The pitfalls of posting photos taken in clinical settings on social media
When and where is it acceptable to take photographs in clinical settings?
The #ImInWorkJeremy hashtag was one of the most memorable social media trends in 2015. It all began when Jeremy Hunt, the secretary of state for health, said in a speech at the King’s Fund that “we do not have a proper seven day service in hospitals,” and that this was a major reason for 6000 avoidable deaths every year in the NHS.
Healthcare staff of all grades took issue with this assertion and posted responses on social media to show what they thought about Hunt’s statement using the hashtag #ImInWorkJeremy. They took to Twitter and posted selfies to let the secretary of state for health know exactly how they were spending their weekends: often on call and working long hours.
In a seemingly good humoured response Hunt posted a photograph of himself with NHS staff using the same hashtag. Unfortunately, in the background of the photo there was a whiteboard displaying confidential patient information. His tweet generated a flurry of outraged responses, and the photograph was promptly deleted and replaced by an edited version.
Although Hunt received little sympathy from the healthcare profession, this act of carelessness could have happened to anyone. Most people carry a smartphone these days, and a photograph can be taken and uploaded to social media within seconds, with little thought for the consequences such posts can have.
Like many individuals, the secretary of state for health took what seemed to be a harmless picture in a clinical setting, but in doing so he breached confidentiality. As one Twitter user said: “If I tweeted a photo with patient identifiable information to over 70 000 people, I would deserve to lose my job as an NHS worker.”
Despite the powerful messages on social media that highlighted the issue of doctors’ working hours, the reaction to the #ImInWorkJeremy campaign prompts the question, “When and where is it acceptable to take photographs in clinical settings?”
What’s the problem?
Our lives are documented on social media—from instant reaction to political events on Twitter to avocado breakfasts on Instagram.
Working in the medical profession, however, means that more stringent rules apply, including what you can and cannot write about on social media, because of the right to patient confidentiality and the level of professionalism required by doctors and medical students.
The rise and prominence of social media prompted the General Medical Council to release a supplement to Good Medical Practice—Doctors’ use of social media. The guidance discusses important features such as maintaining confidentiality, professionalism, and privacy, but also states how social media can benefit patient care, such as by “engaging people in public health and policy discussion.”
The guidelines state: “You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession.” Students and professionals must therefore be cautious about how their online presence could be construed by others.
Before, and since, the release of the guidance in 2013 there have been several cases where the professional lives of medics have been affected as a result of what they have posted online while at work.
In 2009 the craze of “planking” appeared, which led to the temporary suspension of seven doctors and nurses at Great Western Hospital in Swindon. The game, which entailed lying down in unusual places, saw staff from the emergency department lying down on resuscitation trolleys, ward floors, and even the helipad, with photographs uploaded on to Facebook. Although patient care wasn’t compromised, disciplinary hearings were held on the grounds of unprofessional conduct.
Searching the hashtag #deliveryroom on Instagram reveals thousands of results. Most of these are pictures of newborns taken by the parents. However, several photographs taken by medical students and doctors are graphic and display inappropriate content. One example is from Daniel Sanchez, a medical student in Venezuela, whose delivery room selfie included a women exposed from the waist down and clearly in the process of giving birth, complete with the caption: “Lady, I can deliver your baby but first let me take a selfie.” Although Sanchez insists consent was given, the photograph led to disciplinary action.
Another case concerned Mexican medical student Maria Hose Gonzalez, when a private photo sent to a friend on WhatsApp was leaked online. Posing with a big grin and sticking her fingers up at the camera, Gonzalez is seen next to a woman in bed who looks critically ill, with the caption, “I was on duty and saw a lady was dying and then . . . a selfie.” In her defence she claimed that consent was allegedly given and that this was a private photograph that had been hacked and leaked as a personal attack against her.
Using social media for educational purposes
Taking photos of yourself in a clinical setting can be instantly incriminating, but what about photos you take for educational purposes? Even if consent is given, is it right to post photos containing patients on social media?
Figure 1, an app and website launched in 2013 and dubbed “Instagram for doctors,” allows users to view and share clinical photographs of interesting cases for educational purposes. The app has a strict code of use, with patient privacy and consent being paramount.
