This is a hit piece with a divisive agenda. Patients vs. the health establishment. Us vs. them. I had to stop reading. I am not convinced this is widespread behavior. Yes, if I saw myself on social media without consent, I would go straight to the college or professional association with a privacy violation complaint. But this article is just trying to fuel hatred.
I work in operating rooms, and while I think you make a good point, I don’t entirely agree with your comment. I do think that healthcare professionals have a responsibility to be held accountable for their behaviour - and the social medical MedTok thing is disgusting, and ultimately bad for healthcare as an industry that is in the business of caring - because this is exploitation of people who are generally vulnerable in one way or another.
I think using surgery/medical procedures for entertainment is unethical and irresponsible even if consent is given. Firstly in addition to privacy concerns, there is also concerns around being distracted while doing surgery, and infection control risks. For that reason, I don’t think any responsible healthcare practitioners that had their patients well-being at the forefront of their mind would be indulging in that kind of behaviour.
However, I think there is a place for surgery to be shown to the general public, but from an educational perspective for both healthcare professionals that are learning, but also for people to know what happens to their bodies when they have surgery. It should not be some unknown exclusive mystery. (I think the mystery of it is what makes it appealing as a form of entertainment.)
However, I think the sharing of medical procedures should be done responsibly, and accurately, and not for entertainment - which has a tendency to overdramatise things, or misrepresent things.
My biggest daily drama in an operating room is actually often dealing with the anxiety patients have around coming in for their procedures because what they expect to happen is so warped by biased representation’s of what happens in operating rooms.
I think the article does bring to light some issues in healthcare being used as a form of entertainment
My personal experience is that some surgeons (definitely not all of them) are particularly prone to suffering from hubris - at which point they genuinely believe they can do anything they want and it’ll be fine, and god have mercy on anyone who tries to tell them they’re wrong.
> However, I think there is a place for surgery to be shown to the general public, but from an educational perspective for both healthcare professionals that are learning, but also for people to know what happens to their bodies when they have surgery.
Absolutely. Obviously not for every patient as some are more squeamish than others.
I recently underwent a surgical procedure. It was great to be able to find several recorded procedures on YouTube. The videos were recorded in an academic context rather than sensational clickbait, it definitely made going into the procedure easier.
How many does it take to be widespread (or more crucially, addressable) behavior, is it N+you?
Yes, if I saw myself on social media without consent, I would go straight to the college or professional association with a privacy violation complaint. But this article is just trying to fuel hatred.
Are there any release documents for doctors that you can cite that include a patient appearing, either knowingly or unknowingly, in social media? I know this sounds sarcastic because it's so ludicrous but if they exist I would like to know.
Traditional broadcasters have been making medical documentaries, which often show patients, for years. Presumably they've figured out bulletproof release documents. It's clearly not particularly hard to find people who will agree to be on TV for no obvious benefit to them.
In fact I could see an unscrupulous doctor being able to write one vague enough to do it without the person knowing it's going to be in social media. No idea where that would go with ethics boards and such, though.
I don’t know about citable release forms, but there are certainly plastic surgery practices that will give you a discount for being able to use your photos for marketing.
We don’t need a hit piece anyone in the US shouldn’t be surprised by this. It’s the norm to deal with dismissive doctors and nurses saying inappropriate things about patients. That they are also exploiting patients for views is the least bad part about our current system.
That i have to go to 5 doctors to even find one who will take the time to listen to my issue is the problem.
There are a bunch of people who want to be doctors, a bunch of people who want to build hospitals and clinics, and a bunch of people who want prompt and affordable care.
There are impediments to all of these groups doing what they need to do.
> Patients vs. the health establishment. Us vs. them.
Well, yeah; that's the point of the article. That doctors are publicly displaying this attitude on social media, and it's becoming more and more normalized.
I've seen it. I've been victim to it. It's a real thing, causing real harm, and it's not talked about enough.
There are systemic reasons for this, which are worth addressing and exploring, but don't need to be addressed in every article that touches on the subject.
> this article is just trying to fuel hatred.
I don't think that's a fair assessment. This is a real and widespread culture problem. You can see it for yourself, if you choose to.
Casting doubt that this problem exists, while smearing (sourced and verified) pieces that address it as a "hit piece", is just sweeping a big problem under a very squishy rug.
