How to protect the privacy of patients
Experts analyze the legal boundaries of the doctor’s live broadcast. The doctor’s live broadcast fever:
● With the development of Internet medical and social platforms, more and more doctors choose to conduct medical science popularization through live broadcast, but few people pay attention to the hidden risks.
● With the increase in the number of doctors on the Internet, some things are quietly changing, driven by commercialization.
Live streaming behaviors that challenge professional ethics and legal boundaries, such as patient admission, live streaming in the clinic, and even live delivery of goods, appear from time to time. Some doctors’ live streaming has gradually deviated from the original track.
● Doctors should be supported and promoted through the webcast of popular science medical health knowledge, but the premise is that they must meet the requirements of doctors' practice standards, and the popular science and online consultations should be treated differently
□ Our reporter Wen Lijuan
"It's too common. Not only are many doctors in our hospital doing live broadcasts, but also in other hospitals, but few people have considered the boundaries of live broadcasts." As a middle-level manager of a well-known domestic hospital, Sun Ting (pseudonym) is more and more familiar with her. The more peers invest in live broadcasting, they are worried.
In the face of the hot live broadcast, hospitals must encourage doctors to actively embrace new technologies while not knowing how to manage them in compliance.
However, in Sun Ting's view, the problems and hidden risks exposed by the doctor's live broadcast should at least attract the attention of colleagues and related parties.
Sun Ting's concerns are not without reason.
With the development of Internet medical treatment and social platforms, more and more doctors choose to conduct medical science popularization through live broadcast, but few people pay attention to the hidden risks.
For example, live broadcast while inquiring in the consultation room seems to be fresh but hidden risks of infringing on the privacy of patients; while live broadcasts give treatment plans based on the patient's condition, which may seem to be a reference for netizens, but may violate the relevant provisions of the Physician Law.
The latest revision of the Doctor’s Law will be formally implemented on March 1 next year. The new law has made clear requirements and restrictions on doctors’ behavior on the Internet.
Experts interviewed by a reporter from the "Rules of Law Daily" believe that doctors should be supported and promoted through webcast of popular science medical health knowledge, but the premise is that they must meet the requirements of doctors' practice standards, and that science popularization and online consultation should be treated differently.
Doctor live broadcasts are all the rage
Embrace technology to achieve win-win
At 7:20 pm on November 20, the reporter entered the live broadcast room of Zhao Hai (pseudonym), deputy chief physician of orthopedics at a hospital in Shanghai.
This is his second live broadcast on a certain platform. In order to ensure the smooth progress of the live broadcast, he "entered" 10 minutes in advance to adjust the equipment and test the wheat.
The live broadcast lasts 30 minutes, including 15 minutes of popular science and 15 minutes of interactive Q&A.
The theme of this live broadcast is "Under what circumstances should knee osteoarthritis undergo replacement surgery?" Zhao Hai gave a specific introduction from the background and diagnosis.
In the interactive session, netizens raised questions one after another, and Zhao Hai picked 6 of them to answer.
At 8pm, the live broadcast ended.
A total of 672 people watched the live broadcast that day.
Talking about the original intention of live broadcast, Zhao Hai said that on the one hand, it is to help the old and new patients in the several patient groups he built to answer questions; on the other hand, he hopes to share his knowledge and experience in the field of joints with Netizens, benefit more people through medical science.
Nowadays, with the development of Internet medical and social platforms, coupled with the impact of the epidemic, more and more doctors like Zhao Hai conduct medical science popularization through live broadcast, and they are actively creating their own private domain traffic in the field of short video.
According to the "2020 Short Video Platform Doctor KOL Ecological Analysis Report" released by the Xinbang Research Institute, in the first quarter of 2020, there are 941 individual doctor KOL accounts on the Douyin platform, 739 active accounts, and more than 32,000 videos posted. This is equivalent to 45 quarterly update videos for each account.
Data from Boston Consulting's "Digital Development Trends in the Healthcare Industry" shows that there are currently more than 500,000 doctors registered on the online platform, and more than half of them are interested in webcasting and are willing to try it.
From November 29th to December 6th, the reporter conducted statistics on one week's live broadcast in the live broadcast free clinic hall of an online platform: a total of 170 live broadcasts were conducted, involving pediatrics, obstetrics and gynecology, traditional Chinese medicine, internal medicine, dermatology, etc. Sub-fields.
From the perspective of broadcast volume, the top two are internal medicine and pediatrics.
Reporters interviewed multiple live-streaming doctors on multiple platforms and found that live-streaming rewards and paid consultation are their main means of monetization.
Previously, the "2019 Health Science Popularization Video Insight Report" released by the Health China New Media Platform Working Committee also showed that 92.1% of the 9,000 online users have watched health science popularization videos, and more than half of users who are willing to pay .
