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df940103In 1987, during my internship, there was a cautionary tale making the rounds about violating patient privacy and the consequences.  I was in Norfolk but a friend swore he had heard it from a friend who was working in an emergency room in Philadelphia. It seems that a local newscaster showed up after a night of fun with friends with a little problem…a gerbil had “wormed” its way up the newscasters exit hole and had to be extracted. Oh, it was very true, I was assured, the newscaster even had to go to surgery (gerbils are unable to survive the passage through the large bowel no matter how entered). What’s worse, the health care workers who provided the public service of notifying the inquiring public were not only left unrewarded but FIRED.  Can you believe??

These were the days before internet and to be honest, since I didn’t know anyone in Philly the story meant very little to me. I will say I had a friend who happened to be gay that I did tell the story to and he proclaimed it BS. He, as it turns out, was correct. No one, not even Richard Gere, has ever been x-rayed with gerbil remains “up there.”

Doctors see a lot of stuff. For those of us who collect stories, it is a really neat job. People pay money, sit down, look me in the eye, and after I say “How are you today” they say “Fine, except for this gerbil…” Okay, there are no gerbils, but they do tell me a lot of stuff. One of the key classes in medical school is the one where the student is reminded to keep a straight face and show no emotion no matter what comes out of the patient’s mouth. As a physician, your job is to problem-solve, educate, and  instruct, but not to judge.

Doctors have the bond of “guess what silly thing my patient did” in common. The number of people who come in with a Coke bottle where it shouldn’t be and a lame story such as  “I slipped in the shower while drinking a Coke” is actually quite high. Doctors’ lounges used to be places away from the average citizen where these stories could be recounted in a private, safe, environment. Now much health care occurs outside of the hospital, many doctors have little time to lounge, and (at least in the lounges around here) docs hollering, “Say it, Brother Sean” at the TV blaring Fox tend to drown out other conversation. So who can blame doctors for moving this conversation to social media?

Dr Milton Wolf is one such doctor. A Kansan and distant relative of Barack Obama, he graduated about 10 years ago and is a practicing radiologist in Kansas. He is one of 20 some-odd physicians running this year. The odd part, for some, is Dr Wolf’s use of Facebook to “educate.” Turns out that prior to deciding that a career in politics was in order, Dr Wolf found humor in radiographic images of people who suffered tragically, mostly from trauma. He collected these images and posted them, with comment, on a blog and to a Facebook account. One such exchange:

Wolf launched a Facebook chat about the 3D image by explaining it was taken from a postmortem examination. A Facebook friend, Melissa Ring-Pessen, responded that she performed the scan on Jan. 22, 2010, and was admonished for improperly positioning the man’s head.

“Seriously?” she wrote.

“Sheesh Melissa,” Wolf replied, “it’s not like the patient was going to complain.”

There is a video of the reporter confronting Dr Wolf about this post and it is worth watching. Apparently this particular image and discussion was posted before the patient’s funeral.

The Federation of Boards of Medical Examiners has suggested some guidelines for physicians when using social media that include using candor regarding possible personal gain, respecting the privacy of patients, and maintaining professional integrity. For anyone who is in the medical profession and uses social media, this is a must read.

The Doctors’ lounge had a couple of things. It had a door that separated “us” from “them.” The conversations were evanescent; if something untrue or hurtful was said, it didn’t sit on the Internet for years. If someone was too much of a jerk, they wouldn’t get patients sent their way. Lastly, when someone was a persistent problem, the medical staff president was always there to threaten a loss of privileges. Unfortunately no one seems to police the virtual Facebook lounge. Notice that the cautionary tale about the misplaced gerbil ends in a firing. The real story about the real patient (Google search “homicide victim” “Johnson County” Kansas on that date and I bet you can find the decedent’s name) ended in the guy getting on Fox and Friends and running for Senate. Go figure.