Note: This is a true incident. Though all characters in the story are anonymized, they are recognizable to the knowledgeable based on the events portrayed. That they have been anonymized reflects propriety rather than conformity to any hidebound traditions.
John Deer and Jane Doe are part of a small team of medical personnel doing voluntary work in an under-served Central African country that is only now recovering from a prolonged and bloody civil war. They are there treating poor villagers who often travel great distances over days to a hospital where they have a special clinic, the only one of its kind in a region that is bigger than some European countries. They are supported by the local doctors and healthcare workers in that hospital.
One day, Dr. Deer sees a young alcoholic patient who has come to the clinic from one of those remote villages with complaints of abdominal pain and weight loss of a few months duration. He finds a palpable abdominal mass, so he gets Dr. Doe to perform an ultrasound on a small portable scanner that is available there. They find a large complex cystic / solid mass.
They are stumped. Is it something untreatable in their setup, like a cancer, or is it something simpler that they could effectively treat?
John is very active in social media. He has a blog with many loyal readers, a Linkedin profile with many connections, a facebook account with many friends and a twitter account with many followers. His social media connections / friends span the globe and are a smorgasbord of non-medical people and healthcare professionals of various specialities. He tweets about the case asking if anyone can offer a solution to their dilemma. Bharat, a radiologist in India,* replies to his tweet and asks him to upload an ultrasound image so that he could opine.
John, concerned about the patient’s privacy, asks Bharat for his email address to send him the image. The email address is duly obtained via private direct message on twitter. John uses his mobile phone’s camera to take a photo of the ultrasound image from the scanner’s monitor and immediately sends it via his smart phone’s email service to Bharat with a few clinical details, none of which would identify the patient. Bharat just requires a glance at the image to recognize it as an abscess. He sees these just about every day in his practice. He promptly emails John the diagnosis and suggests a possible course of treatment.
John and his team effectively treat the patient and send them home. John emails Bharat to thank him and includes a few details of the treatment. John also thanks Bharat on twitter. A few other medical types on twitter who have followed this post a few congratulatory tweets.
Happy ending to the story.
Now begins a new, fun episode in the saga.
One of the people who followed this story as it unfolded on twitter is Jet Lee,** a young doctor in Australia who is in the finishing stages of his surgical residency. Jet is, like his namesake in filmdom, a star in the medical social media sphere.
Jet tells John that this is worth writing up and publishing as a case report, with special emphasis on the utility of social media platforms such as twitter in offering specialized medical services to under-served areas in the world.
John agrees. John and Jane are now back at their bases in the USA and Europe respectively.
Jet assiduously writes up a proper case report with suitable references and sends copies to John, Jane and Bharat who have been included as co-authors. There follows a chain of emails with suggestions and corrections between the four. All four are satisfied with the crisp case report that emerges after all the corrections. The only thing left now is to find a suitable journal to publish it in.
Jet and John think that it has a good chance of being published in one of the big medical journals which is named and famed for its sharpness.
John submits the case report in the required format to the Sharp Big Medical Journal (hereinafter shortened to SBMJ. Not to be confused with the BMJ).
The person in charge of processing new submissions in SBMJ emails John asking him if he had acquired the necessary consent from the patient for publishing their story.***
Another chain of emails ensues, with copies to all co-authors, with the back-and-forth between John and the SBMJ staffer regarding the specific nature of the consent obtained.
The SBMJ wanted to know if the patient had specifically consented to their medical data being electronically transferred and published. They were very interested in publishing the case report, because they really thought the innovative usage of twitter was a story worth publishing in their august journal. But they were worried about the possible backlash from a poor Central African villager who might sue them over publishing his medical details without obtaining proper consent.
Over the course of several emails, John tried to politely and patiently explain to the SBMJ pedant that it was practically impossible to trace the patient, who would have gone back to their remote village. John actually had trouble contacting the local doctor in the clinic where the patient was seen. That was how things worked in that part of the world.
None of this mattered to SBMJ. Rules were rules. The red tape would only part if the requisite paperwork was provided.
Finally, even the indefatigable John was fed up and he withdrew the submission.
Jet has started his search for medical journals with less exacting standards than the less-than-keen ill-named SBMJ.
There ends the parable.
My opinion/rant about this follows the short footnotes below. Feel free to skip the rant and take home whatever lesson that you have gleaned from the story.
* Very thinly disguised!! There are only three tweeting radiologists from India as far as I know!
**Apologies to the actor with the similar name and to my handsome friend who I think resembles the actor.
***See my opinion below.
Some of my friends in the medical blogosphere and medical twitterverse know that I loathe the red tape associated with submitting articles / papers to big medical journals. The story above just reinforces my loathing.
I prefer posting case reports in my blog rather than go through this.
I seriously cannot fathom the reasoning behind this kind of bureaucratic fanaticism. From the tone of the email responses by the person in the SBMJ above, it was obvious that they wanted to publish this to show themselves to be in the loop regarding the utility of social media. But then, their hidebound nature had to intervene.
I find this highly absurd in this day and age, when social media decides the fate of long-entrenched dictatorships.
I’m sure the local newspaper, if there was one in the Central African country where this occurred, would have been happy to carry this news with “Doctors use twitter to save a patient’s life” as a hyperbolic headline.
In an age where famous and well-respected hospitals vie with each other to be in the news for having been the first to live-tweet or blog a complicated surgical procedure, I find it incredible that there are dinosaurs who insist on this kind of behaviour.
If something like this is published in a blog that has good traffic, and if it is suitably good, it has the potential to “go viral” (at least in the medical corner of the internet).
I hope an editor in at least one big shot journal has the sense to see that if a patient could be successfully treated via twitter, maybe it is not too bad to publish that story.
I don’t think that particular patient would have been too worried about consent, even if it had been required for treatment.
There is a reason these poor people travel for days often in hazardous circumstances to reach these type of voluntary / mission hospitals.
They have no place else to go.
The minute they enter the clinic/hospital, all consent is implied.
They do not have the luxury of choice that those like the officials of big-medical-journals have in their lives.