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Table of Contents

Think

Assess

 Patient: Autonomy

 Practitioner: Beneficence & Nonmaleficence

 Public Policy: Justice

Conclude

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30. Media Communications

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The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head. Often the best part of your work will have nothing to do with potions and powders, but with the exercise of an influence of the strong upon the weak, of the righteous upon the wicked, of the wise upon the foolish.
~ Sir William Osler

Abstract

Medical practitioners who speak to the media must comply with professional and institutional media policies and guidelines and obtain documented informed consent from patients before disclosing any protected health information. Practitioners must prioritize the patient’s autonomy and privacy, and their primary loyalty must always be to their patient-practitioner relationship. Practitioners have a professional obligation to pursue the patient’s best interests, follow professional and institutional media policies, and maintain the patient-centered evidence-based medical profession’s ethical and moral principles. The medical profession also has a social obligation to keep the media informed of evidence-based medicine and healthcare disparities, while ensuring the patient’s right to confidentiality and privacy is protected. The medical practitioner must understand the importance of the patient-practitioner relationship and the consequences of violating patient privacy when communicating with the media.

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Think 

[30:1] Informing the media about evidence-based medicine is a public service that can significantly benefit individuals and the community. Addressing epidemiological issues and healthcare disparities is a professional and social responsibility that medical practitioners must pursue. However, medical practitioners who speak on behalf of an organization must fully comply with their professional and institutional media policies and guidelines. Failure to do so could have legal, institutional, and professional consequences.

[30:2] Medical practitioners who speak to the media on behalf of a patient must only do so with a documented informed consent from the patient that specifically expresses what protected health information (PHI), which is meant to be confidential and private, is permissible to disclose. No protected health information (PHI) can be released to the media without documented patient authorization and institutional approval. If the authorized information is specific to a diagnosis or prognosis, then in addition to documented patient consent and authorization, the information should only be disclosed by the patient’s attending practitioner. If by court order information is requested about nefarious or criminal activities, then only the minimal amount of patient information should be disclosed to those who have the authority to receive such information, which would not be the media. Confidentiality and privacy are the cornerstones of the patient-practitioner relationship, and that trust must never be compromised both for the integrity of the patient-practitioner relationship and for the sake of the public’s trust in the medical profession.

[30:3] When communicating with the media, being addressed as a medical practitioner, and/or wearing the “white coat,” changes the role of the practitioner into someone who now represents the medical profession, the medical institution where the practitioner works and has medical privileges, and where the patient is being treated. All media policies and procedures mandated by the medical profession and the associated institutions must not be violated. When wearing the white coat, and/or being represented as a practitioner, it is imperative that the practitioner minimizes the expression of personal beliefs and political viewpoints and accentuates the demeanor and ethical values of the patient-centered evidence-based medical profession. As a representative of the medical profession and the health care facility, all media communications must reflect the practitioner’s patient-practitioner relationship as always being the practitioner’s primary loyalty.

Assess
Patient: 1) Autonomy

[30:4] Autonomy (informed consent) requires that any patient’s information may only be disclosed if authorized by the patient. Although the institution may own the medical records, the patient owns the information in those records. Any disclosure without patient authorization violates the patient’s civil rights of confidentiality and privacy and violates professional and institutional policy. It is also a violation of the Health Insurance Portability and Accountability Act (HIPAA) federal statute that is punishable by fines of up to $250,000 and a jail term of up to 5 years. When addressing the media, extreme care must be taken to not violate the patient-centered patient-practitioner relationship.

Practitioner: 2) Beneficence & 3) Nonmaleficence

[30:5] Professionally, the medical practitioner must continuously pursue the patient’s best interests as determined by the patient’s reasonable goals, values, and priorities. Therefore, it is incumbent upon the practitioner to reveal to the media only the information that the patient has authorized, and only the information that will not result in psychological, social, or physical harm to the patient, in accordance with the professional principle of nonmaleficence (do no harm). 

[30:6] Wearing the white coat and being addressed as a medical practitioner is a professional honor and should never be taken lightly. Every effort should be taken to keep the white coat immaculately clean and unwrinkled as the white coat represents the medical profession’s clean and ordered environment along with conscientious patient care. All professional and institutional media policies must be followed along with the ethical and moral precepts of the medical profession.

Public Policy: 4) Justice

[30:7] The medical profession has a social obligation of justice to keep the media informed of evidence-based medicine’s progress and how communities can better address various issues related to eliminating healthcare disparities. Communicating to the public the importance of the patient-practitioner relationship and the medical profession’s unwillingness to compromise on the patient’s right to confidentiality and privacy will help increase the social trust in the medical profession.

Conclude

[30:8] The medical practitioner must understand that the patient-practitioner relationship must not be breached when communicating with the media. No protected health information (PHI) can be disclosed to the media without documented patient authorization in the patient’s medical record and institutional approval. One exception would be if there were to be a court order, and then that information would still not be disclosed to the media, but rather only to those authorized to receive that information, and then only the minimal amount of patient information required.

[30:9] In summary, when communicating with the media, medical practitioners must balance their responsibilities to their patients, the medical profession, and the public. They must ensure that they protect patient privacy by obtaining informed consent and adhering to professional and institutional media policies. By maintaining the integrity of the patient-practitioner relationship, practitioners can help build trust in the medical profession and contribute to a better-informed society on matters related to medicine and healthcare disparities.

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30. Review Questions

1. Practitioners who speak to the media on behalf of a patient must have documented informed consent from the patient that specifically expresses what protected health information (PHI) is permissible to disclose along with institutional approval.

