Comments on: HIPAA, Medical Case Reports, and Unbalanced Benefit in News Reporting

By: Nicholas Fogelson

Nicholas Fogelson — Sat, 06 Aug 2011 18:45:36 +0000

Thanks for the vote of confidence! Feel free to donate via paypal nicholas.fogelson@academicobgyn.com

By: William Noblett

William Noblett — Sat, 06 Aug 2011 13:45:11 +0000

It’s a pity you don’t have a donate button! I’d without a doubt donate to this brilliant blog! I suppose for now i’ll settle for book-marking and adding your RSS feed to my Google account. I look forward to fresh updates and will share this website with my Facebook group. Chat soon!

By: phentermine

phentermine — Mon, 11 Jul 2011 09:58:04 +0000

HIPAA-the very reason why I had several co-employees when I used to work for a California health insurance, that were terminated, they mistakenly disclosed personal information to people not authorized and as per HIPAA considered as really private.

By: Easterndrugs

Easterndrugs — Fri, 04 Mar 2011 08:49:53 +0000

I see a lot of things that could be classified as a cross between case reports and first person types of blogging. I have to admit feeling some degree of discomfort with some of them, due to the detail presented.
One thing that helps is when stories are not so contemporaneous, that they are events that have happened several months ago rather than just today, or just this week.
I think you have to anticipate that one way or another patients will learn about your blogging and perhaps begin to check to see what you are writing about.

By: bob

bob — Mon, 21 Feb 2011 09:35:16 +0000

Awesome post! please keep up the great work i would love to hear more like this.

By: Emedoutlet

Emedoutlet — Thu, 27 Jan 2011 06:00:35 +0000

Good article to read on, and yeah even i had seen some of the post disturbing pictures of this nature’s calamity.

By: madelin

madelin — Fri, 23 Jul 2010 12:09:18 +0000

These sort of reports are the most beneficial data in terms of medical activities..

By: Nicholas Fogelson

Nicholas Fogelson — Sat, 26 Jun 2010 14:02:21 +0000

Thanks for your reply, and for pointing out the date on the ultrasound. I will work on that. I had not noticed it and I should have thought of that

By: Vera

Vera — Sat, 26 Jun 2010 06:18:25 +0000

Good for you! First of all, obtaining consent/release authorization is just the safe thing to do, because it is actually quite difficult to completely de-identify everything all the time. For example, I was just scrolling through your blog and noticed a YouTube video of an ultrasound, which had the date on it. Date of service is one of the major identifiers that people slip up on when they are trying to de-identify something. I work at an academic medical center, and we had a lot of issues with trauma surgeons taking pictures of things they find “cool” on their cell phones – yes, those photographs are technically de-identified, but like you said, to the person who has fan blade up their behind, or whatever, it is very much identifiable. So we have photography policies in place basically like your new policy. The thing with the internet, like you noted, is that there is actually a chance now that a patient could find a picture of themselves on Google Images. It’s unlikely that most patients are attending grand rounds or reading case reports and therefore are unlikely to ever find themselves the subject of a physician’s writing. But a blog is entirely different, especially since patients with rare medical conditions often search the internet for information about their condition. If you blog about that condition, it’s not too far-fetched to think they might come across it.

BTW your concern about zip codes – I wouldn’t let it keep you up at night. There is nothing in HIPAA that says “implied” identifiers are identifiers. Especially in an academic setting, it is very common for patients to travel from other areas to see a physician. I wouldn’t assume that your patients share your zip code.

By: Nicholas Fogelson

Nicholas Fogelson — Sat, 06 Mar 2010 00:30:08 +0000

Lindsay – thanks for that perspective. As a physician blogger I trod a fine line. When it comes to the general medical news I can be a reporter and editorialist. But when it comes to patient cases I can’t just be a reporter, since I have privileged information that never would have been given to me out of confidence. Clearly HIPPA protects this information, but HIPPA wasn’t written for the internet age, and there’s still a few gray areas.

By: edwinleap.com | Grand Rounds is up!

edwinleap.com | Grand Rounds is up! — Wed, 10 Feb 2010 13:58:16 +0000

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By: Lindsay Beyerstein

Lindsay Beyerstein — Wed, 10 Feb 2010 04:25:17 +0000

Very interesting post. I’m a reporter. I do both print and photojournalism. In general journalists start from a very different perspective than health care providers. I couldn’t do my job if I assumed that I had to get permission from everyone I wrote about or photographed. It’s not just a practical issue. I couldn’t do my job if I assumed I had to write/shoot the kinds of stuff that every subject would consent to if I were to seek their permission. A lot of the time, my job is to reveal what the subjects would prefer to keep hidden.

It’s a matter of whose interests I’m supposed to uphold. If I were someone’s health care provider, my first duty would be to that person’s welfare, including their privacy. But that’s not how reporting works. In principle, I’m there to tell the truth as I see it. I hope I see things that my subjects would rather keep hidden.

Of course, if I’m doing my job, I’m representing the dignity of the people I’m reporting on. Because it’s always there, no matter who the subject is or what their circumstances. I mean, everyone’s a person with inherent dignity and if that doesn’t come through in my reporting, I’ve screwed up and distorted the picture.

By: Jill

Jill — Fri, 05 Feb 2010 07:22:52 +0000

I’m looking for it. These guys were prolific with the research! Also, MRI imagery makes ortho journals extremely cool.

This is a total trip down memory lane. I remember them using one of the patellar stress test “machines” on me 20 years ago and it looks so archaic in the pictures, like a couple of blocks and a rubber band.

By: Nicholas Fogelson

Nicholas Fogelson — Fri, 05 Feb 2010 03:06:29 +0000

Link that baby up! Lets see that knee article!

By: Jill

Jill — Fri, 05 Feb 2010 00:40:53 +0000

A picture of my patella and tibial tuberosity (and assorted tendons and ligaments) were put in a journal 15 years ago. I found out at a follow up appointment. He was so excited about it and handed me a photocopy of the article.

I cannot believe that I forgot about it and never looked it up.

By: Nicholas Fogelson

Nicholas Fogelson — Fri, 05 Feb 2010 00:08:07 +0000

Thanks for the comments. I’ve always asked for verbal consent to photograph anything of interest, but things have changed a bit with the internet. In the past patients would consent to taking photographs, assuming that they would never see them. And if they were published they would be published in a medical journal, that was almost certainly true. But in the internet age, any photograph that appears in print, whether in a blog or not, is far more likely to turn up, particularly if the patient decides to google their condition. As such, a new kind of consent is in order.

That being said, I think this conversation with patients really opens up the opportunities for participatory medicine. Patients by and large are open to being a part of the educational process, as long as their rights are protected and they feel that they are getting great care.

By: Diana J.

Diana J. — Thu, 04 Feb 2010 21:56:15 +0000

I think you’re quite right – good job for doing that! I was actually thinking about that very issue as I read your last few entries – the ones that had specific patient pictures (prolapsed fibroid, etc.) – I was wondering if the woman had given her permission for her picture to be published. As you say, no one would know that it was her – but if she saw it, she would know that it was her and would perhaps feel violated. Great thoughts, and thanks for bringing this up.

By: Sharon Muza, New Moon Birth

Sharon Muza, New Moon Birth — Thu, 04 Feb 2010 17:32:51 +0000

I applaud your actions and am happy that you will publish info and photos only with the express permission of the subject. That is the honorable thing to do and I appreciate you setting this high standard. Here is hoping that others follow suit!