The document discusses the challenges of maintaining patient confidentiality in the age of social media. It notes that while patients and doctors can benefit from social media connections, boundaries can become blurred and privacy risks emerge. The document outlines recommendations that doctors avoid direct online contact with patients or using social media for clinical purposes due to risks of information being publicly accessible. It also advises against posting identifiable patient photos or information online without consent. Overall, the document emphasizes that confidentiality must remain the top priority for doctors in the digital era.

1. PATIENT
CONFIDENTIALITY
& THE SOCIAL
NETWORK
Iris Thiele Isip Tan MD, MSc
Professor, UP College of Medicine
Chief, UP Medical Informatics Unit
@endocrine_witch

2. CONFIDENTIALITY
IN THE AGE OF
SOCIAL MEDIA
DOCTORS
PROTECT
CONFIDENTIALITY
WHEN PATIENTS
GIVE UP
PRIVACY

3. PRIVACY
CONFIDENTIALITY
About people
About identifiable data
Extension of privacy
Right to be left alone
Limit access to public
Prevent unauthorized access

4. PRIVACY PARADOX
Bushel et al. Protecting human health & security in digital Europe:
How to deal with the “Privacy Paradox”? Sci Eng Ethics 2014
Fear threats
to personal
autonomy and
freedoms from
globalized data
processing by
government
Voluntarily
disclose
personal data on
social networking
sites (names, photos,
dates of birth, marital
status, medical data)

5. Although patients and providers benefit
from SoMe, the boundaries between
physicians and their patients can become
blurred, putting both parties at risk.
Roupret et al. European Association of Urology (@uroweb)recommendations on
the appropriate use of social media. European Urology 2014;66:628-32

6. EXTENDING PATIENT-MD
RELATIONSHIP ONLINE?
Purpose
Content
Response time
Farnan et al. Online medical professionalism: patient and public relationships: Policy statement from the
American College of Physicians and the Federation of State Medical Boards Ann Intern Med 2013;158:620-7

7. Bosslet et al. The patient-doctor relationship and online social networks:
results of a national survey. J Gen Intern Med 2011;26(10):1168-74
National survey of US medical students,
resident & practicing physicians
n=455
NOT ethically acceptable to interact with
patients for either social (68.3%) or patient
care (68%) on online social networks
79% expressed concerns
about maintaining
patient confidentiality

8. CONFIDENTIALITY
IN THE AGE OF
SOCIAL MEDIA
DOCTORS
PROTECT
CONFIDENTIALITY
WHEN PATIENTS
GIVE UP
PRIVACY

9. CONFIDENTIALITY
IS THE PILLAR
OF OUR
PROFESSION.
The patient-physician
relationship is built on
trust that enables
patients to share
intimate details.
Grotty B & Mostaghimi A. Confidentiality
in the Digital Age. BMJ 2014;348:g2943

10. AVOID USING SOCIAL MEDIA
FOR DIRECT PATIENT CARE & CONTACT
Unencrypted
Inadvertently accessible to others
Controlled by a third party
Grotty B & Mostaghimi A. Confidentiality
in the Digital Age. BMJ 2014;348:g2943

11. SOCIAL MEDIA IS
LIKE A CROWDED
ELEVATOR.
Others can easily
overhear conversations
without the benefit
of context.
Grotty B & Mostaghimi A. Confidentiality
in the Digital Age. BMJ 2014;348:g2943

12. SOCIAL MEDIA TO FACILITATE CONVERSATION
AROUND MATTERS OF PUBLIC HEALTH
OR AVAILABILITY OF SERVICES
rather than matters related to a specific patient
Grotty B & Mostaghimi A. Confidentiality in the Digital Age. BMJ 2014;348:g2943

13. www.facebook.com/EndocrineWitch
GIVE NOTICE TO PATIENTS THAT SOCIAL MEDIA IS
NOT MEANT FOR CLINICAL COMMUNICATION
Monitor. Take conversation offline if sensitive information is posted.
Grotty B & Mostaghimi A. Confidentiality in the Digital Age. BMJ 2014;348:g2943

14. — Karen Michelle Devon, MD
I WAS SURPRISED TO FIND AN IMAGE OF
MYSELF, WEARING SCRUBS, AND
HOLDING A THYROID GLAND.
”
“
Devon KM. JAMA 2013;309(18):1901-1902

15. Palacios-Gonzalez C. The ethics of clinical photography & social media.
Med Health Care & Philos DOI 10.1007/s11019-014-9580-y
USE OF CLINICAL PHOTOGRAPHY
PRIMARY
For patient care
SECONDARY
For research and
medical education

16. Clinical photography + social media
DOES NOT equal telemedicine.
Palacios-Gonzalez C. The ethics of clinical photography & social media.
Med Health Care & Philos DOI 10.1007/s11019-014-9580-y
Patients do not have adequate information
to give informed consent.
PRIMARY

17. Even if patients recant consent, nearly impossible
to retrieve or delete clinical images.
Palacios-Gonzalez C. The ethics of clinical photography & social media.
Med Health Care & Philos DOI 10.1007/s11019-014-9580-y
Moderate comments to avoid derogatory remarks
about clinical images or patients depicted.
SECONDARY

18. www.healthxph.net/manifesto
I will value the patient’s
dignity & privacy by not
taking selfies, groufies or
videos during encounters
with patients that include
patients’ body parts,
surgical specimens or that
show patients in the
background without their
consent.
#HEALTHXPH

