Social media have become a dominant force in today’s world. Nearly 3 billion monthly active users use social media to connect with family, friends, those with shared interests, and society at large. In addition, social media are integral in the dissemination of information, education, and advertisements. Within the field of plastic surgery, the impact of social media is significant.1 Plastic surgeons use them as marketing tools, to promote research, to connect with colleagues, and to create a brand.2 The use of social media within plastic surgery has several benefits. Educational materials are disseminated to a much larger audience. Novel techniques and treatment solutions can be circulated across the globe in a matter of seconds. Most importantly, we have the ability to engage and encourage patients to make evidence-based and informed decisions when considering plastic surgery (e.g., #PlasticSurgery and #DoYourHomework).3
Despite the positive impact of social media, it is crucial to recognize that there is potential for untoward consequences. An example is the distribution of identifiable patient material on social media platforms. Medical photography, whether for clinical, academic, or commercial purposes,4 requires the same level of informed consent and confidentiality as other aspects of the medical record.5 When used for publication, many journals, including Plastic and Reconstructive Surgery, require an additional level of consent in the form of a patient photograph authorization form.6 This is to ensure adequate patient awareness of how photographs will be used.
Plastic surgeons use social media to distribute patient images, for both marketing and educational purposes. Although informed consent must be obtained before distribution on social media, the use of patient images on social media is unique in several ways. Because social media are a recent phenomenon, we have not yet comprehensively elucidated patient privacy issues associated with this use. In addition, medical images used for presentations or publications have a clear copyright owner; in contrast, physicians that post by means of social media lose sole control and ownership of the images. There is also general agreement that once something is uploaded to the Internet, it is virtually impossible to permanently remove. Whether these issues are recognized by patients remains unclear. Furthermore, a fundamental aspect of the ethical principle of informed consent is the right to revoke consent at any time.7 Because of the nature of social media, patients effectively surrender this right when they consent to the distribution of photographs or other identifiable material.
Social media are a powerful tool that is here to stay.8 Therefore, adequate patient protection with respect to use must be implemented. As an initial step, we advocate for an additional level of consent to be obtained before distribution of patient materials on social media. Similar to the Journal’s photograph authorization form, the American Society of Plastic Surgeons should create a “Use of Patient Information and/or Photographs on Social Media” consent form. This document must ensure that patients are fully aware that their photographs may become a permanent fixture on the Internet should they consent to their publication by means of social media.
The authors have no financial disclosures related to this article, and no funding was received for this article.
Chad M. Teven, M.D.
The Maclean Center for Clinical Medical Ethics
University of Chicago, and Section of Plastic and Reconstructive Surgery
University of Chicago Medicine
Julie E. Park, M.D.
Section of Plastic and Reconstructive Surgery
University of Chicago Medicine
David H. Song, M.D., M.B.A.
Department of Plastic Surgery
Medstar Georgetown University Hospital
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4. Bhattacharya S. Clinical photography and our responsibilities. Indian J Plast Surg Off Publ Assoc Plast Surg India 2014;47:277280.
5. Dysmorphology Subcommittee of the Clinical Practice Committee, American College of Medical Genetics, United States. Informed consent for medical photographs. Dysmorphology Subcommittee of the Clinical Practice Committee, American College of Medical Genetics. Genet Med Off J Am Coll Med Genet. 2000;2:353355.
6. Patient Photographic Authorization, Release, and Discharge [Internet]. Plast Reconstr Surg. Available at: http://edmgr.ovid.com/prs/accounts/Photorelease_new.pdf
. Accessed April 15, 2017.
7. Satyanarayana Rao KH. Informed consent: An ethical obligation or legal compulsion? J Cutan Aesthet Surg. 2008;1:3335.
8. Rohrich RJ. So, do you want to be Facebook friends? How social media have changed plastic surgery and medicine forever. Plast Reconstr Surg. 2017;139:10211026.
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