Train in Vein Private Practice: When A Doctor Shares Too Much Alexandra

Amy Dunbar, an OB GYN in the Midwest, has recently come under fire for posting comments about a patient on Facebook. The initial comment was a bit snarky, expressing frustration about the patient’s habitual tardiness for appointments:

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“I have a patient who has chosen to either no-show or be late (sometimes hours) for all of her prenatal visits, ultrasounds, and NSTs. She is now 3 hours late for her induction. May I show up late to her delivery?”

After a few comments from friends, she revealed the reason why she has tolerated this patient’s tardiness:

“Here is the explanation why I have put up with it/ not cancelled induction: Prior stillbirth.”

Ohhhh boy. I can see how this has stirred up quite the controversy. Some are insisting that Dr. Dunbar be fired for revealing private patient information on Facebook, while others say she was simply venting about work and never revealed the patient’s actual name. I can see where both sides are coming from.

In terms of confidentiality, I don’t think she technically violated the rules set by the HIPAA (The US Health Insurance Portability and Accountability Act) Privacy Rule against linking Protected Health Information (PHI) to a specific individual. Technicalities aside, while she didn’t reveal the patient’s name, she may have posted too much information after revealing that this patient had a prior stillbirth. Anyone in Dr. Dunbar’s office could potentially identify a woman who was consistently late (not private information) as having suffered a previous stillbirth (very private and devastating information).

The patient would also likely be able to identify herself in reading Dr. Dunbar’s posts and perceive her privacy as having been violated. The original statement about the patient’s lateness, while a bit whiny and maybe not what people want to hear from a doctor, wasn’t revealing any private information. However, mentioning the stillbirth was pretty crass and potentially identifying. Beyond that, mentioning something as heart-wrenching as a woman’s stillbirth on Facebook is something I find extremely crude and unprofessional. Not to mention, maybe the horror of having had a stillbirth is factoring into this patient’s resistance to showing up for appointments. She may be terrified and filled with dread.

I believe the real issue here is that of professionalism. There are strict rules for privacy and confidentiality, but there is nothing set in stone mandating professionalism for doctors or other healthcare workers. Before social media was literally at our fingertips, it was easy to separate the personal from the professional. Do doctors and nurses have the right to a personal life and personal opinions? Yes. Do health care professionals have the right to complain about work and share crazy stories? Sure. Do they have the right to make these things public on Facebook? To that I have to say no, or, only extremely carefully.

As a medical professional, one has a responsibility to the public to uphold a professional image and maintain trust. As medical professionals, we sort of sacrifice the right to be publicly crass, cynical, irresponsible or ridiculous. No one wants to see us drunk at a party knowing we will go to work in the operating room on Monday, and no one wants to hear us rant in detail about our jobs. I try to keep things light, vague, professional and private. I select my audience carefully, and I prefer for people to ask me questions so they can set the limits on what they want to know.

I live in fear of offending or scaring people. Few civilian types want to hear about facial trauma in detail if you know what I mean. I try to leave the drama and humor to Grey’s Anatomy and Scrubs, because that is where it belongs. In reality, we all want to think of the hospital and health care professionals as serious and infallible. Obviously doctors and nurses are human, but unfortunately that human side should be kept mostly private. It’s a tough balance though, as robotic and cold health care workers are equally unappealing. A little bedside manner goes a long way, and a little over-sharing digs a big hole. At the end of the day, no one wants to think about their doctors talking about them on Facebook, revealing details or not.

I believe Amy Dunbar had a right to be annoyed with this patient, but she should have kept that to herself or between her and a friend or colleague in private. Instead, by posting about it on Facebook, she came across as rash, immature, insensitive and unprofessional. I don’t think that she is a bad doctor, though. I sincerely believe that she and other medical professionals can learn an important lesson from this backlash. It is critical that professionals maintain professionalism in the public domain, and this includes online. It is still new territory, and many doctors and nurses may need some training or gentle reminders about what is and is not appropriate. Patient privacy is something that must never be breached, but outside of that there is a lot of gray area in terms of what a health care professional should and should not share.

Above all, one must remember their duty to the public to be professional and trustworthy. That said, I feel sad for Dr. Dunbar. I doubt she meant any harm by her post, and I am willing to bet she feels horrible about her actions. She no doubt became an OB GYN out of love for helping women, and she is likely devastated by how this turned out. I think we can all take this as a lesson in navigating the brave new world of social media. Let’s not burn her at the stake like the poor nurse involved in the Kate Middleton scandal, but let’s make her an example for how health care professionals must never, ever behave.

