WhiteCoat

Unprofessional Act or Political Mudslinging?

Milton Wolf Facebook

US Senate candidate Milton Wolf (@miltonwolfmd), who also happens to be a radiologist, is catching heat because he had previously posted patient x-rays on his Facebook account … and then made what some people would consider as inappropriate comments about the patients who were depicted in the x-rays.

Articles in the Topeka Capital Journal are here, here, and here. Note the repeatedly recycled content.
The story was also picked up in Talking Points Memo and on Breitbart.com

For example, in the comments to the right, he commented that the positioning of a dead patient’s head on CT scan wasn’t going to cause the patient to complain.

A spokesman for the doctor’s opponent, Senator Pat Roberts, said that Dr. Wolf’s posts raised “legal and professional responsibilities to maintain privacy of patient medical information.”

It appears that Dr. Wolf anonymized the pictures before posting them. If that was the case, HIPAA doesn’t apply to deidentified health information, so there was no “legal responsibility” to maintain privacy of medical information that could not be traced back to the patient. Professional responsibility is a separate issue.

John Carney, president of the Center for Practical Bioethics, reportedly stated that Dr. Wolf’s posts would be “beyond alarming for a professional in the field of medicine.” An “array” of other medical ethicists who viewed the images or were provided a description of Dr. Wolf’s materials also reportedly “condemned” Dr. Wolf’s publication of this information “outside confines of a doctor-to-doctor consultation or for the purpose of formal medical research or textbook instruction.”

This last point is an important one. If a picture is used for teaching purposes, why is publishing it “beyond alarming” or worthy of condemnation?

Milton Wolf Ankle Post

Look at the post above. There are two fractures present. Dr. Wolf makes the comments “Sledding accident. Look closely. It’s kinda subtle.” How is such a post “beyond alarming”? Aside from the fact that people can comment in real-time on the content of the picture (which would seem to enhance learning), how is an anonymized Facebook post of this picture ethically any different from the same picture contained in a textbook? And why are unnamed ethicists judging the appropriateness of published material based solely on the medium in which that material is published?

There is a spectrum of online activity in which medical providers can engage. At one extreme is a hospital employee from a “staffing agency” who posted a patient’s name on Facebook and commented “Funny but this patient came in to cure her VD and get birth control.” At the other extreme are the many educational medical sites such as Dermatlas. In the middle is a large grey area. Overreaching “ethical expert opinions” condemning any online medical posts outside the extreme of “formal medical research or textbook instruction” should be carefully questioned. Unfortunately, the Topeka Capital Journal and reporter Tim Carpenter don’t really mention the names of the “array” of other ethicists with whom they presented this information, so it’s difficult to determine how much weight to give Mr. Carpenter’s assertions. Good job on the editorial work, there Capital-Journal. The array of writers involved in editing articles who reviewed this article condemned your work.

The responsibilities of a medical provider who posts patient information online depend on how the information is presented. If we prevented any posting of x-rays or patient pictures, then medical knowledge would advance at a much slower rate – regardless of the medium. I know for a fact that many x-rays and EKGs in medical textbooks are reprinted without the permission of the patient. I see pictures of patient body parts, x-rays, CT scans, and EKGs used in lectures without patient permission. These actions are hardly worthy of condemnation or “beyond alarming.” Conversely, using pictures to belittle patients who have little control over their conditions may be pushing the envelope on professionalism. Remarking that a patient who died from a gunshot wound “got what he deserved” may initially seem harsh, but would it be as inflammatory if the patient was in the process of brutally raping a young child?

Dr. Wolf’s humor may have been a little off-color. Off-color humor may be offensive to some. Should a doctor be labeled as “unprofessional” because that off-color humor offends a minority of people who read it … along with the president of the Center for Practical Bioethics (who probably wouldn’t have been quoted in the news had he not derided Dr. Wolf’s comments), a few unnamed “ethicists”, and a political opponent behind in the polls who stands to gain if the campaign of “unprofessionalism” gains steam?

I’m not condoning Dr. Wolf’s comments, but I think we need to look at the motivations of those publishing information and at the implications of whatever societal rule we want to create. Should off-color commentary render someone unfit for political office?

And by the way, has anyone looked into Tim Carpenter‘s background lately?

Hat tip to a @movinmeat tweet for the initial story. If you want to read his blog, you can go here, but he’s turned into a Twitter bug for the past year or so.

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4 Responses to “Unprofessional Act or Political Mudslinging?”

  1. Nick Genes says:

    I’m not sure HIPAA isn’t an issue here – remember the 18th identifier is “any identifying characteristic” and another piece of PHI is date of service…

    So if this radiologist said, “here’s the guy with the GSW to the temple that we scanned last Friday” and it’s clear elsewhere where the radiologist works, then it sounds like there’s enough identifying information out there to make a match.

    Recall the case of Alexandra Thran – she posted details of a case to her circle on Facebook, no names, but there was enough info for the community to make an ID – she was not fined for violating HIPAA but nonetheless faced board discipline and was fired – http://www.boston.com/lifestyle/health/articles/2011/04/20/for_doctors_social_media_a_tricky_case/

    • WhiteCoat says:

      Good point. Enough innocuous information pieced together can be used to “connect the dots.”

      Dr. Wolf never said when or where the patient was scanned. It was the tech commenting on the x-ray who mentioned when the patient was scanned.
      The other examples in the news consisted of a patient from residency with a GSW to the head and an ankle/talus fracture from an undated accident. Even knowing where Dr. Wolf works, still not enough information to identify the patient.
      HIPAA doesn’t require absolute certainty that there is no way a patient can be identified, only that the risk of re-identification is “very small.”

      As for the Thran case, it is a good reminder of how identities can be reconstructed from disparate information. The hospital can do what it wants for work-related activities/violating hospital policies, but the board action was way overboard. State medical boards are getting to be more of a threat to medical practice than the plaintiff attorneys.

  2. SeaSpray says:

    I think it is a shame this is being used for mudslinging in a political race.

    I understand the black humor venting/coping …but it is probably better that not be made public. I remember one of my co-workers telling me that they slipped up when going into a code and said, “Where’s the party?” ..something they said on those occasions, but this one time a family member was in the room. Nothing came of it but the person saying felt bad and of course very much cared about the patient. Again – coping.

    I do think there are people that would not understand …even feel hurt by such comments. Even if that was not their relative …but had someone die of the same injury. It could cause them to feel emotional pain ..or disturbed and/or that the patient was disrespected by such comments.

    So ..I think he should be forgiven …it certainly should NOT be used against him politically and doing so could actually cause more attention and cause pain to people wondering if that could be their relative, etc ..or just reminding them. Also …people might feel uncomfortable thinking they or loved ones could be joked about like that …even tho also understandable.

    Oh and the person giving out a patient’s name with the diagnosis – especially that one ..wow. The “F” word comes to mind – FIRED. Law suit anyone?

  3. AnonymousGuy says:

    I *can* see this being a problem if the xray were say of a guy’s pelvic region with a comment “look at his tiny wang”. But a xray of an elbow? Nothing really special about that.

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