees that online discourse generates more than just legal issues. In his own online ruminations on his blog and Twitter, Vartabedian avoids discussing any specific case, and any encounters mentioned are fictionalized beyond recognition, he says. His litmus test is how his patients may react to his posts.

“I try to do what I think is ethically right, and what I think my patients would feel good about,” he says.

Before you join the din of medical bloggers or sign up for a social networking account, consider this advice:

Read it over. Before you hit the “publish” or “share” key to display your thoughts to the Internet world, review what you’ve written. Make sure there are no identifying details or information that patients or colleagues might take issue with, says healthcare attorney Steven Kern. Remember that what might seem funny or harmless to you may offend others. “If you think for a second that what you are writing could be misconstrued, take your [fingers] off the keyboard,” Kern says.

Consultant Kenneth Hertz says physicians should take a page from a carpenter’s book. Where they measure twice and cut once, so should the doc read twice and hit send once.

Keep separate profiles. If you publish a social networking profile or broadcast bits on Twitter, keep your professional persona separate from your personal one. As a physician, you should maintain a professional boundary with your patients, Kern says. “As soon as you start mixing friendship or the social or the comfortable zone with the professional zone, I think you can run into some problems,” he says. So don’t post your family’s Disneyland vacation photos to your professional Facebook page.

Look beyond HIPAA. All-out privacy violations such as listing a patient’s name, age, or address are likely rare, but plenty of forays into the cybernetworking world may be inappropriate without being technical HIPAA violations. “Physicians really have an obligation to go well beyond what HIPAA mandates,” says Vartabedian. More subtle ethical violations are far more common - and perhaps just as dangerous.

Follow other bloggers. If you’re considering broadcasting your thoughts online via a blog, first spend a couple weeks reading other medical bloggers, says Vartabedian. Following your trusted and more experienced peers is a good way to learn the optimal topics and the boundaries. “Looking and listening is one of the best things you can do to learn the standards,” Vartabedian says.

Blend cases. If you feel compelled to wax clinical, you should take great pains to fictionalize the case, or blend several cases to ensure one is not identifiable. Perhaps present a story representative of the case or problem you had, Jones says.

Consider a policy. Larger practices should consider a policy outlining what physicians and staff can and cannot communicate online and what media they can use without prior authorization, says Kern. Practices may even need policies for social networking pages. “I think that is an area ripe for all kinds of problems, even if it’s a private access site,” he says.

Use your common sense. “If you wouldn’t say it on an elevator, don’t say it on your blog,” Jones says. Remember, nothing is private anymore, and everything you type - everything- can wind up going viral. “Write as if everything you type can be on CNN, because if it’s anything controversial, it will be.”

But don’t let fears of HIPAA violations and damaged relationships deter you from using the tools the Web offers. Patients are increasingly turning to the Web for information, and physicians should be poised at their keyboards, ready to engage. In the absence of a strong medical community online, misinformation reigns, says Jones. “Doctors need to understand that they have, in my opinion, a moral obligation to get their voices heard online.”

Sara Michael is an associate editor at Physicians Practice. She can be reached at sara.michael@cmpmedica.com. This article originally appeared in the February 2010 issue of Physicians Practice.