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arly this month, Joanna Gaines, co-host of HGTV’s popular “Fixer Upper,” shared her pregnancy news with the world via a baby bump photo and an ultrasound, both posted to Instagram. The congratulations began pouring in from excited fans. But the conversation took a dark turn when a physician commented that the ultrasound appeared to show that Gaines’s baby might have hydrops fetalis. This is a potentially fatal condition in which abnormal amounts of fluid build up in a developing baby’s body. Tabloids such as TMZ and the Hollywood Reporter ran stories about the potential problem.

Not that long ago, photocopying and sending news by mail limited the sharing of an ultrasound image of a developing baby with a few friends and family members. In the age of Facebook and Instagram, such images can be instantly shared with all of one’s social media followers, and their followers, and so on. Such images can go viral.

As practicing physicians and ethicists, that made us wonder: If we see something medically worrisome on social media, are we as doctors obliged to say something?

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In the exam room, it’s our duty to talk to our patients about car seat safety for the young children. But when friends post photos of their adorable children improperly buckled into a car seat, do we have a duty as physicians to contact them? We routinely advise our patients to stop smoking. If a social media contact posts a photo of herself smoking, must we respond with 1-800-QUIT-NOW? Is it incumbent on us to respond with the facts when a social media friend posts a link to a discredited study stating the vaccines cause the flu or autism?

There’s no question that when a physician provides medical advice via social media it must be accurate. A nonmedical individual can comment based on blogs and personal experience, while physicians must give opinions based only on evidence. But whether they’re required to do that, or even if it’s a good idea, is an open question.

In most social media situations, the two of us and our medical colleagues can be considered “physician civilians” — no doctor-patient relationship exists that creates an obligation for us to provide advice.

Chip swears he can already tell it’s a boy. Look at the little heartbeat!! 🙌🏽❤️❤️ #5

A post shared by Joanna Stevens Gaines (@joannagaines) on

Gaines’s physician, of course, has a clear obligation to provide her with information about the ultrasound. It arises from the duty that a physician has to her or his patients, since the care is being given within the context of a clinical relationship. In contrast, interested individuals who aren’t her physician have no obligation to say something on social medial about her baby’s ultrasound, or about others’ medically concerning signs or behaviors.

Physicians often feel an ethical responsibility to respond to medical emergencies outside of the typical patient-physician relationship — think doctors helping someone who has a heart attack on a flight. So should we reach out on social media as good Samaritans?

In this scenario, the physician is the one who creates the patient-physician relationship. (It’s an interesting role reversal, since it’s usually the patient who initiates this relationship.) That places on the physician the responsibility of providing the best possible care under the circumstances, a higher standard than is imposed on a nonprofessional good Samaritans.

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But even taking the good Samaritan approach, a physician who felt compelled to reach out to Gaines about the ultrasound of her baby should do so in a way that respects her privacy, not by posting his or her concern on a publicly available message board, creating tabloid fodder. Reaching out to Gaines this way creates a physician-initiated patient-physician relationship, which requires that her privacy be respected. Failing to do so violates her autonomy, a founding principle of Western medical ethics.

That’s also the opinion of the American Medical Association in its statement on professionalism in the use of social media. The AMA emphasizes the importance of patient privacy and confidentiality when posting content online.

Gaines, or any woman for that matter, has the right to publicize her pregnancy and medical information on social media if she chooses. But that doesn’t change physicians’ professional responsibility to her as a patient — even if she isn’t their patient yet.

Casey Humbyrd, M.D., is an orthopedic surgeon and medical ethicist at Johns Hopkins University. Kavita Shah Arora, M.D., is an OB-GYN and medical ethicist at Case Western Reserve University.

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  • I believe it is wrong to assume they were not told anything. It is not for us on social media, to decide what they knew or if they knew it at all. That is their personal business.
    They posted their picture out of happiness, not because they were searching for a diagnosis, so none should be given.

  • Clearly, responding on a public forum made no sense. But it seems to be incumbent upon a physician to inform the prospective parents if she truly believes that there may be a problem. They cannot be expected to interpret the ultrasound. This is different from a physician walking down teh street and telling smokers to stop–presumably they are adults and are aware of the dangers but choose to ignore them.
    And if I as a citizen note that a particular child in the neighborhood has an unusual amount of broken bones, cuts, burns and the like, shouldn’t I inform the authorities? Maybe everything is legit, maybe the child has a genetic predisposition to weak bones, but what if there is abuse? How many people had an inkling of the children chained to their beds in Perris CA and said nothing because they did not have an obligation to do so?

  • Perhaps Joanna’s doctor informed her of the possible diagnosis and she still chose to celebrate this child’s life. Or perhaps in seeing the whole scan and not just a screenshot, her doctor saw there was nothing wrong.

    • Or perhaps he didn’t. What are you really trying to say here? Suppose there was a problem with the ultrasound and the physician didn’t make the comment.

    • Replying to Steve: I’m saying that some people won’t do as advised and have an abortion in cases like this. I’m pretty sure Chip and Joanna would love this child as long as he or she lived and not take things into their own hands. And that they would not sue the doctors for not being informed of a problem. I also know of numerous situations in which pregnancy scans were interpreted wrongly. The parents were told they should abort what was viewed as a defective baby. They didn’t, the child was born, and there was nothing wrong. I never hear about these doctors later apologizing for the pain they cause by making false determinations of anomaly, only about their fears of being sued for not detecting and reporting even the smallest problem. What is the point, I might ask, of every medical person jumping in to give their opinion?

  • I always think it’s helpful to just consider social media to be just like any public space. The authors raise a vital point here about the importance of privacy. Particularly in cases like this, where any perceived duty to warn could be discharged without doing so publicly. (Again, imagine having a private discussion vs shouting across a crowded public space). The grey area around when a duty to warn actually exists is interesting and, I think, is context-dependent, hinging on risks & benefits. How significant is the danger? What benefits come with a warning? How essential is this particular warning?

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