Deng Liqiang, executive director of the Chinese Society of Health Law and deputy director of Beijing Huawei Law Firm, believes that under the background that the phenomenon of "difficult to see a doctor" has not yet been fundamentally changed, more doctors live online and conduct online consultations, which is a good thing to win. : For patients, they can get professional opinions from professionals; for doctors, they can realize their own value by popularizing medical health knowledge, and some doctors can also get an additional benefit; for hospitals, new channels can be used to build new The medical consultation and professional service model can free up energy to focus more on diagnosis and treatment.
However, with the increase in the number of doctors on the Internet, some things are quietly changing, driven by commercialization.
Live streaming behaviors that challenge professional ethics and legal boundaries, such as patients entering the mirror, live streaming in the clinic, and even live streaming delivery, appear from time to time. Some doctors' live streaming has gradually deviated from the original track-this is exactly what Sun Ting worries about.
Suspected of violating patient privacy
Disputes prone to live broadcast in the clinic
In the consulting room of a hospital in Beijing, the patient Liu Ying (pseudonym) came to see a doctor.
After sitting down, she found that the doctor was talking to the phone while explaining to the phone.
It turned out that the doctor was also doing a live broadcast when she was seeing her, which made Liu Ying feel very uncomfortable.
Since her condition was not complicated, the diagnosis process was quickly over, and she gave up the idea of preventing the doctor's behavior.
But afterwards, she always felt something was wrong.
This phenomenon is also common in the hospital where Sun Ting is located. Some patients also have doctor-patient disputes due to the live broadcast of doctors in the clinic. They call "12345" (government service convenience hotline) to complain to the hospital.
"Doctors feel that it will be more vivid to let patients enter the microscope and conduct science popularization through patient cases, so this form is very popular with doctors." Sun Ting said, but from the perspective of patients, it took them a long time to sit in the consulting room. Doctors need to record videos while inquiring, and the patient's experience of seeking medical care is of course very poor.
What worries Sun Ting even more is that there may be legal risks behind this infringement of patients' privacy, which will bring certain hidden dangers to hospital management.
In this regard, Du Xiujun, a lawyer at the Beijing Manifesto Law Firm, analyzed that doctors’ interviews and live broadcasts in the clinic may first infringe the privacy or personal information rights of patients or other people who accidentally enter the camera; second, they may be distracted during the diagnosis and treatment process. If a medical accident is caused, it is necessary to bear the liability for compensation for fault diagnosis and treatment.
"If the doctor wants to live broadcast while inquiring in the clinic, it is best to obtain the consent of the medical institution, clearly inform the patients and other personnel who need the endoscopy, and obtain the consent of the patients and other personnel. The live broadcast process is handled by a dedicated person other than the physician. , The doctor himself should focus on the diagnosis and treatment process.” Du Xiujun said.
The reporter watched multiple live broadcasts of diagnosis and treatment and found that many doctors did not point the camera at the patient's face or mosaic the patient's head during the live broadcast, but kept the original voice of the patient.
The interviewed experts disagree with such live broadcasts.
In Du Xiujun's view, even if the patient's face is not in the lens, the patient's consent is required, because others may identify the patient through medical information and other information. This situation may still infringe the patient's privacy or personal information rights.
Deng Liqiang also believes that disease itself is a kind of privacy for patients. As long as it does not involve public interest, doctors should not spread it. Any live broadcast may reveal patient information.
The Physician Law clearly stipulates the privacy rights of patients. Not only can it not be disclosed directly, but indirect or possible forms of disclosure are not appropriate.
“It’s not appropriate for a doctor to broadcast live to patients in the clinic,” said Deng Liqiang. As long as it’s live broadcast, it is inevitable that there will be a "show" mentality. Under this mentality, the professionalism and effectiveness of diagnosis and treatment will be great. discount.
Bu He, an equity partner at Beijing Zhongwen Law Firm, also raised another risk: Doctors give a treatment plan based on the patient's condition during the live broadcast and spread it on the Internet. This behavior is also suspected of violating the relevant provisions of the Physician Law.
“If doctors upload their diagnosis and treatment plans to the Internet indiscriminately without examining and investigating patients in person, and without any processing or risk warning on the video diagnosis and treatment plans, it is easy to treat the general public who do not have professional medical knowledge. Cause misleading, cause patients to delay treatment, wrong medication, aggravate the disease and other damage results." Buhe said.
Live streaming damages the image
Product promotion must have standards
Some doctors brought goods during the live broadcast, which also embarrassed Sun Ting. She believed that "this behavior seriously damaged the image of the doctor community."
In the first quarter of this year, data from a head live broadcast platform showed that some doctors who followed hot spots and excellent eloquence had settled on the platform in just a few months, and the number of fans had reached one million.
The reporter entered the keyword "doctor" in the "User" column of the platform. According to incomplete statistics, there are nearly 100 "Internet celebrity doctors" with millions of fans on the display page.
An industry insider told reporters that the strong market, user demand, and the private domain traffic of "net celebrity doctors" make capital optimistic about the monetization capabilities of these "net celebrity doctors".
