The Figure 1 app allows doctors to share and discuss graphic photos of their patients — and allows the public to gawk at them. Doctors and hospitals should be worried about the app’s legal and ethical risks, experts say. Warning: Graphic images.
Figure 1
A few years ago, when Joshua Landy and two colleagues wanted to create an app for doctors to share photos of their patients, their first step was hiring a lawyer.
They were right to be concerned. In the United States, strict so-called HIPAA laws make it illegal for doctors, hospitals, or insurance companies to divulge anyone's personal medical information without consent. Similar laws exist in Canada and other countries.
But these privacy rules do not extend to photos of unidentifiable people. So Landy's team created tools within their app to help doctors remove any personal details, such as faces or tattoos.
Today the app, called Figure 1, is perhaps better known as the "Instagram for doctors." It has hundreds of thousands of users in nearly 100 countries. Doctors post photos — such as graphic shots of rashes, gallstones, oozing infections, and an arm that had been caught in a tortilla slicer, just to name a few — with short captions sometimes noting the patient's age and sex. And they make comments on others' photos, ranging from quick-and-dirty diagnoses to off-color jokes. The images are viewed more than 3 million times a day.
More than 40% of all U.S. medical students use the app, according to Landy, a testament to its power as a teaching tool. But he says it's useful in the clinic too. On Thursday, Figure 1 announced a new feature, called "Paging," that allows doctors to instantly request specialists to comment on specific photos.
"It creates what we're hoping will be a network of hundreds of thousands of health care professionals who can gain access to the knowledge and experience of specialists at any time, anywhere in the world," Landy, an intensive care doctor in Toronto, told BuzzFeed News.
But many experts in health law and ethics, as well as many doctors, feel uneasy about Figure 1 — especially as its network grows. Anyone can download the app and view the photos, and Landy said non–health care professionals make up about 10% of users. Critics say that doctors who post photos may open themselves (and their hospitals) up to legal liability, whether for violating patient privacy or for suggesting an inappropriate diagnosis.
The biggest issue is that doctors don't necessarily ask their patients' permission before snapping their photos and posting them to the app. When doctors upload a photo, a button pops up that will lead them to consent forms. But the app does not store them or collect any data on how often they are used.
And even when patients officially consent, it's not clear whether they truly understand how widely their photos will be shared.
"I'm not sure why this is open to the public," Nicolas Terry, a law professor at Indiana University who specializes in health, told BuzzFeed News. "Because I think that does pose the question: Is this a professional site, or is this thinly disguised medical porn?"
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