What Happens When An OB/GYN Snarks About A Patient on Facebook?

Doctors (along with the rest of us) sometimes seem to forget that the Internet is a real place with real consequences. The things you say and do there matter, and putting something up on a public Facebook post is like standing on a street corner and yelling.

Feb 6, 2013 at 5:30pm | Leave a comment

“That’s cool,” I Tweeted from the waiting room the other day.

“I don’t mind cooling my heels for 20 minutes after my stated appointment time. Had nowhere better to be!”

When it comes to the use of social media to bitch about poor experiences at the doctor’s office/hospital/lab/etc., I’m not alone; patients have taken to the Internet in record numbers to network, exchange information, and more. Let’s face it: it’s frustrating when you’re treated disrespectfully, given confusing information, or not provided with a complete picture of what’s going on. Like a lot of patients, I also don’t lodge formal complaints. (Bad me.)

A 2004 study noted that while complaints could actually improve provision of medical care, the process is hindered by patients not filing them. And by many facilities failing to use complaints effectively to develop better methods for handling patients. Some of us, it seems, just enjoy grousing on the Internets without actually following through.

But what about when the tables are turned? How would I feel if I happened to check my doctor’s Twitter feed (yes, a growing number of medical professionals are using social media) and found a Tweet like “Dreading my next appointment. This patient is always difficult.” How about if I found a Tweet from my dentist’s office mocking my hypersensitive gag reflex, which makes it virtually impossible to take X-rays?

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Photo credit: Army Medicine

I’d be royally righteously pissed, that’s what, and I’d feel horrible to have been made a figure of fun, mockery, or complaint in a public space. While I’m well aware that health care providers, like the rest of us, complain about things that happen on the job, I like to think they do it in privacy, among friends and colleagues, rather than broadcasting those things to the world. Especially when those things include sensitive identifying details that make it easy to tell who their patients are.

SOCIAL MEDIA AS MEDICAL WATERCOOLER

This is a documented issue; a physician in Rhode Island was reprimanded in 2011 after disclosing private information about a patient on Facebook, for example, and last year, two hospitals in California had to deal with breach of privacy situations where personal data was posted on Facebook and medical records were taken home by hospital personnel. Nurses, doctors, medical students, and other staff have been reprimanded, fired, and put on probation for posting photos of medical records, patients, procedures, and more without consent.

It’s a violation of medical ethics and common decency, but also the law; patient privacy is protected under the Healthcare Insurance Portability and Accountability Act (HIPAA). And now, yet another case of violation of patient privacy has arisen, this time at St. John’s Mercy Medical Center in Saint Louis, where an OB/GYN posted a complaint about a patient’s chronic lateness to her Facebook wall, jokingly suggesting that she show up late to the patient’s delivery.

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Photo credit: Army Medicine.

This kind of joke is one that a doctor might make in private among friends and colleagues, but in public? Commenters, including other medical professionals, added their notes on the situation, and the doctor posted an additional note, explaining that the patient had experienced a prior stillbirth. Not only had she complained about a patient publicly, but she’d posted identifying information, potentially enough for someone to figure out who that patient was.

On a purely professional level, it’s uncool to complain about your customers, or clients, or patients, in public. Hey, I’m often frustrated with the people I work with, and I most definitely complain, but not where everyone can see it. I do it when I’m at lunch with other writers, or I do it in email with a friend, or I do it in other controlled, private venues. Because it’s unprofessional, and it makes you look like a giant douche, and it makes people disinclined to work with you and the organizations you work with.

I certainly wouldn’t go to a doctor who made a habit of complaining about/making fun of patients on Facebook or anywhere else in public. And I wouldn’t go to a medical facility that tolerated that kind of behavior from its personnel. This is something that physicians are thinking about, as a recent study published in the “Journal of the American Medical Association” pointed out. While professional organizations have created social media guidelines, medical licensing boards and related authorities are lagging behind, and this is a gap that needs to be filled.

THINGS THAT HAPPEN ON THE INTERNET HAPPEN IN REAL LIFE

Doctors (along with the rest of us) sometimes seem to forget that the Internet is a real place with real consequences. The things you say and do there matter, and putting something up on a public Facebook post is like standing on a street corner and yelling. Most docs probably wouldn’t hang out at the corner of Main and Whatever shouting about how much a patient bugs them...but they would say so on Facebook.

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These ladies nursed pre-HIPAA. Fortunately, they also nursed pre-Facebook. M.S. Bidmead (glasses) looks like she'd get up to all kinds of mischief on the Twitters. 

Photo credit: State Library of South Australia.

And, of course, such posts are also a violation of the law, another pressing concern. Putting patient information in the public sphere is illegal, and that includes comments with identifying info even if the patient isn’t explicitly named. If, for example, my doctor makes a comment about the patient with a giant heart chestpiece, it doesn’t take much sleuthing to figure out who my doctor is talking about, even if I’m not explicitly named: this is a small town and my tattoo is notable.

This is creating real struggles in medical education, where a generation of students used to the constant accessibility and use of social media are prone to overstepping professional and legal boundaries. In 2009, another JAMA article chronicled issues with unprofessional content posted by medical students; 60% of respondents to a survey of medical school deans noted specific incidents that had occurred among their student body.

Amy Dunbar, the OB/GYN who posted publicly about her chronically late patient, isn’t alone in posting complaints about patients, and she’s likely to face penalties for her actions, as well she should. She behaved extremely unprofessionally, endangered the privacy of her patient, and potentially threatened her patient’s health as well; patients count on doctors to protect their privacy and handle their cases professionally.

When doctors let their patients down like this, patients can be left with a sense of broken trust (in addition to a fervent desire for a new physician), and that makes it harder for them to be open about their care needs.

Just like the rest of us, medical professionals absolutely need an outlet. That’s why they have private message boards (and let me tell you, you wouldn’t believe the things that happen on doctors-only message boards!), professional conferences, groups of friends, breakrooms, emails, and other private, secure outlets for discussing their professional frustrations and challenges. But those kinds of conversations need to stay private. 

When people are counting on you in moments of extreme vulnerability, they’re relying on you to not make them subjects of public commentary, mockery, and discussion. Dunbar made a serious party foul here, and she absolutely deserves a formal reprimand and a remedial lesson in how to use social media effectively and appropriately.

Like it or not, your behavior on social media isn't just about you-the-person, it's also about you-the-professional, and people are not going to separate the two. You can't go off-duty, which means you're responsible for keeping the content appropriate, and for thinking about how your actions might reflect on your professionally.