Applied ethics Vongai C. Mlambo, BS, Gloria L. Hwang, MD, FSIR, and Eric J. Keller, MD, MA


Pausing before posting The ethics of #MedTwitter and medical social media


Dr. M cared for a patient with a large cerebral aneurysm rupture. She tweets the following along with her patient’s cerebral angiogram:


The post receives over 1,000 likes and is reshared repeatedly.


Dr. M is one hypothetical IR in a large network of physicians who are on social media platforms like Twitter. The 2014 Radiologists and Social Media (RANSOM) survey indicated that 41% of U.S.-based participants use social media for professional purposes,1 this have been increasing.2


and Social media


can be an excellent forum for clinicians to exchange ideas, network and teach trainees. It can also be a powerful tool for advocacy and public health awareness campaigns.3


But, despite


these opportunities, sharing medical information on social media also raises important considerations regarding patient privacy and dignity as well as potential adverse effects on medical decision-making.


Trust is central to the patient–clinician relationship, and a key part of this trust is protection of patients’ privacy and dignity.4


This has become ever


more important in an era where medical imaging and vignettes have become common on public social media accounts. In the United States, protection of patient information is governed by the Health Insurance Portability and Accountability Act (HIPAA). This act requires removal of identifiers from an individual's health information that could reasonably lead to the information being linked back to the patient before it can be used for secondary purposes. In a study of 1,206 tweets from healthcare professionals, only 2% of posts explicitly violated HIPAA regulations,5


but it is important


to note that both the spirit of HIPAA and medical ethics require us to reach beyond the explicit.6


For example, there’s a tendency to share rare and


But, despite these opportunities, sharing medical information on social media also raises important considerations regarding patient privacy and dignity as well as potential adverse effects on medical decision-making.


sensational cases shortly after they occur, raising the risk of identification.7 Unlike a case report in a journal or conference, these are open fora where patients may follow their clinicians, especially if their condition is rare. Dr. M may have removed explicit identifiers from the angiogram but she practices in an area with few neurointerventionalists who rarely treat ruptured aneurysms and posted this the day after treatment. If a family member, acquaintance or even the patient themself saw the post, they may recognize the patient’s story and feel exposed if consent was not provided. This in turn can have secondary adverse effects by undermining patients’ and families’ trust in future episode of care8


or affecting


their employment if their condition is widely shared.


An additional risk is undermining patient dignity in how we share cases. It is common for co-workers to discuss their mutual work behind closed doors. In healthcare, this work often involves human pain and suffering.9


We talk in sirweb.org/irq | 17


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