On the recent ‘festival’ of live tweeting from A+E/ambulances/GP surgeries;

If done carelessly, thoughtlessly, or simply unimaginatively, this can be unpleasant or even  dangerous.

Consider: (and I’m paraphrasing)

* A tweet commenting that ‘lots of ladies are coming in to A+E for emergency contraception. Didn’t they know they can get it from pharmacies!’

This could make someone, possibly a vulnerable someone, feel stupid, idiotic, clumsy, or/and that their personal details and failings had been passed to a media department for tweeting to make an example of them.

Why not  tweet  ‘do you know you can get emergency contraception from high street pharmacies without a prescription?’ The PR department sending the tweet shouldn’t even know that this type of problem have been dealt with that day.

Or:

* A tweet saying that ‘a young person has been admitted with urinary problems and abdominal pain, and is going for a scan now.’

What if you knew someone that had went to hospital that day? What if you were not that person, but another person in hospital – it is clear that permission has been sought? And is it right that we should be asking someone who is acutely unwell if a press department can tweet details of their case – why is this necessary? Confidentiality is crucial to enable the relationship between doctors and patients. Hospitals can be difficult enough places to contain information – communal wards, busy A+E departments, waiting areas – but this should be reason to preserve details about patients even more, not less.

Why not just say ‘patients with serious illness are routinely brought through A+E to be triaged’.

*A tweet saying that ‘someone came in because they were deaf –  the earphone from their ipod had got stuck in their ear’ or ‘someone came in because a false nail had fallen off’.

Apparently some tweeting Trusts used ‘historical’ or ‘anecdotes’ from staff. This was possibly one.

But

– these may not be wholly true – embellished for the story

– these will not have been given permission by the patient to be disseminated

-the patient may recognise him/herself

-the patient or family/carers may be left feeling a bit stupid

– other people reading the anecdotes may feel worried that their stories in future – if they don’t get attendance ‘right’ – might be used like this

– things that seem like ‘trivial’ to doctors and nurses may not seem so minor to patients. This does not excuse careless use of A+E by patients, but makes me uncomfortable about ‘public shaming’ exercises via twitter. For example, a person may have a mild flu like illness, but because a relative died from an illness that seemed to begin in a similar way, they be more anxious than a healthcare professional would expect from a minor infection.

* A tweet saying ‘an ambulance has been called for an elderly lady who has hit her head’.

– why do we need to know this? The area covered may be geographically small; what if a neighbour sees an ambulance and deduces the background? While it should be possible for people to know what public services are doing, do we need this level of detail – which is also pegged to a specific time frame, being twitter? Who is it helping – the patients, or a public image?

In conclusion

– the massive advantages of a real time connecting system for discussion – twitter – gives scope to erode confidentiality

– just because it can be difficult to maintain confidentiality in acute settings does not mean that we should further threaten or spoil it via thoughtless tweets discussing specific patient care

– Trust hinges on confidence in confidentiality between patients and healthcare professionals. We lack evidence that tweeting can improve use of emergency care and we have not investigated the potential harms

– We should consider whether tweeting is being done to benefit us, professionals, institutions or a media or PR department  before patient care.