“Doctors on social media share embarrassing photos, details of patients”

Some doctors have misgivings about employing social media in the service of patient care: “What if one finds something that is not warm and fuzzy?” frets resident physician Haider Javed Warraich in a post this week on the New York Times’ Well blog. Despite his reservations, Warraich defends the practice, pointing out that doctors have used online intel to gauge suicide risk, discover relevant undisclosed criminal histories, and contact the families of unresponsive patients.

Social networking was also helpful on the day of the Boston Marathon bombing. Doctors near the finish line tweeted accounts of the attack to local emergency personnel six minutes before official announcements were made, giving staff critical time to prepare for the arrival of victims.

But until the utility of online sharing in health care contexts becomes obvious to hospital operatives, they’ll continue to view it the way the rest of us regard twerking—if we ignore it long enough, surely it will just go away. Nearly 60 percent of the health care professionals surveyed by InCrowd report having no social media access in clinical settings at work.

The American Nurses Association, American Medical Association, and other trade groups have tried to soften administrators’ hard line by setting standards for social media use in the workplace. They’ve published guidelines packed with nuggets like “Pause before you post” and “Be aware that any information [you] post on a social networking site may be disseminated (whether intended or not) to a larger audience.”

via Slate

This really isn’t as difficult as Slate makes it seem.

Social media employing any potentially identifying information should be permissable if and only if there is a clear benefit to the patient, and privacy precautions are taken.

It’s really that simple.

There’s no reason why doctors need to be digging around or worrying about patients’ undisclosed criminal history, and there’s certainly no reason why we ought to view privacy violations as inevitable.

The life-saving nature of certain types of tweet (for example, the doctors who seek help in assessing suicide risk) may suggest that some types of privacy violations may seem justifiable, but there is no reason why professionals should not be held to roughly the same standards as other life-saving professional ethical codes with regards to judgment calls, and full privacy protections should only be waived if for some reason adhering to them might cause serious harm.

Professionals who don’t take privacy seriously should lose their license and face criminal charges. If the profession won’t police itself, the entire profession will suffer a loss of credibility – patients will rightfully lose faith and trust in doctors.

The issue seems somehow more complicated than this in the Slate article because they use examples that border on dishonesty: why would they even include the Boston Marathon bombing incident? What possible reason could they have for treating that situation as if it were somehow in the same category as the incident with the nurses who posted private patient photos on their Facebook pages? The Boston Marathon case could not have involved privacy violations, since the tweeters were writing about what they’d observed in a public situation.

Under no circumstances should patient information be uploaded to any site for reasons that are not beneficial to the patient. Nobody should be afraid to seek medical help for fear that he will end up on a Facebook page, ridiculed by the so-called professionals.

A good rule of thumb might go like this:  if you would be embarrassed, ashamed, or afraid of what people might think if the person whose information you posted found out what you did, you are probably committing a crime.

In 1999 the California HealthCare Foundation issued a report titled “The Future of the Internet in Health Care: Five-Year Forecast,” by Robert Mittman and Mary Cain of the Institute for the Future… overall, the forecast proved remarkably prescient. Its conclusions about online privacy foreshadow the equilibrium most contemporary patients and providers have reached: “[T]here will inevitably be several well-publicized incidents of people being harmed by public releases of their health care information—those exceptional cases will shape the debate,” the report predicts. “[I]n the end, people and organizations will have to learn to live with a less-than-perfect combination of technologies and policies.”

There’s “less than perfect”, and then there’s just professionals who aren’t behaving according to professional standards.

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“The Man Who Was Treated for $17,000 Less”

The insurance policy, the clerk said, would pay up to $2,500 for the surgeon—more than enough—and up to $2,500 for the hospital’s charges for the operating room, nursing, recovery room, etc. The estimated hospital charge was $23,000. She asked him to pay roughly $20,000 upfront to cover the estimated balance….

…Hospitals and other providers make their “list” prices as high as possible when negotiating contracts with health plans and Medicare regulators. No one is ever expected to pay the list price. Anybody who has seen an “Explanation of Benefits” statement from a health plan will note a very high charge from the provider, and an “adjusted charge” based upon the contracted fee schedule, which usually leaves the patient with little or nothing in out-of-pocket expenses. The only people routinely faced with list prices are those few people who have insurance like my patient’s—that doesn’t include a pre-negotiated fee schedule with contracted providers—or those who have no insurance.

Most people are unaware that if they don’t use insurance, they can negotiate upfront cash prices with hospitals and providers substantially below the “list” price. Doctors are happy to do this. We get paid promptly, without paying office staff to wade through the insurance-payment morass.

So we canceled the surgery and started the scheduling process all over again, this time classifying my patient as a “self-pay” (or uninsured) patient….He underwent his operation the very next day, with a total bill of just a little over $3,000, including doctor and hospital fees. He ended up saving $17,000 by not using insurance…

…[E]ven with the markdown for upfront “cash-pay” patients, none of the providers was losing money on my patient. Otherwise they wouldn’t have agreed to the prices. With the third-party payer taken out of the picture, we got a better idea of the market prices for the services. It is the third-party payment system that interferes with true price competition, so “market clearing prices” can’t develop.

Take the examples of Lasik eye surgery or cosmetic surgery. These services are not covered by insurance. Providers compete on the basis of quality, outcomes and price. And prices have continually dropped as quality and services have improved—unlike the rest of health care.

When my patient returned for his post-op visit we discussed the experience. It was clear to both of us that the only way to make health care more affordable is to diminish the role of third-party payers.

via The Wall Street Journal