Patient Privacy, Confidentiality Hippa. Must Answer Questions:

¶ … patient privacy, confidentiality HIPPA. Must answer questions: Describe issue impact population affects. What arguments facts article support proposed solution.

Park, Alice. (2009, September 23). Are med-student tweets breaching patient privacy? Time

Magazine. Retrieved March 27, 2011 at http://www.time.com/time/health/article/0,8599,1925430,00.html

Patient privacy article review:

Park, Alice. (2009, September 23). Are med-student tweets breaching patient privacy? Time

Magazine. Retrieved March 27, 2011 at http://www.time.com/time/health/article/0,8599,1925430,00.html

According to Time Magazine, the Internet has proved to be both a boon to and a bane of patients in the modern era of medicine. On one hand, the Internet can provide a powerful resource for patients, enabling them to share information as well as commiserate with other sufferers. Consider this example of one patient with kidney cancer, whose primary physician recommended a website to research cancer specialists: "Within 11 minutes of submitting his first post to the Association of Cancer Online Resources…[the cancer patient] received recommendations for top specialists -- with links included -- from patients on the site's kidney-cancer list. Within half an hour, an e-mail arrived from an ACOR member suggesting which scans might be appropriate and offering details about interleukin-2, the only treatment at the time that resembled a cure" (Rochman 2010). This demonstrates how the Internet can allow patients to direct their own treatment, no longer rendering them at the mercy of their doctors or insurance companies to learn about the best doctors or the most innovative treatments.

However, the Internet has also rendered patients more vulnerable than ever before to disclosures of private information. Despite efforts of federal and state legislatures to enact laws to protect patient privacy, as well as ethical guidelines issued by the American Medical Association (AMA), technology is changing faster than ever before. The Internet has become a wild, Wild West of the free flow of ideas -- and profound ethical questions still remain regarding how medical information should be discussed online.

While patients' use of the Internet as informed consumers has clear benefits, there are serious privacy concerns when the issue is turned around and it is doctors who are sharing information about patients online. Hearing about individuals publically embarrassing themselves on Facebook and Twitter has become commonplace. "Personal profiles on Facebook and other social-networking sites are a trove of inappropriate and embarrassing photographs and discomfiting breaches of confidentiality. You might expect that from your friends and even some colleagues -- but what about your doctor?" (Park 2009:1).

Medical students, residents, and young doctors have proven to be one of the worst culprits for engaging in such practices. Accustomed to revealing everything about their vocational and scholastic lives online, they often have difficulty exercising ethical judgment and self-censorship regarding patient information. The Journal of the American Medical Association's study of 80 medical-school deans found that over 60% of students "reported incidents involving unprofessional postings and 13% admitted to incidents that violated patient privacy" on social networking sites (Park 2009:1)."They view their Facebook pages as their Internet persona…They think it's something only for their friends, even though it's not private" (Gill 2009:1).

One dean of a medical school defended the practice of online exchanges amongst medical students, cautiously, pointing out that doctors have always talked about problems with colleagues, and sharing information can be an important method of arriving at the correct treatment for the patient. This is particularly true for young doctors, who are beginning their practice. Additionally, talking about the feelings and emotions involved in treating patients can generate a sense of "reflection, empathy and understanding," which are often cited as qualities that are lacking in contemporary doctors. After all, patients on online message boards and other forms of social networking share symptoms and information. Patients have advocated for expanded access to their records online, as well as information about clinical trials pertinent to their illnesses. Why not allow doctors to be as open as their patients, the argument in favor of 'sharing' amongst medical students asks?

Doctors, however, have a legal obligation not to make reference to any identifying information about their patients. Simply not using patients' names online is not enough. Any other identifying details can also run the risk of violating patient-privacy laws, as well as the ethical guidelines of the American Medical Association (AMA). "Even without applying ethical standards, courts generally allow a cause of action for a breach of confidentiality against a treating physician who divulges confidential medical information without proper authorization from the patient" (Patient confidentiality, 2011, AMA). While laws vary from state to state, in general only patients in specific classified categories (such as the mentally incompetent, old, or young) can have intermediaries agree to release their information. The situations discovered online on Twitter and Facebook by the Journal of the American Medical Association's study do not comply with such standards. Additionally, the ethical guidelines of the AMA hold that unless the patient seems to be a risk to him or herself or others, "the purpose of a physician's ethical duty to maintain patient confidentiality is to allow the patient to feel free to make a full and frank disclosure of information to the physician with the knowledge that the physician will protect the confidential nature of the information disclosed" (Patient confidentiality, 2011, AMA).

Facebook and Twitter are relatively public forums, and when patients see individuals they know to be doctors talking about medical information of patients -- even if no names are disclosed -- they may question the trust they place in their own doctors' judgment. Even when speaking informally online, doctors should be aware that they have an obligation to protect patient privacy for their profession's integrity as well as their own. Ethics classes are clearly required at medical schools to give students a better foundation about how to approach their online lives in an ethical and professional manner.