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, causing distress to the patient's relative?

Appropriate Action for Social Media Posting of Patient Images

The hospital ethics committee must be consulted immediately to assess the HIPAA violation, determine appropriate disciplinary action, and ensure institutional reporting requirements are met, while the post must be deleted immediately and the patient/family informed of the breach. 1

Why Consulting the Ethics Committee is Essential

This situation constitutes a serious breach of professional conduct that requires institutional oversight beyond a simple apology. The intern's action represents multiple violations:

• HIPAA violations can occur even without obvious patient identifiers - the combination of timing (operating room), location (specific hospital), and clinical features can allow patient identification 1
• State Medical Boards have taken disciplinary actions in 56% of cases involving physician violations of online professionalism, and 14% of UK General Medical Council investigations resulted in suspended or restricted medical registrations 1
• The hospital's risk management and ethics committee must assess potential HIPAA violations and determine appropriate disciplinary measures to protect both the institution and future patients 1

Why Other Options Are Inadequate

Option A (Do Nothing) is Completely Inappropriate

• The absence of obvious identifiers does NOT eliminate HIPAA violations - date of service, specific institution, practitioner, or limited geographic information can constitute protected health information violations 1
• Once posted online, content is permanent and irrevocable with no control over dissemination to unintended audiences 1
• The American College of Physicians explicitly documents that physicians taking digital photographs during surgery represents a very public professional misstep that harms both the individual and the profession 2

Option C (Apology and Deletion Alone) is Insufficient

While these actions are necessary first steps, they do not address:

• The mandatory institutional reporting requirements for potential HIPAA violations 1
• The need for formal documentation and investigation of the breach
• Potential criminal penalties and medical license restrictions that require institutional legal review 1
• The requirement to inform the patient/family of the privacy breach and document their response

Required Immediate Actions (In Order)

1. Delete the post immediately - when patients or family members request post withdrawal, their wishes must be respected and the post removed 2, 1

2. Notify the hospital ethics committee and risk management to initiate formal investigation and determine if State Medical Board reporting is required 1

3. Inform the patient and family of the privacy breach - patients have a right to full disclosure when errors occur, and this maintains trust 3

4. Document the incident thoroughly including the intern's actions, timeline of discovery, and all corrective measures taken

Critical Educational Points

Informed consent and HIPAA authorization must be obtained from patients BEFORE posting any case-specific information, images, or video on social media 2, 1. This consent must:

• Be obtained separately from surgical consent to avoid coercion 2
• Allow patients to review the potential content and platforms before posting 2
• Be specific to social media use, not just general medical education 1

Potential Consequences That Justify Ethics Committee Involvement

• Fines and litigation exposure from unprofessional social media behavior 1
• Medical license restriction, suspension, or revocation due to HIPAA violations 1
• Permanent damage to professional reputation and loss of patient and institutional trust 1
• Potential criminal penalties for HIPAA violations 1

Common Pitfall to Avoid

Do not accept the intern's claim that "no identification" makes the post acceptable - this fundamentally misunderstands HIPAA requirements and the permanence of online content 1. The combination of contextual information (operating room, timing, institution) can enable patient identification even without names or faces visible 1.