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.
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?
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?