• August 29, 2015

There May Be Skeletons in Your Doc's Online Profile

Now on Facebook: Your Future Doctor, Partying 2

DMHC (Used by permission of Blast Books Inc.)

Medical students at the turn of the century often took pictures of themselves with cadavers or skeletons. This postcard from 1911 is inscribed on the back: "Dr. ___'s first patient!"

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close Now on Facebook: Your Future Doctor, Partying 2

DMHC (Used by permission of Blast Books Inc.)

Medical students at the turn of the century often took pictures of themselves with cadavers or skeletons. This postcard from 1911 is inscribed on the back: "Dr. ___'s first patient!"

Lindsay A. Thompson was shocked when she and her colleagues perused several hundred of their students' Facebook pages a few years ago. The students had posted pictures from alcohol-soaked parties and gag photos of cross-dressing, and joined groups with acronyms like PIMP.

Nothing unusual for Facebook, of course, but the profiles did not belong to undergraduates; they belonged to medical students and residents at the University of Florida, where Dr. Thompson is an assistant professor of pediatrics. These were people caring for patients. PIMP stood for Party of Important Male Physicians. One photograph even showed a physician-in-training wearing a lab coat that read Kevorkian Medical Clinic.

It's probably not how patients at a university hospital or clinic want to see their caregivers. But medical schools across the country are grappling with ways to rein in students who think nothing of posting pictures of last night's party—or even patients' photos—online.

State University of New York Upstate Medical University, for example, has added discussions of Facebook and ethics to its curriculum. The medical school made local headlines last fall when a doctor who had just done a residency there posted a color photo on Facebook of the top of a head with the brain exposed. According to the news reports, the doctor's friends left comments such as, "Do you feel like Hannibal Lecter sometimes?" and, "Love a good BRAIN in the early morning!" (The school investigated, concerned that the photo might be of a patient, but found no evidence that it was.)

Of 78 schools that responded to a survey last year published by The Journal of the American Medical Association, 47 reported that students had posted unprofessional information online. Six of those schools reported that the postings had included a breach of patient confidentiality.

"Medical students are out there seeing patients a week after they start medical school," says Henry M. Sondheimer, senior director of student affairs and student programs at the Association of American Medical Colleges. "They haven't thought about the implication that they are now in different roles with patients than they were two weeks ago."

Although concerns about online content and patient privacy are relatively new, medical students have been taking jokey pictures ever since they could get their hands on cameras.

A recent book, Dissection: Photographs of a Rite of Passage in American Medicine: 1880-1930, includes more than 100 photographs of medical students posing with their cadavers.

In some, students stand sternly around the corpses, but others are more lighthearted. In one photograph, titled "A Student's Dream," a student lies on the dissection table while several cadavers "stand" over him, posed to look like they are about to cut him open. In another, a young man pretends to play cards with a skeleton. Among some medical students, it was customary to send cards with pictures of themselves and their cadavers.

One of the book's authors, John Harley Warner, chairman of Yale University's history-of-medicine program, says many of the corpses—often stolen from graves—were African-American or poor, and relatives of such disenfranchised people were not likely to complain about breaches of privacy. The photographs may have served as a way for medical students to bond and to cope with a morbid situation, says Mr. Warner.

For some students today, postings on Facebook may still serve that function, but Mr. Warner says students at Yale are uneasy with the idea.

"Dark humor remains a part of things and helps them get through, but I think for our students the idea of taking a photograph like this, and certainly circulating it, doesn't fit their sense of self," he says.

But because that's not true for every student, medical schools are finding it necessary to add regulations about online material to their existing rules on patient privacy or professional behavior. About 30 of the schools in the JAMA study reported that they now have policies on student-posted online content, and five of the 46 schools that didn't have policies at the time of the survey were developing them.

Vanderbilt University put into effect a formal policy for its School of Medicine and School of Nursing last month. The new rule extends existing rules on presenting a professional image to explicitly include social media.

"Some of this is just reminding people that you represent yourself and you represent Vanderbilt if you're speaking about Vanderbilt, no matter what medium you're using," says Jill D. Austin, chief marketing officer at the university's medical center.

Beginning this July, the University of Michigan School of Dentistry will add discussions on professionalism and social media throughout students' tenure there, says Lynn Johnson, the school's assistant dean for informatics and innovation. "This is not going to go away," Ms. Johnson says. "I think it's only getting bigger."

Some students have realized that online postings can cause a problem, at least for their professional futures, says Lauren S. Hughes, president of the American Medical Student Association.

"I think the patient confidentiality is secondary," she says. "I've heard from many of my peers as they get close to their residency—just to be safe, they're increasing their security on their online presence." The association plans to discuss students' social-media use during its annual convention, in Anaheim, Calif., this March.

New recommendations or rules must balance students' right to free speech with the need to keep patient information private, says Meredith Szumski, director of student affairs at the University of California at Los Angeles's David Geffen School of Medicine. Last year Ms. Szumski and several colleagues surveyed students, faculty and staff members, and administrators, and found that, while most agreed on the importance of rules protecting patient privacy, they were divided on regulating outside student activities like drinking.

In other words, some at medical schools still think party pictures should be beyond a university's control.

"There really is a huge generational change in regard to privacy of information," says Sara Jo Grethlein, associate dean for graduate medical education at SUNY Upstate. The kinds of photographs she would have hidden from her parents when she was younger "are being posted for all the world to see."