If it's a problem that seems to be growing in frequency, I find it completely fair to draw attention to the issue this way.
Reinforce in medical professionals that patient privacy is crucial and that explicit, informed consent is not negotiable when it comes to sharing their stories on socials (with the exception of anonymised medical papers created for academic purposes).
It doesn't have to be widespread to do a lot of harm.
The worst of the homeless -- street homeless, pushing stolen shopping carts -- are a tiny minority, but it's what everyone remembers. It harms both public perception of unhoused individuals and the way public policy regarding homelessness gets made.
I have a couple doctor friends, and they on occasion share to a private group chat anonymized screenshots of humorous patient intakes and reports, and retell stories of the amusing situations they get into and patients they encounter. There's also some tales of drama between staff and how silly some of their mandatory racial/gender/body-positivity seminars are.
They're otherwise more diligent and ethically minded than their coworkers in how they attend to patients and happen to be very progressive politically. I believe they see it as irreverent gossip about work just like any other profession, although sometimes to me it seems like TMI.
It doesn't shock me though, my grandfather told me stories of how at NYU Medical & Dentistry school he and other students in the late 1930s would prank subway-goers by leaving a purse with a cadaver body part inside.
While gossip to private circles may be widespread, I am unsure if public sharing is.
I can tell you right now that if I found out I was a patient of one of your doctor friends whose medical information was shared, even anonymized, with their friend circle for a laugh I'd be furious and looking for heads to roll.
Maybe it only seems divisive depending on what side of the divide you find yourself.
I've seen a lot of hateful, unhinged, divisive attacks from the health establishment on ordinary people in the past few years. Much of it cheered on by people in internet forums such as this one.
Agreed. Professionals like doctors in general have something to lose - it makes little sense for them to break patient confidentiality plus a number of laws to promote themselves on Instagram.
On other hand the gazillion self taught quacks and wannabe influencers out there won't be bothered by morals and a few laws if the price is a thousand more followers.
Agreed.
In articles like this you could detail 20 cases which makes it feels like it’s a lot. Then you go see how much is actually 20 cases in comparison with all the ethical doctors on TikTok and you realize that it’s a really small percentage, almost negligible.
And for those who do this and get caught (like for every other unethical or illegal behavior) the punishment is usually swift and clear, considering that in the medical profession you might not be indicted but you could still lose your license. So yes, hit piece with an agenda.
The problem with that attitude is what you do with the information that at least one out of 20 million (US) healthcare workers has committed a privacy infraction.
Yes, it was wrong for that one person to do that. Yes, they should face appropriate consequences in order to attempt to make the victim whole, to change their own behavior, and to serve as a warning/deterrent to reduce the probability that their peers will make the same mistake.
But one infraction does not mean that people should stop going to the doctor; that harm is a negligible, infinitesimal fraction of the benefit that medical professionals provide to our society. A news article warning about "Doctors on TikTok" will, at the margins, cause some people to not seek care they need, and can cause far more harm than one instance of this behavior.
It’s my understanding the plastic surgeons ask after the fact, pre/post photos are taken for the medical record. If the patients are happy at their follow up you ask for consent.
In your situation it does seem coercive to ask beforehand.
Haha. Took me a second since anesthesiologists in the Nordics generelly do not stay in the room, but keep 2-3 rooms going and have specialist nurses for monitoring.
Oh interesting, so you’re only in the room for induction and reversal/extubation?
I trained in Canada where the anesthesiologist stays in the room for the whole case, I joke around with my anesthesia friends that 95% of their day job is playing sudoku or trading stocks haha.
Not sure if the Canadian system is evidence-based or political given what’s happened in the US.
My understanding is the Nordic systems are public? Curious your thoughts as to whether keeping an anesthesiologist in the room for the entire case is inefficient / wasted resources or there is a real safety benefit.
What’s funny is I have some journalist friends and they used to tell stories of colleagues who would literally call someone and tell them “please say ‘X’” and then would run a story of “a person on the street says ‘X’.”
And would get emails like “anyone willing to give a background flavor quote on…”
Whenever I see a news story and the random example is some rich New York person I assume they are friends with the producer or whatnot.
So I think journalists have always done this, just now it’s so much easier.
