A couple of people have asked me to address the recent story in California about some hospital employees who took pictures of a dying patient and posted them on Facebook. Some of these people have been fired, and others have been disciplined. "Aha," some have said, "this shows that Facebook and other social media should be banned from hospital servers."
Here's what it really shows. It shows that some people are really insensitive and don't understand the privacy laws.
Is Facebook the cause of this? No. Does it facilitate the publication of pictures of all kinds? Yes.
As noted here, breaches of patient confidentiality can happen in many ways. Apparently, a common problem is when patient data is faxed to the wrong telephone number. And then there are the occasional cases where a portable computer with patient records is lost.
I know the counter-argument. These other examples are minor lapses and don't cause patient data to be spread to thousands of people instantaneously.
But here is the point. If you block Facebook on the hospital server, will it nonetheless be used in the wrong way by misguided people? Yes. They will use their iPhones or some other such handheld devices.
I know this sounds like the pro-gun argument, "Guns don't kill people. People do." However you might feel about that issue, this one is different. By blocking this medium on your hospital server, you will remove a highly effective communications tool, all because you are fearful that a few misguided people will misuse it. You trade the illusion of security for a loss of community.
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16 comments:
Thanks so much for drawing attention to the fact that the issue is the people, not the tool. The other recent issue is the nurse who was fired after posting on FB that she hoped one of her patients would "rot in hell" - she's suing to get her job back because she didn't say publicly WHICH of her patients she hoped would die and rot!
Seems pretty clear to me that the problem there isn't Facebook: blocking Facebook won't block stupidity.
But you stopped one step short of the solution: instilling a culture in which people just plain do their jobs, and are trusted accordingly.
I confess to some angst regarding whether allowing access to FB in the hospital simply enables behavior such as that described, but I agree with you, Paul, that it is the behavior that is the root of the problem.
Anyone who has worked in a hospital knows they are very gossipy places and sensational cases have always received attention from hospital staff. It is just the culture of 'sharing' (ugh) and the ability to widely disseminate information now that is new. As one health care official put it in the LA Times:
"We already have guidelines; social media is simply another form of communication. It's no different from e-mail or talking to someone in an elevator," Bennett said. "The safe advice is to assume anything you put out on a social media site has the potential to be public."
nonlocal MD
From Facebook:
Mika: Agree, the blocking is just a skiddish corporate reaction like hiding under a rock.
Toni Brayer: I agree. I was interviewed for that article and said the same thing. My comments weren't included by the reporter. HIPPA and other privacy laws need strict enforcement and hospitals need clear privacy policies.
The fact that Facebook is not anonymous makes it a safer place overall.
Michael: But removing Facebook from the hospital server makes it appear as if administration is taking a proactive stand against this kind of abuse. Of course the real problem is the employees demonstrating a profound lack of respect for patients, but utilizing hospital resources to spread the offending behavior to the world has to be compound the embarrassment.
From Facebook:
Kmla: People will find other ways, if one particular method is blocked.
From Facebook:
Brenda: The issue is HIPPA and respect, not Facebook. Those same staff could just as easily have posted a video on YouTube. Or posted the photos once they got home.
I think the hospital should enact some fierce training in privacy and ethics rules.
Banning Facebook won't solve the underlying problem.
Paul! It's HIPAA not HIPPA
rookie mistake---I'm surprised at you!!
Wasn't my mistake, but I could have easily made it, too!
Nonlocal,
THANKS - the elevator analogy has been on the tip of my tongue for weeks.
Every hospital elevator has signs about respecting patient privacy i.e. not talking about patients in the elevator. The most basic social media policy could be "Don't say anything on Facebook you wouldn't say on a crowded elevator."
Except it applies to all conversations, not just Facebook.
Hi Paul,
Great post. In a related (too long!) blogpost I made a similar point: What is more important: behaving badly or being seen to behave badly?
http://wishfulthinkinginmedicaleducation.blogspot.com/2010/01/what-is-more-important-behaving-badly.html
I agree with all who have posted here that is the behaviour and attitude which is the issue rather than the technology. Hopefully, we can move beyond the arguments oftechnological determinism which seem to have surrounded the use of new media, and instead take a social constructivist approach. It is what we make it.
I agree.
Unfortunately there is no cure for stupid and if people feel so inclined to post pt information on facebook they will do so on a mobile device I'm sure. And if it comes to the point that my lifeline is taken away from me because of idiocracy then we seriously need to reevaluate the screening process for healthcare providers.
I'm sure these images were shared , at least originally, via a mobile device, so whether or not hospital pcs have access to facebook is irrelevant.
This just makes providing good patient care more difficult for the good healthcare providers by continuing to limit purr access to all the usually information available inthe Internet.
The bottom-line is integrity, and unfortunately, I do not think blocking facebook will teach that.
Now, I love social media, and I agree with you that it has done and has the capacity to do great things in the health care field. I feel that in this instance, Facebook has just exploited the fact that staff members likely don't understand HIPAA and other privacy laws. Employers should emphasize the importance of patient privacy, and focus on how not to use social media. There's no way to completely cut out Facebook, Twitter, and the like from a hospital or any other kind of workplace environment, so I feel that we should work with social media to promote better patient safety rather than work around it.
You can't legislate compassion. You can give rules and try to brow beat your employees but respect and compassion rests within the employee. Of course extreme cases will be talked about within the hospital, but scenerios such as talking in a public elevator-or even bedside a comatose patient-should be places employees dare not tread. Keep locker room talk in the locker room. And show a little respect for the patient. I totally agree-this isn't a facebook issue, it's a question of integrity.
I often read that hospital staff say they are insanely busy and barely have time to go to the bathroom or enjoy a ten-minute lunch. So how is it that nurses and others have time to take photos and post information about patients on Facebook? Perhaps they are not so busy after all.
We have "incidents" where employees discuss other patients in elevators, in front of visitors and other patients. It seems no matter how many times you tell people not to do that, there are always people who will.
Interestingly, it seems to be those same people, who think the patients are there for them, rather than the other way around.
The culture is one of compassion and helping. You've said it time and time again: "treat others how you would want to be treated".
Now change the word "treat" to "respect". I think respect for patients is a lost art. Sometimes they have this assembly line metality and patients are just another cog or widget to be handled before the shift is over.
It would be easy to say, lets fire all these people; but with vacancy rates and competition for those skilled personnel what they are, it is hard for some organizations to manage. But I've always said, "give me 5 who do a great job over 10 who are mediocre".
Paul, you are dead on. Facebook, or any other site is not the root cause of the issue, uninformed people are. You inspired me to write an expansion on the topic. I gave you a trackback for being today's muse: Blocking Social Media is pointless
http://www.healthtechnica.com/blogsphere/2010/08/11/it-is-a-management-issue-silly-blocking-social-media-is-pointless/
What this and countless other examples suggest is that the nature of social media makes it very easy to expose incompetence and insensitivity in the workplace. That's why hospital management's reflexive reaction to privacy violations and inappropriate work behavior is to shut down access. Otherwise, they'd have to be more introspective and figure out what they aren't doing to better train and supervise their employees to perform appropriately. The examples cited above reveal a profound lack of judgement, suggesting neglectful oversight and a lack of adequate training on what to do and say online and offline. When weighing the costs involved with remediation, it is no wonder that blocking social media channels is cheaper. Truly sad.
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