1. lkristel - February 02, 2010 at 08:32 am

I hope Mr. Warner's comments are taken out of context because as they are presented here, it seems as if he condones photographing cadavers as a means of bonding and coping--as long as the patients' families don't know. He implies that it was OK in the past when the cadavers were poor African-Americans. It's odd to me that he focuses on current Yale students' disinclination to participate in such coping and bonding from only their point of view, ignoring the issue of a family's right to privacy. It "doesn't fit their sense of self"? Maybe they are just respectful people.

On another note, the students who oppose regulation of their partying pictures may avoid censure only to suffer the consequences of a poor reputation preceding them when they're out there practicing.

2. jlaster - February 02, 2010 at 09:37 am

I think you hit on a good point, lkristel. He was saying that it wasn't "OK" in the sense that it's a morally acceptable action today, but it was much more accepted at the time given the patients' lack of stature.

Jill Laster

3. jlaster - February 02, 2010 at 09:39 am

Or, rather, he wasn't saying it is OK today, but that it was more accepted at the time given patients' lack of social stature.


4. 11182967 - February 04, 2010 at 09:27 am

Good that the New York Upstate Medical University is fighting obesity on many fronts by precipitating "lo-cal" headlines!

5. jlaster - February 04, 2010 at 09:51 am

11182967: We think that for some reason the line break that was hyphenated in the print edition made its way into the online edition. We've fixed that, and thanks for pointing it out! -Jill

6. johntoradze - February 04, 2010 at 11:57 am

Let's get real. People have to be able to make jokes about what is going on, the worse it is, the hairier the jokes. Hospice care nurses can get pretty raucous too, and I won't start on what ER docs and surgeons have thought was hilarious.

I don't think these students will suffer in professional practice. I think the ones that will suffer, who will be at higher risk for suicide and drug addiction are the ones without a sense of humor.

I think one of the good things about the shadow side of the internet is that it is forcing us to come to terms with the reality of what it is to be human with less hypocrisy. This article has all the spine of a planarian worm, but at least it doesn't take a "Cluck cluck" tone.

7. schaber - February 04, 2010 at 12:16 pm

Such behavior should make people think twice about donating their body to science.

8. bmljenny - February 04, 2010 at 03:13 pm

Commenter schaber raises an important issue. Not only do inappropriate cadaver images have consequences for the student's reputation, but they could definitely affect an institution's ability to make the case for body donation and even organ donation. Medical schools take great pains to assure families that their loved ones' remains will be used seriously and treated with dignity. UCLA had to do a lot of scrambling to reassure people after a scandal with their body donation program. At some point computer anatomy training may make body donation obsolete, but until then schools need to be pretty squeaky clean about their use of these bodies.

9. facdevniu - February 04, 2010 at 04:21 pm

Several years ago I listened to an NPR story that emphasized the reverence medical students (at one particular school that I cannot recall) have for "their" cadavers. Some even took time to reflect and thank the individual and their family for making the cadaver available. It was a moving story, and I am not a praying person, but I was encouraged by the respect the medical students portrayed to the cadaver.

My father was a body donor and I plan to do the same, but after reading this story, I have some reservations because of the lack of good judgement some medical students have when dealing with dead bodies.

10. drfunz - February 04, 2010 at 05:13 pm

I taught Gross Anatomy for years. My syllabus included a part about respect for the cadavers and warned the students that I would fail them for the course if they, in any way, did not treat them with respect. Cadavers are the under the care of the University and "freedom of speech" does not include inappropriate lab behavior.

Immaturity is a good reason to reject students who apply to medical school too early or who re part of 6 year programs. Accept the older more mature students instead. This generation might be bright enough to be physicians, but their socialization is dreadful, and when that is teamed up with immaturity and lack of experience, disaster results.

At Georgetown, there was a memorial Mass (religious service) and the donors' relatives are invited. The medical and nursing students thank the relatives personally for the gift of their cadaver.

11. bridge - February 05, 2010 at 10:11 am

@facdevniu, I was thinking of an NPR story as well, and I wonder if it's the same one you were thinking of--I found the one I recalled: it was a story about the book _Stiff_, and I was heartened to hear the author speak of a medical school where the cadavers were treated with appropriate reverence. I recall her saying that when the students were finished, there was some sort of memorial service held in tribute to the donors. That's the benevolent picture I've held in my mind since hearing that story, and I supposed it was the norm--but this story presents quite another.

The NPR story is at http://www.npr.org/templates/story/story.php?storyId=1249206

12. rhetoricat - February 05, 2010 at 05:45 pm

I've always planned to donate my body to science, and while I realize that it will no longer be _me_ once I am dead, it still bothers me to think of someone treating my body in a disrespectful manner. Even moreso, it upsets me to think of having the body of a loved one treated disrespectfully. I know that those in stressful occupations often feel the need to inject humor into their daily activities as a means to cope with that stress, but I wonder if there isn't a better way to add humor--one that doesn't come at the expense of others.

13. cellomind - February 10, 2010 at 10:56 pm

As a medical student I am apalled by this report. We have been taught at my school to respect our cadavers. However, most of us already felt we should treat our cadavers with respect. It is a tremendous honor to have people willing to donate their bodies for our medical education. They are giving us the tools to help the living. I do not believe posting innapropriate pictures with cadavers is a way of coping. It is disrespectful, period. It shows a lack of compassion that scares me if these people want to become doctors.

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