At
Mercy Hospital, there was an obstretrician/gynecologist who upon posting on her
Facebook wall patient details; she was fired. She was merely venting her
frustrations because said patient was late for her appointments. She did not
post said patient’s name or photo and only included some medical data that is
not specific for any patient. Her post ended with “May I show up late for her
delivery?”
In the USA, there is no law
prescribing the exact specifications of the patient-doctor relationship.
Instead it was based on the Hippocratic Oath with this passage: "Whatever,
in connection with my professional service, or not in connection with it, I see
or hear, in the life of men, which ought not to be spoken of abroad, I will not
divulge, as reckoning that all such should be kept secret." And
information divulged by the patient can only be said to fellow medical
professionals as evidenced from this passage, again from the Hippocratic Oath: "Those
things which are sacred, are to be imparted only to sacred persons; and it is
not lawful to impart them to the profane until they have been initiated into
the mysteries of the science."2
And instead, doctor-patient
confidentiality is centered on ethics and there has to be a doctor-patient
relationship to warrant secrecy for effective healthcare. Laws only specify up
to what extent such information can be made available. Such cases include
notifiable diseases and medical databases although patient identifiers are not
included. Finally, only the patient can void the doctor-patient relationship and
in medico-jurisprudence cases where medical information is necessary.2
First and foremost, there was no
patient-identifier present in the doctor’s Facebook post. The patient’s photo
was not even present on the doctor’s wall making it difficult to say that the
doctor was pertaining to a specific patient. The obstetrician/gynecologist was
merely expressing her right to free speech and venting because of her time
wasted due to the patient’s lateness. It can be argued that her post was
demeaning to the patient but only up to a certain extent. It can be likened to
an employee in a company venting about her customers but we seldom hear
complaints about these people. However, it seems that the doctor is subject to
higher standards than most employees.
The doctor-patient relationship is a
relationship that is based on trust. This means that the patient can trust the
doctor to always do what is in his/her own best interest. The doctor is tasked
to always be professional towards patients and is trusted that he/she will
prescribe the necessary medical interventions. This element of trust is crucial
because without it; healthcare cannot be effective. 1
What people are reacting in this
doctor’s case would be the issue of trust. Even though there were no
patient-identifiers present in the Facebook wall; they feel that the trust
people put in doctors has been violated because details that can only be
obtained from a real-live patient has been announced in public. There is an
implied understanding that parts of the medical interview is confidential;
there are exceptions but even then, these are rare.
And when doctors reveal intimate
details, it was as if the doctor was undressing a patient in public and exposing
the patient’s body. It is this act of nakedness that is inherent in the
doctor’s seemingly harmless Facebook post. The doctor may not have posted the
name or photo but she has still exposed part of the patient to the public.
Which brings us to the final point:
should the doctor have been fired for exercising her right to free speech? And
the resounding answer is no. Instead she should have been given a reprimand.
Medical professionals are subject to a higher standard because there is an
element of trust in order to deliver effective health care. The difficulty lies
in determining where does this trust end and where does it begin. With the
advent of new technologies such as social media; information is easily spread.
For instance, post an embarrassing photo and it will spread like wildfire.
As such, all medical professionals
must always be cautious in posting details about patients even if they are unremarkable
and innocent. It also helps if the tone is in a neutral manner. It is not that
medical professionals are to be silent but they should be highly aware that
whatever they say is subject to higher scrutiny because they deal directly with
people’s lives and can affect them. Whether we like it or not, we will always
be under intense scrutiny and as such we will have to deal with job pressures
in a professional manner.
References:
1. “The Doctor–Patient Relationship Challenges, Opportunities, and
Strategies”. Susan Dorr Goold, Mack
Lipkin, Jr. 25. Jul, 2013. J Gen Intern Med: 1999 January; 14 (Suppl 1):
S26-S33.
2.
"Healthcare - Doctor-Patient Confidentiality." Encyclopedia of
Everyday Law. Ed. Shirelle Phelps. Gale Cengage, 2003. eNotes.com.
25 Jul, 2013. <http://www.enotes. com/healthcare-reference/>.
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