What Can You Say in an Elevator? Protecting patients from medical students

I have argued previously that, prior to encouraging medical students to engage with social media, we should establish guidelines to protect patients, institutions, and students themselves from naive transgressions.

My post received some welcomed criticism for being overly conservative. Here, I outline my specific concerns about the subtleties of the risks medical students pose to patients. 

            As the number one priority of medicine, patients should be the number one privacy concern for medical schools. Patients are the most vulnerable stakeholders in the social media health space. Not only is their information the most potent, but their engagement with the medical profession explicitly entails protection of this information by a professional organization that is trained and federally mandated to do so. While the laws and consequences are detailed in the HIPPA documentation, medical students are rarely offered more insight than the commandment “Do not share patient information.” 

Here's why I think we need much more than such simplistic admonitions.

            Medical students are expected to share patient information all the time, and it is considered appropriate to discuss patients so long as they can’t be identified, but how can one be sure? Is it appropriate to discuss the particulars of a patient in a full elevator, so long as their name and demographics are left out? Can anything about the patient at all be discussed in an elevator? If the patient has heart disease, surely it’s okay to discuss the pathophysiology of the disease itself. But what if they have a rare condition? Isn’t it possible that discussion of a rare cardiac abnormality while stepping into an elevator may occur in the presence of family members leaving that elevator? Isn’t it likely that they may have just been Googling their loved-one’s symptoms and have that rare abnormality on their minds? The point is to illustrate the subtleties that are glossed over by the admonition “don’t share patient information.” If such subtleties exist on elevators, surely there is even more grey territory in social media situations. For example, it is not uncommon for students to post status updates about interesting cases. If something like “I saw Ebstein’s abnormality today!” were posted as a status update, it is conceivable that a distant friend viewing that update may connect this with a family member. Worse still are the consequences of a student blogging about such an experience.

            While we trust physicians to exercise appropriate judgment in these areas, we cannot expect medical students to have the knowledge and experience to make these judgments. Before the advent of social media, students simply did not have to worry about broadcasting patient information because the traditional media, print and television reporters, did not approach medical students for stories. If a medical student did find themselves in such a position, they were likely sophisticated enough to earn such interest and therefore mature enough to control their comments. In the connected age, however, medical students’ comments may instead find wide distribution specifically because they have injudiciously, and unknowingly, said things they shouldn’t.

            How do we adequately protect patients from such inadvertent transgressions? One option is to demand student abstinence from including medical content of any kind in the social media space. While tempting, this position is both unenforceable (social media and medicine are central to students’ lives) and excessively restrictive (prohibiting medical content on social media deprives students the opportunity to learn the many beneficial potentials of social media use in the healthcare space). The alternative, unfettered use, is equally untenable. The best path toward patient protection would be student training in appropriate use.

What would this training look like?

Are there examples out there?