What is the appropriate action if an intern takes a picture of a patient's leg in the operating room and posts it on social media?

Appropriate Action for Social Media Posting of Patient Images

The hospital ethics committee must be consulted immediately, and the post must be deleted regardless of the intern's claim about de-identification, as this constitutes a serious HIPAA violation with potential legal and professional consequences. 1, 2

Why "No Identification" is Not a Valid Defense

The intern's assertion that the image shows no identification is medically and legally incorrect:

• Even seemingly de-identified images can constitute PHI violations when combined with contextual information such as the operating room setting, timing of the procedure, specific institution, or unique clinical features that could allow patient identification 1, 2
• The Department of Health and Human Services reports that the majority of recent HIPAA violations stem from employees mishandling protected health information through inappropriate social sharing 1
• Once posted online, content becomes permanent and irrevocable, with no control over dissemination to unintended audiences, making the violation irreversible even after deletion 1, 2

Required Immediate Actions

Step 1: Delete the Post Immediately

• When patients or family members request post withdrawal, their wishes must be respected and the post removed immediately 1, 2
• This applies even if the intern believes no identification occurred 1

Step 2: Consult Hospital Ethics Committee

• The hospital's risk management and ethics committee should be consulted to assess potential HIPAA violations and determine appropriate disciplinary measures 2
• Institutions may use inappropriate social media posts as a basis for disciplining or terminating employed physicians, making formal institutional review essential 1

Serious Consequences That Justify Ethics Committee Involvement

The severity of this violation warrants more than just an apology and deletion:

• State Medical Boards have taken disciplinary actions (restriction, suspension, or revocation of medical licenses) for physician violations of online professionalism in 56% of US State Medical Boards 1, 2
• 14% of UK General Medical Council investigations regarding social media usage resulted in suspended or restricted registrations 1, 2
• Potential consequences include fines, litigation, imprisonment, and permanent damage to professional reputation 1, 2

Why Informed Consent Was Required Before Posting

The intern violated fundamental consent requirements:

• Informed consent and HIPAA authorization must be obtained from patients before posting any case-specific information, images, or video on social media 1, 2
• Patients must explicitly consent to each specific use, including social media, and should have the opportunity to review potential content before posting 1, 2
• The fact that the family is now upset demonstrates the lack of proper consent 1

Common Pitfalls to Avoid

• Do not accept "de-identification" as adequate protection - the combination of operating room setting, timing, and institutional context can still allow identification 1, 2
• Do not treat this as a minor educational moment - the legal and professional ramifications require formal institutional review 1, 2
• Do not assume deletion alone resolves the issue - the content may have already been disseminated, and institutional policies likely require formal reporting 1, 2

Answer: B - Consult hospital ethical committee (while also ensuring immediate deletion of the post and addressing the family's concerns)