Text/ Xin Ying Wang Weining
Editor / Wang Xiao
Photo/pixabay
A doctor in Shandong Province was suspected of broadcasting a clip of gynecological surgery on the Internet and was investigated.
At 21:00 on January 18, the Donggang Branch of the Public Security Bureau of Rizhao City, Shandong Province, issued an announcement: After receiving a report from the masses that a doctor was suspected of broadcasting gynecological surgery clips on the Internet, the relevant personnel of the hospital involved were investigated, and at about 18:00, the doctor involved, Li Mou, was arrested, and the case is currently under further investigation.
The doctor involved, Li Mou, is an anesthesiologist at Rizhao Central Hospital, and an office staff member of the hospital responded to the "Finance and Economic Health" that said: "The hospital will never tolerate this matter, and it still needs to wait for the results of the public security organs' investigation, take the next step according to the results, and release the results of the treatment at the first time." ”
As of the time the live broadcast room was banned, the above live broadcast was carried out for a total of 1 hour and 18 minutes. According to the "Medical Community" report, the video whistleblower said that when he accidentally flipped to the live broadcast room, the live broadcast content was a female patient who had just completed surgery. Subsequently, her husband entered the room to put on the patient's underwear, and some of the exposed parts were photographed without the patient's knowledge.
Station B responded on January 18, "After internal verification, the live broadcast room you reported was repeatedly warned and cut off during the live broadcast on January 15, and then permanently banned." At present, it has been reported to the public security organs and will actively cooperate with the police to carry out investigation and evidence collection. ”
"At the level of the law, doctors may be suspected of infringing on the privacy rights of patients, human invasion, invasion, infringement, infringement, and dissemination of obscene materials, depending on the circumstances." Lu Yiguang, director of the Pharmaceutical and Health Business Research Committee of the Shanghai Lawyers Association, analyzed.
Live surgery emerged with the popularity of 4G networks in 2014 and has developed rapidly under the impetus of the COVID-19 pandemic in 2020. This kind of live broadcast of medical scenes will become more and more common, from patient consultation to professional surgery live broadcast, however, the accompanying voices of doubt are also continuous, so where should the boundary be drawn after all?
Whether the patient is informed or not, the risk of live broadcasting is very large
In this live broadcast incident, if the patient of the doctor's live broadcast behavior in this case is really unaware, and Ai Qing, a lawyer at Beijing Tianshuang Law Firm, analyzes it, then the doctor may violate the provisions of 253 of the Criminal Law, sell or provide citizens' personal information to others, and if the circumstances are serious, he shall be sentenced to fixed-term imprisonment of not more than three years or criminal detention, and shall also be fined or fined alone; if the circumstances are particularly serious, he shall be sentenced to fixed-term imprisonment of not less than three years but not more than seven years, and shall also be fined. Where citizens' personal information obtained in the course of performing duties or providing services is sold or provided to others, a heavier punishment shall be given.
Moreover, according to the provisions of the Physician Law, if a physician has the act of leaking patients' privacy or personal information in his or her practice activities, the competent health department of the people's government at or above the county level shall order corrections, give a warning, confiscate the illegal gains, and impose a fine of between 10,000 and 30,000 yuan;
In the current case, the parties have not disclosed whether the patient and his family understand and agree to this live broadcast.
Even with the informed consent of patients, there are many problems. For example, live broadcasts of gynecological surgeries are not the first time they have sparked controversy. As early as 2007, at the China Changsha Gynecology Minimally Invasive Academic Summit, it was announced that the first live broadcast of gynecological surgery in China would be carried out, and online debate ensued.
The organizers of the conference believe that this is a public welfare publicity, an opportunity for gynecologists in the province to exchange and learn, and also allow more people to better understand gynecological surgery. However, in the eyes of some netizens, the organizers are using the female body as a "gimmick and selling point", and the women who should be cared for have become "objects and playthings to be watched", and the netizen characterized the live broadcast as "a thorough medical hype game".
Nowadays, it is more and more convenient to shoot and publish videos. Doctors set up a mobile phone in the clinic, mosaic the patient's face, or only present part of the patient's limbs, a "consultation process" live broadcast or recording began, on the major video platforms, such videos can be seen everywhere, many of which are for the purpose of publicity doctors live broadcast, but also involve medical advertising.