Which uncovers an even bigger problem: people making medical decisions on whatever some "influencer" on Tiktok says. In this case actually the quotes are unwarranted - the influencer DID influence a person. And not in a good way.
Edit: just wait until AI starts giving medical advice and people start listening to it.
And before that, people made medical decisions based on something they saw on Dr. Oz. Down to buying a more expensive supplement because he said it had to be that brand. (I worked in the pharmacy for some years in the 00s and early 10s).
And they'd get medical advice from grandmothers, aunts, parents, and friends. And be convinced they were right even though they weren't.
Alternative "medicine" has been around for many many years. I'm pretty sure there are books about it.
This isn't a new thing, it just uses whatever tech people happen to use (or lack thereof).
>Which uncovers an even bigger problem: people making medical decisions on whatever some "influencer" on Tiktok says.
What if the influencer is... a doctor? I recently saw a TikTok from a self proclaimed doctor with about 500k likes about how Benadryl is not recommended as an antihistamine anymore compared to newer ones like Claritin because it can potentially cause dementia when habitually used for many years.
I don't know if it's true or not, but it's something I'd consider looking into further the next time I need to make a decision like that.
Interesting side note. I tried to actually find this TikTok and searched "benadryl" in TikTok's search and got this message instead of any search results:
>Be informed and aware
>Some substances can be dangerous when used or misused. Learn more about how drugs, alcohol and tobacco can affect your mind, body and behavior: https://www.tiktok.com/safety/substance-support/
But it's also important to acknowledge that doctors also give bad and incorrect medical advice. That's why the concept of "getting a second opinion" exists. I think especially in the United States, there are many maladaptive incentives that encourage this. In the United States, it's still routinely recommended by doctors to circumcise baby boys for supposed health purposes even though no other developed country does this for non religious reasons.
I think the healthcare situation in the U.S. has given going to see a doctor this rarified air - like I had to fill out so many forms to go through this experience, I got to my appointment right on time and still had to wait 45 minutes, and will have to deal with so much hassle after it's done and probably a surprise bill or at least a phone call with either the doctor's office, or my health insurance company. It's like peasants seeking an audience with the king.
What is even worse about these doctors, is that sometimes they may be doctors, but not medical doctors.
I watched a video on YT once and the doctor's explanation for why his advice would work seemed a bit weird to me. Checking his credentials it turns out he's not a medical doctor and known for alternate science and questionable view points.
All the YT comments were really positive of course, giving any reader zero value or a chance for a different view.
Karens already give medical advice and people already listen to it and now whooping cough is back. We don't need to wait for AI. Please stop trotting out this bogeyman as if LLMs are currently transformative -
they are not.
TBH LLMs probably give better medical advice on average than the median layperson (if deprived of Google).
Recent slang term for people who are rude and entitled with customer facing, typically retail, employees in order to unfairly get their own way. But you'll often see it extended to anyone complaining about something in a way to silence any criticism by labeling them rude and unreasonable.
It's why in general I am always skeptical of content creators who are mainly known for their profession, since it's so easy for them to break their code of conduct of always remain professional.
Due to a variety of reasons, like wealth, ego or political/religious agenda.
For example transgender, both for and against, there are medical professionals pushing nonsense for political gain/clout.
Or say police officers giving advice about traffic stops that isn't based on any procedure but instead "common sense".
Pre and Post Op Surgical photos are considered part of patient's medical record. I don't know about laws in the Canada, but in the US HIPAA provides how medical information must be treated. Specifically the HIPAA Privacy Rule sets the standard of how Personal Health Information must be protected.
Even if the images are altered to make them impossible to identify the individual, the patient still "owns" their medical record and if that patients medical information is not being used in the course of treating that patient, then informed consent must be given before it can be used for other purposes.
Edit to add:
It's going to be very difficult to explain why a doctor posting their patients pre/post op photos on TikTok without consent is not a violation of HIPAA Privacy Rule.
Deidentified data isn’t Protected Health Information. There are valid reasons other than the provision of care to access PHI for deidentification, it can also be automated at the time of collection. Healthcare operations being a nice vague one, or a limited dataset. These don’t require consent.
Deidentification is technically possible but much harder to do and reidentification risks are higher (e.g. distinctive mark) so it’s strongly advised to obtain consent.