 Featured image via ShutterStock

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  1. I wouldn’t use her if I knew she was writing these kinds of things on fb. The patient sounds like kind of a douche and she didn’t reveal her name but it shows a complete lack of professionalism on the part of the doctor. Vent with a coworker but fb is not the place.

  2. From the patient point of view it would make me very uncomfortable to go to a doctor thinking about the embarrassing things they could share with others. Even if they didn’t reveal my name it would make me very uncomfortable.

  3. I don’t know… she didn’t reveal her patient’s identity at all. She didn’t say the patient’s name. And people complain about their jobs ALL the time. I agree it was unwise to make a post about it on facebook, but I don’t think she should get fired because of it. It’s sort of a similar situation as the Applebees waitress. Overall, it was unprofessional. If the hospital she works at has a social media contract that she violated then I feel that’s grounds for termination of employment. But like I said, she didn’t reveal the patient’s identity nor the location of the hospital in which she works in. Jus’ sayin’.

    • I totally agree that she didn’t break any laws. I mostly think it’s unprofessional. And putting myself in the patients shoes, I would feel pretty uncomfortable. Thank you for the comment!!

  4. Love the quote at the end regarding Alexandra “a lot of people sleep with her because she is an anesthesiologist”. I have to say, being put under anesthesia was the best sleep I’ve ever had!

    @Akilah, being a doctor myself, I can say that when I’m late it’s because of other patients being late, patients complaining of too many other issues than what the appointment was for, and the most frequent reason is because of medical emergencies that need emergent attention before routine issues.

    When my patient is more than 15 mins late for a 30 min appointment, I have them reschedule or have them wait until after all the other patients who are on time have been seen. Yes these patients get pissed off, few fire me, most are never late again to their appt. When patients have too many complaints, I tell them I only have so many minutes to spend with them and they have to pick the top 1-2 complaints to discuss at that appointment. Regarding emergencies, it can’t be helped. I have my secretary inform patients approximately how late I’ll be and give them the option to wait or reschedule. You have every right to ask your doctor why he/she was late. You also have the right to charge your doctor for your time lost in the waiting room as long as you inform your doctor before creating a doctor-patient relationship.

    In regards to being “one of the highest paid professions”, if you take away the office rent/mortgage, utilities (phone, internet, electricity, water/sewage, biohazard pick-up, etc), employee salaries & benefits (health, TDI insurances, training courses, retirement plans, paid holidays), office insurances (general liability, malpractice, disability), office supplies and machinery, medical supplies, licenses, repayment of educational loans (sometimes in the hundreds of thousands), take home pay is very little for private practice docs. What you see as payment to the doctor from your health insurance company, it has to cover all that stuff. Afterall, running an office is a business and the biggest cuts of the pie go towards taking care of the employees’ salaries/benefits and other insurances.

    Your criticism about the OB/Gyn doctor in this article fails. She was dedicated. She kept taking care of the patient despite the patient’s lack of respect for the doctor’s time, always showing up late or not showing up at all. Anyone in any profession would get frustrated by a client like that. The patient’s tardiness is what makes the doctor late for another patient. Her no-show takes away a timeslot that could have been given to see another patient. The doctor could have fired the patient for noncompliance and let another doctor deal with it, but she stayed. She cared about making sure the baby be delivered alive and well.

    • That’s a great point Maria, I agree that she was dedicated to the patient and I do admire that. I never said that she was a bad doctor, or that she didn’t care about the patient. In fact, I am sure it is just the opposite. I just think that she should have kept the conversation about tardiness between her and the patient instead of making such a public posting. But I really don’t think she meant to be malicious, she got frustrated just like we all do.

      • @Alexandra, I thought your article was good and wasn’t implying you criticized the doctor. I was addressing my comments to @Akilah.

  5. I agree with the idea that this is crass and extremely unprofessional. Mostly my issue is the idea that doctors can complain when they, themselves are rarely prompt, and they are also in one of the highest paid professions available. Does that mean their time should be wasted? Absolutely not, but she should probably be more dedicated to being understanding of her patients than so dedicated to taking the time to put them on blast on Facebook.

    • Thank you Akilah! Doctors being late is a whole new topic… Sadly, they always are. Well, not for the OR… but for clinic? Quite often. To be fair, it is rarely the doctor’s fault. It’s no ones fault really; the way the system works is flawed. Doctors are incredibly overscheduled in clinics, often with overlapping time slots for patients and unrealistic blocks of time booked for each patient. This is just how it works so that everyone can be seen. Not to mention there is paperwork, charting, billing, and dictation that needs to be done between patients (also time that isn’t scheduled). It’s a frustrating problem, and I don’t know how to fix it… But I can advise you to try to schedule the first appointment of the day or the first appointment after lunch :)