"'Internet celebrity doctors' increase the number of outpatient visits by creating their own IP, which can be realized in the form of live broadcast delivery, live broadcast rewards, display window delivery, and online consultation."
In fact, the types of goods on the platform have not been fully liberalized.
The reporter noticed that the "Letter of Commitment" signed by the doctor and a live broadcast platform also clearly stated that "Ads for medical treatment, medicines, medical equipment, health food, formula foods for special medical purposes, etc. shall not be published in any form, and users shall not be guided in any form. See a doctor".
According to Article 28 of the Physician Law, physicians shall use drugs, disinfectants, and medical devices that have been approved or filed in accordance with the law, and adopt legal, compliant, and scientific diagnosis and treatment methods.
In addition to being used for diagnosis and treatment in accordance with regulations, anesthetics, medical toxic drugs, psychotropic drugs, radioactive drugs, etc. shall not be used.
Zhou Lin, a lawyer from Beijing Zhongwen Law Firm, said that without treating patients in person, doctors should not rashly introduce and promote any medicines and equipment in the live broadcast, so as not to mislead the general public and cause them to treat medicines and medicines. Accidents occurred due to improper use of equipment.
In addition, Zhou Lin also mentioned that doctors’ introductions and recommendations for drugs or medical devices are inevitably suspected of endorsing drug and medical device manufacturers. If product quality problems occur, they may have a negative impact on the doctors, and even bear the corresponding burden. responsibility.
Therefore, touchnet doctors should be cautious about the realization of the commercialization of practice, and should fully consider the risks of practice for the realization of commercial delivery, live broadcast rewards, and paid consultation.
Du Xiujun added that the introduction of medicines or medical devices by doctors on live broadcasts can be regarded as advertising and is regulated by the Advertising Law and the Anti-Unfair Competition Law. It must not contain false or misleading content, and must not deceive or mislead consumers. Do not slander the products of the same industry.
Live broadcast boundary is worth discussing
Mainstream content should be popular science
So, where is the boundary of the doctor's live broadcast?
This problem not only confuses the hospital administrators, but also the doctors who do live broadcasts are constantly experimenting.
Many people in the industry believe that, no matter what, live broadcast during working hours is an inappropriate behavior, which affects the overall image of hospitals and doctors.
So, should there be regulations for non-working hours live broadcasting?
Buhe believes that publicizing and promoting health science knowledge appropriate to the position, and providing health education and health guidance to patients and the public are the proper meanings of doctors' practice. Therefore, the law does not prohibit doctors from spreading science on live webcasts or online platforms. Medical and health knowledge.
However, the law imposes many restrictions on online diagnosis, treatment, and consultation as a doctor in a hospital, which obtains a high rate of attention and high remuneration, because diagnosis and treatment are related to the personal safety of the public.
"Doctors have the right to obtain remuneration for labor and enjoy the benefits provided by the state. However, the behavior of doctors to obtain remuneration from the management of their registered medical institutions and obtain remuneration for online diagnosis and treatment involves the issue of whether doctors practice medicine for individuals and the legality of their professional income. "Buhe said that according to Article 20 of the Physician Law, individual physicians who practice medicine shall go through the approval or filing procedures in accordance with the law; individual practitioners who practice medicine must have been registered and have practiced in medical and health institutions for five years.
Therefore, doctors can carry out diagnosis and treatment at will without obtaining the qualifications of doctors in accordance with the law.
In fact, in recent years, in order to further regulate Internet diagnosis and treatment behavior, the National Health Commission and the State Administration of Traditional Chinese Medicine have successively issued "Internet Diagnosis and Treatment Management Measures (Trial)", "Internet Hospital Management Measures (Trial)", and "Telemedicine Service Management Specifications (Trial) )" and other documents, which put forward access thresholds and clear requirements for online diagnosis and treatment.
In Buhe's view, these documents mean that medical institutions or practicing physicians cannot arbitrarily conduct online diagnosis and treatment, and online diagnosis and treatment can only be carried out during follow-up visits for some common and chronic diseases.
"Practicing physicians, as professional physicians registered in medical and health institutions, should strictly practise in the practicing institutions. Therefore, the popularization of health and medical knowledge by'net celebrity doctors' on the network platform is not prohibited by law, and the remuneration generated should be regarded as Their part-time income, but if they are benefited from conducting diagnosis and treatment activities on the network in the name of a registered doctor, they should be restricted by law." Buhe said.
Because of this, the interviewed experts agreed that the mainstream content of doctors’ live broadcasts should be medical science.
"Doctors’ live broadcast of popular science medical health knowledge is not only the obligation of doctors, but also their contribution to a healthy China. It should be supported and promoted, but the premise is that they should meet the requirements of doctors’ practice standards. This kind of popular science is aimed at the general public, so doctors The public must be accepted by simple and popular methods, and some basic knowledge can be learned quickly." Deng Liqiang reminded doctors that the difference between popular science and online consultation must be clearly distinguished during live broadcast.