I expect most TikTok doctors are getting consent, I’ve heard happy aesthetics patients tend to give consent.
If it is an image of a part of my body I don't see how it is deidentifiable. Unless you literally redraw it. Also the article is about the problem of TT doctors who are NOT getting consent.
> If it is an image of a part of my body I don't see how it is deidentifiable
Depends how unique the part of your body looks, I agree it’s very hard (potentially impossible) so it shouldn’t be done.
My point is mostly about the comment I was replying to which posited this as a hypothetical and incorrectly stated it couldn’t be used, I’m clarifying that’s not how HIPAA works.
It’s still deidentified if only you recognize it. It violates deidentification only if others recognize it and tie it to you.
And it doesn’t violate HIPAA even in those situations as HIPAA allows a certain percentage of reidentification (not specified in the law, but generally accepted at 1%) before it’s a breach.
We’re talking about pre and post op photos. Not data. Again to reiterate it’s going to be very hard to argue tiktok posts fall under an exception for the privacy rule.
Photos are a type of data and are equivalent under HIPAA which only considers "Full-face photographs and any comparable images" PHI.
For further clarification of what "any comparable images" means we can turn to the slightly less ambiguous commentary from HHS:
>Comments: Some comments noted that identifiers that accompany photographic images are often needed to interpret the image and that it would be difficult to use the image alone to identify the individual.
>Response: We agree that our proposed requirement to remove all photographic images was more than necessary. Many photographs of lesions, for example, which cannot usually be used alone to identify an individual, are included in health records. In this final rule, the only absolute requirement is the removal of full-face photographs, and we depend on the 'catch-all' of 'any other unique characteristic' to pick up the unusual case where another type of photographic image might be used to identify an individual.
> it’s going to be very hard to argue tiktok posts fall under an exception for the privacy rule.
I completely agree that it's very hard to deidentify photos to a degree that they can be publicly disclosed (noting that TikTok is not specifically relevant to this challenge, the same considerations apply to a training dataset as one example).
However, you described a specific hypothetical (Even if the images are altered to make them impossible to identify the individual) that would by definition satisfy deidentification requirements and no longer be considered PHI per this guidance.
> IMHO the real question of privacy is whether they would be identifiable to others, not to themselves
I disagree. Just because my headless naked body can't easily be traced to me doesn't mean my privacy isn't violated if pictures are shared without my explicit concent.
Yeah, it would be identifiable to others, so that’s a violation of your privacy.
A more accurate analogy is if someone shared a picture of the back of your own hand or something that would be basically impossible for anyone but you to recognize.
I’m not saying it is or is not a violation of your privacy, but your example is flawed.
If I was in a situation where I have not given consent to take that picture, and I see that shared, it would make me wonder if any other pictures I didn’t agree to were also taken.
Privacy is about being in control of what information about you is made available and to whom. Identification is relevant by implication, not by definition.
You might insist that people knock before entering your room to respect your privacy. No identification is relevant here; your housemates know who and where you are already.
Someone might ask you what you did this weekend, and you might not want to reveal that you spent the weekend on a hobby you're embarrassed or sensitive about. Maybe you spent the weekend writing your novel, but you aren't ready for people to know about it yet. If you tell a white lie that you spent the weekend camping, you're doing so to preserve your privacy. Again, no identification is relevant here.
If something can be linked back to you, then you lose control of the information and your privacy is compromised. But that's an implication of the definition, not the definition itself.
If there is a publicly available picture of you that you did not consent to be published and literally nobody can currently identify it as you that is still a privacy violation.
It is a violation because of the lack of consent, but it is also a violation because now you have to live with the fact that maybe some other information can link you to that picture in the future. There is no such thing as perfect privacy if any link can be created in the future, and the fear of the creation of that link going forward is itself a problem for the subject.
> literally nobody can currently identify it as you that is still a privacy violation.
In this hypothetical it is not a privacy violation under HIPAA (US) or PHIPA (Ontario, Canada) as consent would not be required.
Whether such a level of deidentification is possible is a different question and I agree it’s best to avoid the situation altogether.
> if any link can be created in the future
An example of this is CT/MRI scans of the head that were shared in open databases. The technology now exists to make a 3D rendering of the patients face which was not anticipated 15 years ago when these datasets were made.
