by Nathaniel J. Smith, Truman State University
As healthcare professionals, speech-language pathologists (SLPs) and audiologists have the responsibility to maintain strict client confidentiality. Since this ethical imperative is taught, tested, and retaught at both the undergraduate and postgraduate levels, those who breach client confidentiality can hardly plead ignorance. Furthermore, unless they have been living under the proverbial rock, SLPs and audiologists know they are practicing in a small world, in McLuhan's "global village." So, why would any SLP or audiologist share a client's unredacted treatment records or post comments about a client that contain specific, potentially identifying details on a social media platform like Facebook? Moreover, what should an SLP or audiologist do if they are a witness to an online breach of confidentiality? For some possible answers to these questions, consider the following scenario.
Jane, who has just completed her Clinical Fellowship Year, begins working as a school-based SLP in a semi-rural school district. Her new colleague, Roberta, is not only a seasoned SLP, but also a well-known member of the local community. Jane, to her surprise, observes Roberta commit a number of social media blunders, including a) posting comments about her clients on Facebook on her personal profile page (these comments are mostly vague, but some contain specific details) and b) not adequately separating her personal and professional life (Roberta has added friends, acquaintances, family members, colleagues, and parents of clients to her Facebook friend list). Also, Jane learns that Roberta, by her own admission, shares progress reports with parents via Facebook. Although Jane thinks Roberta's online behavior is very unprofessional, she is not sure that it definitely constitutes a breach of confidentiality. Moreover, since Jane is not only young, but also a new hire, she is hesitant to challenge Roberta who is not only matronly, but also married to the high school principal. Thus, Jane, intimated by Roberta's status and incapacitated by her own uncertainty, is reluctant to rock the boat. She does, however, record her sporadic observations in a notebook, including both the date and time.
One day, after taking a long hiatus from social media, Jane reads an old post on Roberta's personal Facebook page concerning a female client who has curly red hair, wears a pair of purple shoes, and produces a lateralized /s/. Shocked, Jane realizes that she can identify Roberta's client from these and other specific details: her name is Sally Henderson. Although Jane has never worked with this client, Jane has seen her before on many occasions, mostly in the cafeteria while on lunch duty. Concerned, Jane reads through more of Roberta's posts. She identifies another client on Roberta's personal profile, and she discovers a private message, containing a student's unredacted progress report in JPG format, that Roberta, having failed to select the correct privacy settings, has unwittingly made public. The report contains personally identifiable information, including the student's name, age, and date of birth. Alarmed, Jane navigates to ASHA's website to consult the ASHA Code of Ethics (2016).
Consulting the ASHA Code of Ethics (2016), Jane correctly determines that Roberta has violated Principle I, Rules O and P. Since she has publicly posted a client's unredacted progress report, and thus failed to "protect the confidentiality and security of records of professional services provided" (ASHA, 2016), Roberta has violated Principle I, Rule O. Moreover, Roberta's action is in clear violation of her client's rights under the Family Educational Rights and Privacy Act (FERPA, 1974), which stipulates that students' educational records may only be disclosed to eligible third parties, such as "school officials" who have a "legitimate educational interest" (FERPA, 1974). Since she has publicly posted specific, identifying details about at least two of her clients, and thus failed "to protect the confidentiality of any professional or personal information about persons served professionally" (ASHA, 2016), Roberta has violated Principle I, Rule P.
Jane, aware that she is now involved in Roberta's ethical misuse of social media, resolves to take decisive action. Jane knows that this is imperative because of Principle IV, Rule M. Since she has "evidence that the Code of Ethics may have been violated" (ASHA, 2016), Jane has "the responsibility to work collaboratively to resolve the situation" (ASHA, 2016). Otherwise, Jane herself will be complicit in Roberta's misconduct.
Thus, after careful consideration, Jane rightly decides to speak directly with Roberta. Jane explains to Roberta in a candid, but non-confrontational manner why her aforementioned misuses of social media constitute potentially sanctionable violations of ASHA's Code of Ethics (2016) and potentially actionable violations of FERPA (1974). Roberta, who at first reacts defensively, concedes, unable to refute Jane's cogent argument. Jane, drawing on inspiration from McGary and Rowden-Racette (2012), then urges Roberta to take the following steps in order to resolve this ethical dilemma: a) edit or delete all posts on her personal Facebook page concerning her clients b) refrain from making specific references to her clients in the future on social media platforms c) create a separate Facebook business page for parents of clients, colleagues, and other professionals and d) cease and desist from sharing any and all treatment records via social media. Roberta remains silent, but her look of contrition indicates that she will heed Jane's advice. Jane further counsels Roberta, who has adopted a very informal online persona, to adhere to well-established social media etiquette guidelines for professionals. Among these, as outlined by Ritch and McGary (n.d.), is the admonition to "Practice HALT" (i.e., to not post anything when one is "Hungry, Angry, Lonely, or Tired"). Roberta, who confesses to writing most of her posts late at night, promises to practice HALT in the future.
Whether hungry, angry, lonely, tired, or afflicted by some other condition that impairs their judgment, audiologists or SLPs who commit online breaches of client confidentiality not only harm their clients, but also their own professions and their related professions. As per Principle I of the ASHA Code of Ethics (2016), audiologists and SLPs are duty-bound to protect the welfare of their clients. Posting comments about clients that contain specific, potentially identifying details is not just a serious breach of "netiquette," but also a serious breach of professionalism. Making clients' unredacted treatment records public, which, in addition to violating the ASHA Code of Ethics (2016), may also violate government legislation such as FERPA (1974), is likewise unprofessional. Every such instance of unprofessionalism erodes the public trust invested in audiologists, SLPs, and other healthcare professionals. Thus, SLPs and audiologists who witness online breaches of confidentiality must act in the interest of their clients, their professions, and their related professions according to the Principles and Rules of the ASHA Code of Ethics (2016).
American Speech-Language-Hearing Association. (2016). Code of Ethics [Ethics]. Retrieved from /Code-of-Ethics/.
Family Educational Rights and Privacy Act of 1974, 20 U.S.C. § 1232g (1974).
McGary, M., & Rowden-Racette, K. (2012). Social media: To friend or not to friend. The ASHA Leader. doi:10.1044/leader.GS.17022012.np.
Ritch, S., & McGary, M. (n.d.) Social media etiquette for professionals. Retrieved from /associates/Social-Media-Etiquette-for-Professionals/.