2. When communicating with the media, being addressed as a practitioner, and/or wearing the “white coat” changes the person’s role into someone who now represents the medical profession, the medical institutions where the practitioner works and has medical privileges.

3. When wearing the white coat, and/or being represented as a practitioner, it is imperative that the practitioner minimizes the expression of personal beliefs and political viewpoints and accentuates the demeanor and ethical values of the, patient-centered, evidence-based medical profession.

4. Every effort should be taken to keep the white coat immaculately clean and unwrinkled as the white coat represents the medical profession’s clean and ordered environment along with conscientious patient care.

5. The medical profession has a social obligation of justice to keep the media informed of evidence-based medicine’s progress and how communities can better address various issues related to eliminating healthcare disparities.

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30. Clinical Vignettes

1. Mr. John Smith is a 45-year-old patient who has been diagnosed with stage 3 colon cancer. He has been receiving chemotherapy treatments for the past six months and has been closely monitored by his attending oncologist, Dr. Kaiden Rodriguez. Recently, a local news agency contacted Dr. Rodriguez requesting an interview to discuss the effectiveness of the chemotherapy treatments Mr. Smith has received. What ethical considerations should Dr. Rodriguez take into account when deciding whether or not to grant an interview to the news agency about Mr. Smith's treatments?

2. Ms. Emily Johnson is a 30-year-old practitioner who works in a local hospital's emergency department. One evening, she witnessed a car accident on her way home from work and stopped to provide assistance. The local news agency arrived on the scene and requested an interview with Ms. Johnson about her experience as a nurse and the care she provided to the accident victims. What ethical considerations should Ms. Johnson take into account when deciding whether or not to grant an interview to the news agency about the accident?

3. Mr. James Wilson, a 52-year-old engineer, presents to the emergency department with severe abdominal pain and vomiting. The differential diagnosis includes acute appendicitis, diverticulitis, and intestinal obstruction. The medical team orders several diagnostic tests and administers IV fluids and pain medication. While waiting for the test results, Mr. Wilson asks to speak to a member of the hospital's media relations team to share his positive experience with the care he received so far. He requests to take a photo with one of the medical practitioners, wearing a white coat, to share on his social media platforms.

4. Mr. Solomon Yates, a 50-year-old retired construction worker, presents to the clinic with a history of hypertension and high cholesterol. His blood pressure is 150/90 mmHg, and his total cholesterol is 250 mg/dL. The clinical differential diagnosis includes hypertension, hypercholesterolemia, and increased cardiovascular risk. The ethical question is: how can medical practitioners fulfill their social obligation to keep the media informed of evidence-based medicine's progress in eliminating healthcare disparities while ensuring patient confidentiality and privacy?

5. Dr. Miles Jones is a 55-year-old practitioner and researcher who works at a prestigious medical institution. He has been invited to speak on a panel about the importance of evidence-based medicine in addressing healthcare disparities. During the event, Dr. Jones wears his white coat and is introduced as a practitioner from the institution where he works. He speaks about the institution's efforts to address healthcare disparities and emphasizes the importance of evidence-based medicine. What is the ethical obligation of Dr. Jones, as a medical practitioner, when communicating with the media and being addressed as a practitioner and/or wearing the white coat?

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30. Reflection Vignettes

1. Ms. Samantha Lee, a 45-year-old politician, is admitted to the hospital with severe chest pain, shortness of breath, and dizziness. The practitioner orders a series of tests and diagnoses Ms. Lee with an acute myocardial infarction (heart attack). The patient's political status attracts the media, and they request updates on Ms. Lee's condition. The practitioner is concerned about violating patient privacy laws and the patient's right to confidentiality. The practitioner consults with the hospital's ethics committee for guidance on how to balance the patient's right to privacy with the public's right to know.

Think

Assess

  Patient: Autonomy

  Practitioner: Beneficence & Nonmaleficence

  Public Policy: Justice

Conclude

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2. Mr. John Doe, a 55-year-old politician, is admitted to a hospital with symptoms of a sexually transmitted infection (STI). After testing positive for syphilis, he is treated by a prominent venereologist who maintains an active blog on STI treatments. The venereologist, unaware of Mr. Doe's political status, posts about treating a patient with syphilis on their blog. News outlets soon pick up on the story and begin speculating about the identity of the high-profile patient. The hospital administration is pressured to release information on the patient, but is bound by patient confidentiality laws. The venereologist is asked to provide information to the media but refuses, citing patient confidentiality. he reckless use of social media by the prominent venereologist has caused harm to the patient with high political status. Patient confidentiality and privacy is a fundamental principle in medical ethics, and the violation of these principles has led to significant harm to the patient. The media scrutiny and the consequent public disclosure of the patient's illness could cause the patient emotional distress, and further exacerbate their illness. Moreover, the revelation of the patient's illness may cause damage to their reputation and even impact their ability to perform their duties. The venereologist's breach of patient confidentiality not only violates medical ethics but also poses significant legal liability. The patient has a right to sue the venereologist for breach of confidentiality and privacy, which could result in significant damages to the practitioner's reputation and practice. Additionally, the venereologist may also face disciplinary action from the medical board, and their license may be revoked or suspended. In conclusion, the reckless use of social media by healthcare providers can cause significant harm to patients and result in significant legal and ethical consequences. It is crucial that healthcare providers uphold patient confidentiality and privacy, and that they are aware of the legal and ethical implications of their actions.

Think

Assess

  Patient: Autonomy

  Practitioner: Beneficence & Nonmaleficence

  Public Policy: Justice

Conclude

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