"In this hypothetical it is not a privacy violation under ... PHIPA (Ontario, Canada) as consent would not be required."
That is not categorically true, PHIPA requires research ethics board to review research disclosures to determine if consent is required. So what is "too much" information that might violate privacy under Ontario law is a moving target, as our ability to violate privacy with less and less information progresses the standard should be more and more restrictive.
Research use of course does not mean that the data needs to be public, as in my example, and raw data is often not made public. In your example it was, if that same database were created today I am confident the ethics board enlisted to review the disclosure would disallow it.
Under PHIPA you can essentially use PHI for: direct patient care, research, or quality improvement. All QI does not need patient consent. Most research also does not need patient consent.
Research requires REB approval. Institutional policy usually requires a REB to determine that the proposed initiative is not research but this varies. It is trivial to get QI approved.
The act of deidentification is considered a "use" and therefore would require an REB approval or be structured as QI. However, once deidentified the data is no longer protected under PHIPA and can be used for anything.
There is some nuance to this, such as you can't have a planned use of the deidentified data and not have disclosed it in the initial QI or research plan, but you can subsequently use the data as long as it was not planned at the time of initial application.
Without getting lost in the weeds, there is little protection on deidentified data once it exists.
> Without getting lost in the weeds, there is little protection on deidentified data once it exists.
That's what I said I think.. the law is about making it exist and the standard for being allowed to make it is dictated by the REB - so that's a moving target, you can't say specifically what would be allowed today will be allowed 5 years from now.
These are "uses" of data but they don't seem to in any way involve making the data public - I think if you published deidentified data to a public forum of any kind under the auspice of "educating agents" you'd get a very big fine! (You need example charts to educate certain healthcare workers, using real ones with the name blanked out is fine - publishing that on the Internet probably going to get you a violation.)
These are just standard legislative exceptions saying "you can use the data you have to run the operation without fear of getting in trouble" not publication rules.
ETA: You obviously know about the legislation, if you know of instances of orgs using these rules to publish data.. blow that damn whistle!
There is no protection against the use and disclosure of deidentified health information as regulated by PHIPA or the IPC of Ontario. The IPC has clarified through guidance that deid data is not protected however the act of deid constitutes “use” and therefore must be through an approved means. These scenarios are approved exceptions to patient consent for use.
Some institutions and systems have internal policies that add exceed PHIPA. For example ConnectingOntario which is the closest thing to a provincial EMR only allows access for direct patient care (i.e. not even REB approved research). Some academic hospitals also add approval requirements for the disclosure of deid data to other institutions or on credentialed access repositories.
I started my medical career in Ontario and this is done all the time for things like publishing case reports, online (or non-institutional) lectures and case banks (e.g. on the publicly accessible Radiopaedia).
Not sure what you mean by whistleblowing, this is completely legal in both Ontario and the US and in my opinion entirely ethical (for the most part).
I’m not saying it’s a good idea or ethical to use these exceptions to consent for posting marketing materials on TikTok. The CPSO which regulates physicians may still find the action unprofessional/unethical for reasons not related to violating the law, but their standard is different (“behavior unbecoming of the profession” and “behavior that degrades patient trust in the practice of physicians”).
On a side note I think I’m getting old but what does “ETA” mean (other than estimated time to arrival)?
It's really not perfect privacy. Adding onto the example below: Would you argue that you had perfect privacy if public toilets were in the street and you decided to wear a mask? Maybe you have repudiation, but not privacy.
influencers are either spreading propaganda or trying to sell a product. its literally in the name: they influence. pretty disgusting how normalized it is
I think OP’s point is, even “influencers for all kinds of niches” are still… trying to either sell you something or pushing some version of propaganda. It’s the same across all industries and social medias. Opening Twitter and accidentally scrolling through “For You” feed kinda shows how awful tech influencers are as well.
But how is it different than someone writing a blog post, a book or giving a talk? If someone is just sharing their opinions it doesn't mean they are trying to sell you something or spread propaganda.
It is not, they are still under the general term of “influencer”. It also depends on the person who is writing a blog or a book. “Do they have any sort of financial interest at sharing this opinion?” usually covers most of the cases.
