by Craig Klugman, Ph.D.
According to a news report in The Washington Post, a number of medical staff at a Pittsburgh hospital have been reprimanded over a gross violation of a patient’s privacy. The patient was under anesthesia and a crowd of staff gathered to watch and take photos of “a patient’s genitals with a foreign object protrusion.” Many photos were shared with others. The “crowd” was significant and consisted of more people than those involved with the patient’s care. According to one person interviewed in the investigation (who took a picture of the patient when requested to do so): “There were so many people it looked like a cheerleader type pyramid.”
I am friends with many health care providers and I have seen them post pictures of unusual surgeries on Facebook, or sent me a text with a picture with a caption like, “can you believe this thing?” I have been told stories of surgeons inviting people to take a look at a patient’s unusual anatomy during a procedure. Such medical gawking is common. My response to hearing or seeing such behavior has always been “did you ask the patient to consent to being viewed in this way?” and “Have you thought about the risk to your professional integrity and current and future job prospects if others see this.” After all, if one is fired for violating patient privacy, that may negatively impact ability to get a future job. Many employers check applicant’s social media feeds and posting gawking photos may limit one’s job prospects. My next piece of advice is to always take down the offending post. Of course, nothing on the internet is every truly deleted, so it’s best never to post in the first place.
To me, it is clear that taking pictures of patients without their consent and using their vulnerable bodies as a source of amusement or entertainment is a gross violation of ethics. A patient is not a carnival sideshow exhibit. This is a human being who has placed her or his trust and well-being in the hands of the medical professionals. There is an ethical and legal expectation of confidentiality. These actions are nothing less than a violation of trust.
However, when I’ve stated my concerns about gawking to the same professionals, I’ve been given remarkably similar explanations by those who have offended: (1) “You don’t understand operating room culture. We’re just blowing off steam in a tense environment.” Similar excuses have been offered by police officers who shoot a person after mistaking a toy for a weapon. A culture of disrespect and demeaning others to deal with the stress of the job does not excuse these behaviors but rather points to a need to change the culture. Yes, there are stressful jobs and that means as a society we need to ensure there are appropriate ways to address that stress rather than giving a pass to brutal behavior.
(2) “It’s a learning opportunity. By showing the unusual we can help our peers to learn.” If this is truly a learning opportunity, then you can write an article, prepare a presentation, or teach a class after you receive the patient’s permission. If the object of gawking was unexpected and there was no way to get the patient’s permission beforehand, then take the picture, do not share it with anyone, and ask the patient for permission after the procedure. If the patient declines, then delete the picture. If the patient does not sign a photo release and consent or does not object, that should not be taken as permission: Delete the pictures. Real learning opportunities will not be compromised by asking for permission. In fact, asking for permission is a great learning opportunity in itself and role models good behavior for trainees.
(3) “We’re medical professionals, we see this stuff all the time.” If one sees these things all the time, then there should be no reason to gawk at a patient. If what you are seeing is not unusual, then why post it online or text your colleagues to run down to the OR to see this patient? Logically, the patient’s condition cannot “unusual” and “usual” at the same time. What this excuse really says is that the gawking behavior happens all the time.
In the incident reported in the Washington Post, the patient was alerted to the violation. Following a report by a hospital executive, the hospital and Pennsylvania Department of health & Human Services investigated. As a result, three staff members were suspended and required to take CME on HIPAA, patient privacy and ethics. All staff were emailed a reminder about institutional policies regarding filming patients, were given an in-service on privacy and confidentiality, and department leadership was changed. In my mind, they got off easy.
While having a policy and providing education are necessary steps, they are not sufficient. The culture of medicine which tolerates seeing patients as objects is the core of the problem and needs to change.