Monday, February 15, 2010

The Risks of Hospitals Live-Tweeting Surgeries

Should hospitals send twitter "updates" on patients undergoing complicated catheter ablation procedures using "pre-approved" scripted story lines?
In a far corner of the operating room Thursday, a Web producer and a cardiac expert with St. Vincent’s huddled over a laptop. They chronicled the procedure largely from a script that Oza had signed off on a day earlier.

The procedure uses radio frequencies to scar parts of the heart. The scars block signals sent from a quartet of veins in the left atrium, signals that cause the heart to go haywire. The entire procedure is done using a catheter inserted into a patient’s groin while the patient is anesthetized.

Given several hours of time to fill and only a page and a half of script, Candy Bowen, the Web producer, sprinkled in descriptions about atrial fibrillation and gave health tips. Meanwhile, in the waiting room, Peacock’s family watched the updates on a wide-screen television.

“It’s some reassurance that everything’s going well,” Melissa Peacock said.

A few minutes before 6 p.m., this message popped up on Twitter: “Mr. P says Hi, and is responsive.” And then a minute later: “Mr. P has been informed that his family has been updated. And he’s smiling.”
I'm all for education using social networking, but when doctors and technicians tweet live (even if it's scripted), they risk appearing more concerned about their marketing efforts than the patient's well-being. If a complication ever arose in such a situation, what would happen? Would the world be updated? What about the family watching the tweets on television as a doctor returns to explain what really happened during the procedure?

One only has to look back at the problems a formerly anonymous doctor blogger encountered when his identity was revealed in court during a malpractice trial and the contents of his blog than might have been used against him in court. He settled.

As trendy as tweeting "live" surgical procedures might seem, I fail to see how this benefits the patient undergoing surgery at all. Education of a surgical procedure can always occur before or after a procedure. If a complication were to arise during a live-tweeted or scripted-tweet surgery, the responsible doctor and hospital might ultimately find themselves in the very uncomfortable position of having to explain their actions to a jury.



Nicholas Fogelson, MD said...

I think you have a very good point. Certainly if the doctor is the one doing the tweeting or directing the tweeting it is a problem. The patient would also have to be fully aware it is going on and be OK with it.

It is a brave new world, and the rules are changing every day. I don't think we can always apply what we thought was right/ethical to new technologies - things are changing so fast and appropriate behavior has yet to be established. Explicit patient consent is the one thing that is really clearly needed, the rest is to be determined I think.

I can think of several situations where a patient might want to be a part of this. Perhaps just for education, but also think of this - a patient agrees to allow live blogging of their surgery, and that content is popular enough to justify advertising sale - the patient might then justly ask for a substantial portion of those ad dollars. Sounds crazy? You never know.

Medintern said...

I would also think this is a significant violation of HIPAA, and while that may be overlooked if everything turns out okay, if things go sour, an overzealous lawyer could seize on that fact.

DrJohnM said...

They must be much more confident and less superstitious than I. Even after years, AF ablation garners significant worry from the operator and staff alike.

In fact, all ablation induces a healthy dose of concern, as even a "simple SVT" can morph into a difficult septal atrial tachycardia requiring any hours of work.

Twitttering live seems like taunting the ablation spirits and hence a really bad idea.


Anonymous said...

I am a patient who experienced a 7 hr ablation. There is absolutly no way I would consent to anyone twittering anything related to my procedure. It would be just my luck to have it morph onto YouTube...

Anonymous said...

I agree with Anonymous, I think that this will lead to youtube and an increased transparency and public availability of health-care information. This may not appeal to many patients, but it need to only appeal to a very small number of patients who are willing to sign away their privacy rights in exchange for a moment in the spotlight to chage the way we view medical privacy.

-Aurora from

Nicholas Fogelson, MD said...

It wouldn't be a HIPPA violation if it wasn't patient identifiable, but I certainly wouldn't do it without explicit patient consent.

Paul Dorio said...

I couldn't agree more. I have a hard time demonstrating to my colleagues the value of social media as it is. Now imagine if I suggested to them that I wanted to start tweeting my procedures and CT scan readings as well! I'd probably be sanctioned. I think Twitter/social media are best utilized as additional methods of communication, after the fact and when appropriate attention has been given to one's licensed duties.