No selfies in the hospital, please

Monday December 24 2018


By Dr Nelly Bosire

Being a patient puts you in a vulnerable position – you have to put your trust in strangers to care for you in a manner that even a family member may not be able to.

And not only that, to trust that the stranger with whom you will likely share your innermost secrets, will keep them confidential and not breach the trust you have placed in them and your privacy.

Very few people would allow their spouses to give them a bedpan, yet in the hospital, they will trustingly take their clothes off for a stranger to touch and probe them at will.

This demonstrates the power healthcare providers wield over their patients.

To safeguard the patient in this seemingly imbalanced equation. We have the Hippocratic Oath and the Nightingale Pledge that have endured the test of time to protect patients. The oldest and most binding of all pledges for physicians is the Hippocratic Oath: What I may see or hear in the course of treatment or even outside of treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

Modification of the oath


Subsequent modification of the oath to keep with the times has not changed anything with regard to patient privacy.

It maintains: I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know.

For nurses, the Nightingale Pledge states: I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping, and all family affairs coming to my knowledge in the practice of my calling.

One of the most solemn ceremonies in the medical profession is the oathing ceremony. Passing the final examination in medical school is not a passport to practise medicine in Kenya. The somberness with which this ceremony is carried out reflects the great responsibility that practitioners bear when they go forth in the world and touch patients.

New doctors are inducted into the profession with an overview of the responsibility they are about to sign on to, the Code of Professional Conduct that they shall ascribe to and the disciplinary measures in place that deal with deviance.

Not unique

During university graduation ceremonies, it is only doctors who must publicly recite the oath as they accept their degrees.

This practice is not unique to Kenya. It happens all over the world with procedural variations but with a common goal.

It is therefore infuriating to see practitioners who have utter disregard for the oath in the age of social media. Social media has greatly enhanced information sharing, learning, consulting and updates in the world of medicine. This has greatly benefitted patients with improved care and better outcomes at a click of a button.

However, social media in healthcare settings comes with pitfalls, with a new crime slowly rearing its ugly head, when the professionals entrusted to safeguard the most vulnerable, breach their privacy at the click of a button.

We must all rise and take issue with healthcare providers who are willfully embarrassing the noble profession by callously exposing their patients. Malawi set the pace by suspending a nurse who took a selfie in the labour ward with an exposed mother behind her on the delivery couch.

It is imperative that proper investigation and appropriate disciplinary measures be taken to safeguard patients.

Just when I thought it could not get any worse, a friend sent me a tweet from a Nigerian doctor in Enugu, who made fun of his patient in labour for passing stool during childbirth.

I am still flaming with anger. As an obstetrician/gynaecologist who spends her days helping mothers walk through the miracle of bringing forth life, I was extremely miffed, as I believe my colleagues would be too.

Barely a day later

Barely a day later, another allegation of a social media post made by health professionals, all smiles in an operating room with the patient right behind them found its way to my phone, and I had to pose and ask the hard questions.

Where are we going wrong? Do our medical, nursing and clinical medicine students appreciate the bioethics and jurisprudence courses they take? Are we doing enough on mentorship with regard to professional conduct?

The developed world already has clear guidelines and policies regulating social media interaction for health practitioners.

For instance, the General Medical Council in the United Kingdom has a whole section on social media under its “Ethical Guidance” rules.

Up to par

The Medical Board of Australia is equally up to par with its guidelines on the use of social media by health practitioners, in relation to their patients. The American Medical Association clearly spells it out under the Code of Medical Ethics Opinion 2.3.2.

The message must be clear to all and sundry: forget millennialism, patient privacy is sacrosanct and must always be regarded as so!