19. www.healthxph.net/manifesto
I will refrain from posting
information online that
will compromise
patient confidentiality
and privacy.
#HEALTHXPH

20. PATIENT IDENTIFIERS
Names
Geographic information
Dates (eg. birth date, admission date,
discharge date, date of death)
Telephone numbers
Fax numbers
Email addresses
Social security numbers
Medical record numbers
Health plan beneficiary numbers
Account numbers
Certificate/license numbers
Vehicle identifiers & serial numbers,
including license plate numbers
Device identifiers and serial numbers
URLs
IP address numbers
Biometric identifiers (eg. finger and voice prints)
Full-face photographic images & any
comparable images
Other unique identifying numbers,
characteristics or codes
Protected health
information
any medical information
about a specific patient
in combination with any
information that could be
used to identify that patient

21. CONFIDENTIALITY
IN THE AGE OF
SOCIAL MEDIA
DOCTORS
PROTECT
CONFIDENTIALITY
WHEN PATIENTS
GIVE UP
PRIVACY

22. PUBLIC HAS FEWER WORRIES ABOUT SHARING
HEALTH INFORMATION THAN OTHER PERSONAL DATA
Andrew Cole. BMJ 2013;347:f4753
The Wellcome Trust. Summary report of qualitative research into public attitudes to personal data and linking personal data.
Jul 2013. www.wellcome.ac.uk/stellent/groups/ corporatesite/@msh_grants/documents/web_document/wtp053205.pdf.

23. HEALTH INFORMATION SHOULD NOT BE SHARED TO
EMPLOYERS, INSURANCE PROVIDERS & DRUG MANUFACTURERS.
Andrew Cole. BMJ 2013;347:f4753
The Wellcome Trust. Summary report of qualitative research into public attitudes to personal data and linking personal data.
Jul 2013. www.wellcome.ac.uk/stellent/groups/ corporatesite/@msh_grants/documents/web_document/wtp053205.pdf.

24. Andrew Cole. BMJ 2013;347:f4753
The Wellcome Trust. Summary report of qualitative research into public attitudes to personal data and linking personal data.
Jul 2013. www.wellcome.ac.uk/stellent/groups/ corporatesite/@msh_grants/documents/web_document/wtp053205.pdf.
DATA LINKAGE,
WHERE INFORMATION
FROM ONE SOURCE
IS USED TO INFORM
WORK IN
ANOTHER AREA
Ex. Supermarket loyalty card to
gauge public health program

25. J Am Acad Dermatol 2013;68:1030-3
Sarah liked Dr. W’s Facebook page.
She commented on a discount coupon for tattoo removal.
Sarah’s mother fears that “everyone will know” about Sarah’s tattoo.
The mother demands that the clinic inactivate the Facebook page
immediately.

26. DR. W SHOULD …
A. Make no changes to the Facebook site.
B. Institute a system for monitoring the site on a regular
basis to purge inappropriate posts.
C. Disable the site’s comment section to eliminate the
possibility of patient’s disclosing personal information.
D. Discontinue the requirement that patients “Like” the
Facebook page to receive discount coupons.
E. Discontinue the Facebook site.
Orenstein et al. E-professionalism at the dermatology office: New challenges to
confidentiality in the era of social networking. J Am Acad Dermatol 2013;68:1030-3

27. DR. W SHOULD …
A. Make no changes to the Facebook site.
Sarah has the right to post
protected health information
(PHI).
Exercise vigilance when
establishing a web forum
with foreseeable risk of
unintentional disclosure of PHI.
Orenstein et al. E-professionalism at the dermatology office: New challenges to
confidentiality in the era of social networking. J Am Acad Dermatol 2013;68:1030-3

28. DR. W SHOULD …
B. Institute a system for monitoring the site on a regular
basis to purge inappropriate posts.
Approach is labor-intensive and
imperfect
Instantaneous dissemination of
information on social networks
Impossible to remove
information from cached Web
pages
Orenstein et al. E-professionalism at the dermatology office: New challenges to
confidentiality in the era of social networking. J Am Acad Dermatol 2013;68:1030-3

29. DR. W SHOULD …
C. Disable the site’s comment section to eliminate the
possibility of patient’s disclosing personal information.
Limits potential for
patient education
Orenstein et al. E-professionalism at the dermatology office: New challenges to
confidentiality in the era of social networking. J Am Acad Dermatol 2013;68:1030-3

30. DR. W SHOULD …
D. Discontinue the requirement that patients “Like” the
Facebook page to receive discount coupons.
Prevent the MD’s direct complicity in
exposing the patient’s treatment for
a potentially stigmatizing condition
Upholds social justice
Orenstein et al. E-professionalism at the dermatology office: New challenges to
confidentiality in the era of social networking. J Am Acad Dermatol 2013;68:1030-3

31. DR. W SHOULD …
A. Make no changes to the Facebook site.
B. Institute a system for monitoring the site on a regular
basis to purge inappropriate posts.
C. Disable the site’s comment section to eliminate the
possibility of patient’s disclosing personal information.
D. Discontinue the requirement that patients “Like” the
Facebook page to receive discount coupons.
E. Discontinue the Facebook site.
J Am Acad Dermatol 2013;68:1030-3

33. Social media is a
window through which
we ask people to look.
How big we make the
window is up to us, as
is what we do in front
of the window.
Journal of the American Pharmacists Association Nov/Dec 2013doi: 10.1331/JAPhA.2013.13536