Thread by @aoglasser, A Friday #tweetorial #medthread about patient privacy on#medtwitter #SoMeThere are many facets [...]

A Friday #tweetorial #medthread about patient privacy on
#medtwitter #SoMe

There are many facets of patient privacy & professionalism concerns in this communal space—I’m going to focus on this through the
lens of case-based teaching

1/N

We know that #medtwitter & #SoMe enhance learning based on tenants of adult learning theory—this includes the microsimulation, mini-challenges, & active discussion of case-based learning.

However, how can we make this effective safe for our patients AND ourselves?

2/N

I want to introduce this concept—the term came to me a couple of weeks ago:

“POST THE PEARL, NOT THE PATIENT”

3/N

What does this mean?

When you are inspired to share a learning pearl from a case, I strongly encourage you to pause…& consider how you can best share the take-away without revealing anything about the patient themselves (potentially
ID’ing info, images, radiographs)…

4/N

“But I didn’t violate HIPAA!”

But…
but what?
I think our responsibility here extends beyond the 18 HIPAA variables

https://cphs.berkeley.edu/hipaa/hipaa18.html

5/N

The onus on what “counts” as potentially identifiable information in the digital
era. Even if you think you have de-identified a case, it may be surprisingly easy for someone to put the pieces together and recognize themselves or someone they know in that case description.

6/N

analogously--beyond #SoMe, many journals now require signed patient
consent to submit case reports.

No longer are journals only mailed to subscribers or buried in library stacks.

Articles are online, shared in new ways, and firewalls may be coming down.

7/N

We so often feel the pull to share the rare, unusual, or challenging

All these variables potentially add up

MORE discoverable

MORE identifiable
esp in smaller communities or when your twitter bio id’s where you work

Times stamps (“today”, “last night”) compound this

8/N

Additionally, please be very careful sharing (even vaguely) bad outcomes-- #medtwitter has created a safe space for many of us, but I worry
that this is not the safest space for us to decompress & debrief from bad
outcomes

for privacy & medicolegal concerns

9/N

Ask yourself—what would a patient or a family member/friend
think if they saw your tweet and realized you were talking about them?
(Even if it isn’t unprofessionally worded)

How would they feel?

What would it do to patient trust?

10/N

https://www.sciencedirect.com/science/article/pii/S0002934319303298?via%3Dihub

Let’s utilize some HYPOTHETICAL cases as learning examples

These are all fake, unsent tweets

I provide two ways to tweet the same “pearl”, you vote on
what seems a safer yet still effective means to use #medtwitter for #meded

11/N

Example

, focusing on informative that may be vague...but not vague enough

Which tweet is safer & more effective teaching?

the Twitter poll will be in the next slide, and comments are welcome

12/N

what say you?
which option would you go with for example 1?
13/N

Example

, focusing on sharing a bad outcome

Which tweet is safer & more effective teaching?

the Twitter poll will be in the next slide, and comments are welcome

14/N

what say you?

which option would you go with for example 2?

15/N

Example

, focusing again on "vague but is it vague enough?" information

Which tweet is safer & more effective teaching?

the Twitter poll will be in the next slide, and comments are welcome

16/N

Example , focusing again on "vague but is it vague enough?" informationWhich tweet is safer & more effective teaching?the Twitter poll will be in the next slide, and comments are welcome16/N

what say you?

which option would you go with for example 3?

17/N

let's also add a word about amalgam cases
@TheRealDoctorT is a master at this--and has been very TRANSPARENT about his writing process--I think this is vitally important to help role model "best practice" for other engaging on #medtwitter
https://twitter.com/TheRealDoctorT/status/1160279717150433280?s=20
18/N

https://twitter.com/TheRealDoctorT/status/1160279717150433280?s=20

what if you cannot avoid patient-specific info, including images?
GET CONSENT!
and not just "shared with permission"--explicit consent about what will be shared & on what platform for what purpose
@AndreMansoor has been very transparent about this
https://twitter.com/AndreMansoor/status/1102449437937299457 19/N

https://twitter.com/AndreMansoor/status/1102449437937299457

More resources to wrap us up:

Two excellent articles from the pathology realm, including how to take “journalistic liberties” without diluting the learning value of the case
@JMGardnerMD @evemariecrane @TimAllenMDJD
https://journalofethics.ama-assn.org/article/pathology-image-sharing-social-media-recommendations-protecting-privacy-while-motivating-education/2016-08

https://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2018-0313-SA

20/N

Pathology Image-Sharing on Social Media: Recommendations for Protecting Privacy While Motivating...

Pathologists’ adoption of practical social media use guidelines can help mitigate risk to patients.

https://journalofethics.ama-assn.org/article/pathology-image-sharing-social-media-recommendations-protecting-privacy-while-motivating-education/2016-08

@dinkjardine @virenkaul @nvhstewart also led a fantastic session on the professionalism of social media at @acgme #acgme2020 #acgmetweets last week--this was the thread of my live tweeting from it

https://twitter.com/aoglasser/status/1233790168299114496

21/N