Physicians and other medical professionals from the United States who volunteer for Operation Smile must sign a code of conduct that forbids posting pictures of patients. Ayala says that on the rare occasion when they learn that a picture has been posted inappropriate, Operation Smile contacts the healthcare provider and asks them to remove the post. "Most times the reaction will be 'Oh I'm sorry. I didn't realize,'" he says. "I don't know where the disconnect comes from because these are practitioners who would never do this in the United States."
In many cases, medical students and doctors may not realize the differing patient privacy laws in other countries or that that these laws could be even stricter than those in the U.S.
"A lot of people consider this an ethical gray area," said Reed Van Deusen, MD, an assistant professor of internal medicine and pediatrics at the University of Pittsburgh, who was not involved with the study. "It is pretty complicated, but I agree with their basic tenet that trainees, and physicians in general, should not be posting pictures of patients, whether they are in this country or not. I think it is going to take a bit of a culture change to get everyone else on the same page."
Terry Kind, MD, a director of pediatric medical student education at the Children's National Medical Center at George Washington University, in Washington, DC, said medical school faculty must teach students about issues like these, namely by modeling professional behavior themselves.
"(Social media) is here and not going away," Kind said. "There are opportunities for use, but there is risk. The nature of the widespread dissemination is people forget to have that internal check on professionalism."