Wayfaring MD

There’s a scene in Elementary where Dr. Watson is talking to her therapist and hesitates to talk about Sherlock, and her therapist says “my confidentiality protects your confidentiality.” Watson’s not technically Sherlock’s doctor, but I was wondering if that’s really true in the case of HIPAA. Could a medical professional divulge potentially identifying information about their patients to their own psychiatrist? Does their confidentiality really “protect” yours? -asortoflight

I’m not so sure about that. The rule is pretty much don’t give identifying patient information to anyone other than the patient or people who they permit you to share with. I suppose Watson could talk about Sherlock and not give away identifiers, though. But no, doctors shouldn’t be telling other doctors about their patients unless it’s a consult situation or a group practice type thing. 

Now in my (and Cranquis’ and all the other TOADS) case, our anonymity does protect our patients’ anonymity. Sure, we change demographic information, but even if we didn’t, it would be very difficult to identify our patients without knowing who we were or where we lived or worked. 

My question is if you know or know of places I can find some regulations in regards to posting medical-related materials such as photos of injuries or operations that i find educational. I’ve come across several tumblr and even photos on fb depicting an open heart surgery and would like some clarification on policies in regards this. Thank you! -foolstodustydeath

Hey friend, thanks!

So when taking or collecting photos of patients, a few rules apply almost everywhere:

1. You should not be able to identify the patient by the picture— all patient identifiers (numbers, dates, locations) and distinctive features (tattoos, scars, face, etc) should be covered. 

2. If you’re taking a picture of a patient, you should have their written consent to do so and to use it in an educational setting. 

3. Many hospitals require you to call a hospital-employed photographer to take these pictures to ensure proper use of them.

4. Even if you’re keeping them just for personal use and studying, they have to be de-identified in case your computer/cell phone/whatever gets “intercepted”. If not de-identified, the data should be encrypted or password protected.  

5. Don’t post them on social media sites. Just don’t do it. You take a big risk in doing it. If you post patient pictures (even anonymized) on a site with your name on it, you could lose your job, get kicked out of school, get sued, etc. It happens, friends. 

**For CTs, X-Rays, EKGs, and other imaging studies, I think you can generally use the images as long as patient identifiers are removed. I have my own personal collection of interesting x-ray and CT findings as well as a notebook full of EKGs to study by, but all have been de-identified. 

I’m not sure if the official HIPAA rules touch on this subject or not. They stay pretty general and mostly just talk about keeping information de-identified. For more specifics on what it means for something to be anonymized or de-identified, check those HIPAA rules above. Also check with your school administration or hospital legal department and find out the policies specific to your area.