Patient privacy should be respected abroad and online

Taking an unauthorized photo of a patient and posting it on Facebook is a giant no-no for health-care providers, who follow strict federal guidelines protecting patient privacy.

But what if the patient is a little girl in Ecuador receiving a vaccine from an American medical student, who’s in the country on a medical outreach trip? Although taking photos of patients in developing countries and posting them on the Web may not be illegal, it’s not ethical, say researchers from the University of Florida.

It’s long been a common practice for health care providers to snap photos while volunteering their time in developing countries, generally to bring back evidence of the conditions patients face there. But reporting in the Journal of Medical Internet Research, UF College of Medicine researchers say providers should treat patients’ privacy with the same reverence no matter where the care takes place.

“A medical student would not take a picture of a patient in clinic here and post it on Facebook,” said Erik Black, Ph.D., an assistant professor of pediatrics with the UF College of Medicine and one of the lead authors of the paper. “But there is a disconnect on these trips. We are not respecting these people as individuals. If we are not going to respect them in the same way we respect patients in the United States, why are we even going?”

UF researchers examined the Facebook profile pages of 1,023 medical students and residents, finding no breaches of patients’ privacy in the United States. But they did find 12 photos depicting patient care in developing countries.

Every year during spring break, students from all health fields fan out across the globe to work in clinics in medically underserved nations, such as the Dominican Republic, Haiti and Ecuador. For students, who work closely with faculty mentors on these trips, it’s a chance to get hands-on experience in a patient-care setting and help people who sometimes travel for days in search of care.

Legally, privacy protection under the Health Insurance Portability and Accountability Act only extends to patients in the United States, said Lindsay Thompson, M.D., an assistant professor of pediatrics in the College of Medicine and also a lead author of the report. If a nation has privacy laws in place, doctors must follow them when practicing there. In addition, Thompson says doctors are ethically bound to adhere to the laws of the state or country in which they practice.

“We in the medical profession have to be held to a different standard,” Thompson said. “Our actions, however altruistic they are, could have some unintended consequences.”

In many cases, medical students and doctors may not even be fully aware of the differing patient privacy laws in a given country or that that these laws could be even stricter than those in the U.S.

“A lot of people consider this an ethical gray area,” said Reed Van Deusen, M.D., an assistant professor of internal medicine and pediatrics at the University of Pittsburgh, who was not affiliated with the study. “It is pretty complicated, but I agree with their basic tenet that trainees, and physicians in general, should not be posting pictures of patients, whether they are in this country or not. I think it is going to take a bit of a culture change to get everyone else on the same page.”

Terry Kind, M.D., a director of pediatric medical student education at the Children’s National Medical Center at the George Washington University, says it’s important for medical school faculty to teach students about issues like these, namely by modeling professional behavior themselves.

“(Social media) is here and not going away,” Kind said. “There are opportunities for use, but there is risk. The nature of the widespread dissemination is people forget to have that internal check on professionalism.”

In the United States, patients who agree to be photographed sign written consent forms. But Black says even getting consent from patients in developing countries poses an ethical challenge. If a doctor or medical student asks, patients may feel they have to sign the form to receive medical care.

Also, because the Internet is global, posting these pictures to social networking sites could have repercussions for some patients, particularly if the images were taken in countries where being treated by an American doctor is frowned upon.

Even posting photos to a “private” page is not really ensuring patient privacy because, in some cases, the person posting the photo could be sharing it with 1,000 “friends,” Black said.

“We are not telling people not to do anything,” Black said. “We are telling them to think about it. Use your moral and ethical compass. What if this was your child?”