Medical secrets on social networks

Doctors have always discussed difficult cases in conferences or informally in the hospital. But more and more are doing it on social networks, especially on Twitter, where confidential information is disseminated.

Problematic images

When a colleague of Trent Walradt told him about his heavy use of Twitter, the gastroenterologist at Brigham and Women’s Hospital in Boston was intrigued by the benefits and potential problems of this 21st-century practice.^e century.

“He mentioned that in several tweets from other doctors there were problematic images, says the D^r Walradt. We could potentially identify a patient. Or a doctor’s conflict of interest, such as compensation from a device manufacturer, was not disclosed. We decided to find out more. »

Last summer in theAmerican Journal of Gastroenterologythe D^r Walradt showed that in more than one in six images posted on Twitter by American gastroenterologists, the patient’s identity could be inferred. “In the vast majority of cases, it is by the date of the image, but we saw the date of birth in 0.8% of cases, and sometimes even the patient’s face. »

Mathieu Nadeau-Vallée, resident doctor at the University of Montreal Hospital Center (CHUM) who is very active on social networks to counter misinformation, confirms that the publication of medical imaging can be “problematic”.

When an x-ray serves as an advertisement

Sign that the question is more and more burning, the British magazine Frontline Gastroenterology organized a colloquium on Twitter in early November on the issue. “For many physicians, this is an invaluable tool for sharing knowledge,” says Richard Hansen, a pediatric gastroenterologist working at a Scottish research centre. He published an essay on the problem of medical discussions on Twitter last year in the journal Nature Reviews Gastroenterology & Hepatology.

“But medical journals have a proven system for preventing confidential patient information from being published and securing their consent for publication. »

According to the D^r Nadeau-Vallée, if it is not possible to identify the patient, the latter should not be affected, even if his x-ray is used for publicity purposes.

A case in Quebec

The College of Physicians has received several reports from doctors who have disclosed confidential information on social networks, according to the College’s communications director, Leslie Labranche. But only one gave rise to an investigation. It is a family doctor from Trois-Rivières, Christian Clavel, who revealed on his Facebook page information about a neighbor with whom he had a dispute and who had been his patient. The College’s Code of Ethics specifically mentions the importance of patient privacy on social media.

The Toronto tiktoker…

Martin Jugenburg is a plastic surgeon from Toronto. He is also very active on TikTok and Instagram, where he shows “before” and “after” images of his patients. But it was a camera that unknowingly films patients in his clinic that drew attention to his case, wonderfully illustrating the excesses of “Med Tok”, the nickname given to doctors who are very active on the platform.

“In 2018, CBC revealed the existence of these hidden cameras which, according to the D^r Jugenburg, were used for security,” says Tina Yang of the Toronto law firm Waddell Phillips. “We also discovered the dozens of images of patients on social networks and filed a request for collective action. » The College of Physicians of Ontario severely punished in 2020 the D^r Jugenburg, with a six-month suspension specifically related to images posted on social media. The class action is based on three plaintiffs, but could affect 7,200 patients at D^r Jugenburg.

… and the Montreal plastic surgeon

When she started her plastic surgery practice in Montreal, Amanda Fanous didn’t want to use social media to make herself known. “It didn’t interest me at all to go down that road,” said the D^D Fanous. My philosophy is to serve patients, not to impose a model of beauty on them. But I realized that patients want to have contact with plastic surgeons before meeting them, before contacting them. So I took to Instagram. »

A year and a half ago, the D^D Fanous migrated to TikTok. Isn’t she worried that “before and after” videos will give some people the impression that certain beauty standards have to be met?

One of D’s TikTok videos^D Fanous is devoted to requests to have a “symmetrical face”. “It can’t be,” she said. There was a study with supermodels whose portrait had been modified to duplicate half of their face. People who viewed the photos found the real photos to be more beautiful than photos of supermodels with perfectly symmetrical faces. ” The D^D Fanous asks verbally – then in writing – for the consent of her patients before publishing images. A third of them accept that their images be used on social networks. They can also change their minds, and the D^D Fanous then removes the images from its sites. “It happens a few times a year. »