Dicere Non Nocere: Public Disclosure of Identifiable Patient Information by Health Professionals on Social Media

Background: Respecting patient privacy and confidentiality is critical for doctor-patient relationships and public trust in medical professionals. The frequency of potentially identifiable disclosures online during periods of active engagement is unknown. Our aim was to quantify potentially identifiable content shared by physicians and other health care providers on social media using the hashtag #ShareAStoryInOneTweet. Methods: We used Symplur Signals software to access Twitter API and searched for tweets including the hashtag. We identified 1206 tweets by doctors, nurses, and other health professionals out of 43,374 tweets shared May 1-31, 2018. We evaluated tweet content in January 2019, eight months after the study period. To determine the incidence of sharing names or potentially identifiable information about patients, we performed a content analysis of the 754 tweets in which tweets disclosed information about others. We also evaluated whether participants raised concerns about privacy breaches and estimated the frequency of deleted tweets. We used dual, blinded coding for a 10% sample to estimate inter-coder reliability for potential identifiability of tweet content using Cohen kappa statistic. Results 656 participants, including 486 doctors (74.1%) and 98 nurses (14.9%), shared 754 tweets disclosing information about others rather than themselves. Professional participants sharing stories about patient care disclosed the time frame in 95 (12.6%) and included patient names in 15 (2.0%) of tweets. We estimated that friends or families could likely identify the clinical scenario described in 32.1% of the 754 tweets. Among 348 tweets about potentially living patients, we estimated 162 (46.6%) were likely identifiable by patients. Inter-coder reliability in rating the potential identifiability demonstrated 86.8% agreement, with a Cohen Kappa of 0.8 suggesting substantial agreement Of the 1206 tweets we identified, 78 (6.5%) had been deleted on the website but were still viewable in the analytics software dataset. Conclusions: During periods of active sharing online, nurses, physicians, and other health professionals may sometimes share more information than patients or families might expect. More study is needed to determine whether similar events arise frequently online and to understand how to best ensure that patient rights are adequately respected.