Only verified users can upload images and comment, which means that specialist advice can be obtained quickly from thousands of doctors worldwide. Confidentiality is maintained as the app will automatically block out faces, with the user also able to use a manual tool to remove all identifying features, such as tattoos. Before going “live” and visible to other users, the photograph is checked by a medical officer. Patients must sign a digital consent, which is emailed to them for their records.
When clinical photographs are taken, full consent must be given for their purpose. In 2014, the Medical Defence Union reported a case of a medical student tweeting a photograph of a patient’s hands. Despite the medical student being instructed to take the photograph by the consultant, consent was given only for the photograph to be stored in medical records. The photograph, along with a hashtag naming the medical condition the patient had, was uploaded to Twitter. Owing to the characteristic deformity and a characteristic ring she was wearing, the patient was identified by a member of a Twitter community for people with this condition. A breach such as this could easily result in a fitness to practise investigation for a medical student by their medical school.
To post or not to post?
“My advice to medical students who use social media is they should be mindful about what they post,” says Nirmai Kakani. As a consultant vascular interventional radiologist at Manchester Royal Infirmary, Kakani encourages students to use social media as a tool for discussing scenarios, but “the problem arises if real cases are shared. Interesting and unusual cases are more likely to be discussed, which may allow patients to be identified.” Social media users usually have their location and even the hospital they work at visible on their profiles, which increases the risks of patients being identified.
Whether it’s acceptable to take photos in a clinical setting is a grey area, but ultimately it’s about patient consent, confidentiality, and professionalism.
Sally Old, medicolegal adviser at the Medical Defence Union, says: “Posting details of a clinical case, however heavily anonymised, without patient consent would constitute a breach of confidentiality.” In its explanatory guidance Doctors’ Use of Social Media, the General Medical Council states that doctors must not discuss individual patients or their care via publicly accessible social media.
Remember that when something is shared through social media it may not just be your friends and family who see it but it could potentially be shared with patients, employers, colleagues, national media, and regulatory bodies, for example. “Before posting, consider how you would feel if a colleague or patient saw what you had written, or if it was shared to a wider audience. You should also review the privacy settings for each of your social media profiles regularly,” advises Old.
She explains that images or audiovisual recordings of patients can be used only if you have the patient’s written consent to the specific use. If you are sharing with a colleague for a second opinion, get the patient’s consent and ensure that the image is transmitted and stored securely. Don’t use a photo sharing app or website as these might not be secure, and bear in mind that it is possible that images and recordings posted online may be reused in a different context.
“When anonymising the photo bear in mind that this does not mean just removing the patient’s name and other identifying labels. Consider whether the photograph includes a feature that could allow someone, including the patient, to identify themselves,” says Old.
As almost every aspect of life seems to be documented online, it may be tempting to capture all of your milestones and achievements at medical school on social media. Be cautious, however, for, as the General Medical Council guidance on social media use for doctors says, “Many improper disclosures [of confidentiality] are unintentional.” It can be easy to do, so don’t get caught out like Jeremy Hunt was—you may not be as lucky as him.Brendan Westhoff, final year medical student 1
1University of Southampton
Competing interests: None declared.
Provenance and peer review: Commissioned; not externally peer reviewed.
- Hunt J. Jeremy Hunt sets out his 25-year vision for the NHS. Presented at the King’s Fund, London 2015. http://www.kingsfund.org.uk/audio-video/jeremy-hunt-sets-out-his-25-year-vision-nhs.
- Knapton S. #ImInWorkJeremy: NHS staff post weekend working pictures on Twitter. Telegraph 2015 July 19. www.telegraph.co.uk/news/health/news/11749289/ImInWorkJeremy-NHS-staff-post-weekend-working-pictures-on-Twitter.html.
- Press Association. Hospital staff suspended for Facebook “lying down game.” Guardian 2009 September 9. www.theguardian.com/uk/2009/sep/09/hospital-lying-down-game.
- Willis A. Doctors are taking selfies next to women’s vaginas while delivering babies. Metro 2015 July 16. http://metro.co.uk/2015/07/16/doctors-are-taking-selfies-next-to-womens-vaginas-while-delivering-babies-5298106/.
- Figure 1. FAQ. https://figure1.com/sections/faq/.
Cite this as: Student BMJ 2015;23:h6561