I can see a point where divorce lawyers start doing tiktoks over the weirdest things said during settlements.
Seems professionalism goes out of the window - esp those who practice crap like boob, tummy and butt lift cosmetic surgery - yes woman who had a mastectomy have a need for it.
That would be fascinating and probably socially valuable, as long as the stories were anonymized.
People go into marriages completely oblivious to the ~40% chance that the person they're marrying will turn out in n years to be their life's greatest nemesis, in multiple comically extreme and callous ways.
No comment suggested otherwise. But if the divorce rate is in the 40% ~ 70% range then the callous nemesis rate is in the 40% ~ 70% range too, even if the latter is a slightly lower number than the former.
Why is this article focusing on TikTok when it is obvious that Instagram is the worst when it comes to vanity, celebrity worship, teenage angst, eating disorder, fad health influencing etc.?
TikTok is mentioned five times within the article. Instagram is mentioned five times within the article. "Tiktok" is mentioned as a placeholder for social media, and the article is not particularly focused on it.
At least in my feed, I'd argue what's worse is the surprising frequency with which medical doctors engage in credential-backed sensationalism, sometimes even manufacturing outright misinformation, all for the sake of views. TikTok and platforms like it have birthed a disturbing little army of Dr. Oz wannabes.
How else do you get views? Be the first to say something confidently even if it is incorrect in the long term. This is exactly what happened with the pandemic and many of these medical personalities are backpedaling their original claims/takes.
It's understandable why they'd be the worst clients though. Imagine training rigorously for a decade without any real pay, and after that you are trying to save lives and suddenly the way you order tests doesn't work anymore for no reason.
I wouldn't have much patience to deal with that. I got 12 complex patients that need shit done for them, and my login don't work because I missed some email, or something updated, or some network thing is down etc etc. Sounds like someone has not done their job well enough and that interrupting my patient care that I dedicated my life to.
I work in IT, hang out with a ton of physicians though, and I absolutely get why they'd be bad clients. They don't got any time to deal with issues.
Doctors are not just jerks to IT, they're often jerks to everyone around them in healthcare setting. Going to school for a decade isn't an excuse to act like that. You don't hear stereotypes of guys working 12 hr days in 100 degree weather being pricks, but you hear it about highly educated doctors all the time.
The big question is whether one even needs medical care to begin with. Go look at popular books like “Being Mortal” in which one of the core arguments is whether intervention harms more than it helps one live with a specific goal (I.e. quality of life/health span).
Social media doctors are clearly driven by the same idea this article calls out. Most of them want out so they can “practice” on social media instead of in the system. Many will do whatever it takes to make it. This can be seen by the absurdity of posts and privacy violations being made.
The sad part of all this is that you can get more helpful information from a 15s TikTok than you may get from a 15 minute doctor visit you waited months for. While most TikTok doctors today are the early adopters, you’ll start to see the laggards who have actual valuable information adopt it with time like we’ve seen on YouTube.
> The big question is whether one even needs medical care to begin with.
Well, then while we are at it we might as well evaluate whether we need to be on this planet at all? I mean what's even the point in being mortal if in the end we are anyway going to the mortuary? We might as well fast track it. I mean, right?
So my question is - did you write this statement in all seriousness or there were traces of sarcasm that my radar totally failed to detect.
The comment is about the need for medical intervention. TikTok and other social media platforms can convince you that you have all sorts of medical issues when you do not. And even if you did, the question still remains as to if intervention harms your overall quality of life.
This is not a generalization saying to not get checked for cancer or other serious diseases early, but to take any self-promotional “medical advice” with a grain of salt like whether you need to fix your nose, buy expensive probiotics, or try to get prescribed a certain drug based on a list of symptoms.
And no, we should not fast track death. Life is already too short.
I think you’d find people who get knee and hip replacements have their quality of life restored considerably.
They have also found breast reductions to also enhance quality of life for those patients that need them (which isnt exclusive to women - some men grow breast tissue too albeit it’s rarer and often not as big as women).
There’s a wide variety of procedures that do indeed improve quality of life. I myself had a reconstructive surgery and my quality of life improved significantly. I’m fortunate to have had it.
So the question as to whether people need medical care to begin with is a bit of a waste of time in my humble opinion.
