Inappropriate Use of Twitter by Medical Students and Professionals

Reading this Time.com article about medical students using social networking sites like Twitter to post inappropriate things about their patients made me ask myself about the general potential of sites like this to violate privacy: not only that of their users, but of unwitting people in users’ lives as well. The idea of medical students posting tweets about their patients really disgusts me—not only is this a blatant violation of patient confidentiality policies, but it seems to me a selfish use of social networking sites that suggests the poster cares more about their own social-network personality than they do about the health or comfort of their patient. The American Medical Association website section on patient confidentiality laws says of implied consent:

“…[M]edical personnel directly involved in a patient's care or treatment generally have access to the medical record. Even if the patient has not expressly authorized disclosure of his or her medical record, such consent is implied from the patient's acceptance of treatment or hospitalization.”

However, the consent discussed here refers to the patient’s allowance of medical professionals to have access to their records—not random internet surfers. I did some research on Twitter and on Facebook to see whether this article has any basis in fact:, and found many Facebook groups for medical students, (such as this one for international med students) a lot of which include discussion boards where members can post questions about difficult patients. Similarly, a quick twitter search of key phrases like “my patient” or “diagnose” turned out a surprising amount of posts. Many of these don’t use patient names, but I still think that a lot of them would be considered breaches of privacy because they reveal critical information, like age and physical symptoms. With the technological resources available today, virtually anyone on Twitter who wanted to could figure out where the doctor or student who posted a tweet was located, where they worked and, theoretically, who the patient in question might be. Some of the tweets that I found the most disgusting are students or medical professionals making fun of their patients:

littlemissnikki says “oh btw my penis implant patient is 75. admitting diagnosis was erectile dysfunction”

while doxadeo says “Today, my delirious alcohol withdrawal patient exposed himself and peed all over his bed... while we were rounding on him! lol...”

Patients with serious problems like alcohol addiction should not be publicly mocked, and certainly not by their doctors. This is clearly an awful breach of patient confidentiality as well as just pure disrespect on the part of the doctor who posted it. Additionnally, I found a few conversations between medical students discussing problems diagnosing patients, such as this one:

@Halimshariff My case study is about an 82 year old male with ongoing shortness of breath, leg swelling, chest pain, and fatigue.

@jennakharrison the patient has chf,

@Halimshariff I guess it is pericarditis. I have to explain why his symptoms occurred and how his condition improved after surgery.

@Halimshariff Jon gave me the answer. I just need help explaining what the hell is going on (swollen legs, high BP, etc.). You rock at this!

Again, it’s unclear where the lines are drawn in terms of patient confidentiality because no names are named, but I know that if I were the patient in question I would certainly feel uncomfortable with my doctor posting private information about my symptoms and problems on Twitter. A lot of times, medical problems are sensitive—we often don’t even want to describe symptoms or issues to our friends, let alone have them shared all over the internet.

- Miranda