Previously, there were media reports that patients had doctor-patient disputes due to the doctor's live broadcast in the clinic, and called the service convenience hotline to complain to the hospital.
Which ones can be live streamed?
"Some doctors' live broadcasts have gone beyond the scope of academic exchanges and become a tool for many doctors or hospitals to carry out brand packaging and brand promotion, and most doctors will ensure the informed consent of patients, but still need to prevent violations of patient privacy." Zhang Qiang, founder of Dr. Zhang Qiang Group, told Finance and Economics Great Health.
In fact, the live broadcast of surgery has become more and more standardized, and it is currently mostly used as an academic exchange, designed for the targeted broadcast of people in the academic circle, which is not visible to the public.
The original purpose of the live broadcast of surgery was to disseminate the surgical footage to the venue or network in real time for everyone to observe and learn. It is equivalent to transferring the traditional doctor's learning in the operating room to online. Subsequently, it gradually derived the function of showing the technical level and communicating with each other among peers, which was more popular with doctors.
For example, since the Shanghai Tenth People's Hospital launched the live broadcast of surgery in 2019, a total of 500 live operations have been carried out in one and a half years, which has attracted surgeons from all over the world to watch and exchange.
Zhang Qiang introduced that professional doctors watch live broadcasts, focusing on technical details and so on. Of course, you may see a good surgical experience, and sometimes you will see that the general technique is not as good as your own, but this does not affect the meaning of academic communication itself.
According to a medical project brand director of the live broadcasting platform Wei Roar, the surgical live broadcast usually has a designated whitelist user login to watch, and requires a real-name system, and the live broadcast platform records the information of all viewers in accordance with the requirements of the organizer under the premise of user consent, and the live broadcast content and user viewing information need to be traceable.
However, the "Finance and Economics Big Health" reporter still saw on some professional live broadcast platforms, the live video of heart surgery can still be clicked on at will, the details of the operating room are clear, and some people wear headsets to explain.
Ji Huakui, editor-in-chief of the Chinese non-public medical institution Medical Association Medical Association, analyzed that this also means that the transmission method of the original patient's informed consent has changed. In addition, some professional surgical live broadcast screens have been recorded in violation of the law, processed and played on the public platform, and some of the content that causes discomfort to ordinary people is indeed inappropriate to appear on the public communication platform.
Even if a patient signs an informed consent form, there is a risk that the live broadcast doctor may infringe on the patient's rights.
Xu Kai, a lawyer at Beijing Huayi Law Firm, analyzed that the live broadcasts conducted by doctors to promote themselves are usually not related to the medical services that patients seek. In accordance with the requirements of the Personal Information Protection Law, the authorized use of personal information must meet the principles of legality, propriety, necessity and good faith. The authorization required by doctors for live broadcasting is generally for personal publicity purposes, rather than medical services, and is therefore not justified and necessary.
"Therefore, if the patient makes a claim after the fact and claims infringement, even if the informed consent is signed, the doctor or medical institution may not be exempt from liability, and it is likely that the patient will still be liable for the infringement of citizens' personal information or privacy rights." Xu Kai said.
Even in the industry, the controversy over live surgery has not stopped, such as the death of surgical patients during live broadcasting.
Publicly available information shows that there were two deaths related to live-streaming surgeries during the International Heart Conference. One of these cases occurred in 2004, when a patient in Milan, Italy, died after percutaneous heart valve implantation. In August 2015, a Japanese surgeon performed a live broadcast of laparoscopic liver tumor surgery in India, and the patient died after the operation. In 2019, there was also a case of gastric contraction surgery in China that was broadcast live, and the death of the patient 5 days after the operation triggered a doctor-patient dispute.
What worries the executives of a top three hospital in Beijing is that many hospital leaders now promote live surgery. The supervision of the Internet has not yet reached the level of offline law enforcement.
How to regulate the double-edged sword of live surgery?
Some medical device manufacturers hope to be able to teach and promote the use of their products in live broadcasts, so they have also become the helpers of the popularization of live surgery.
Ji Huakui introduced, "At present, the demand for live broadcasting of surgery such as cardiology surgery and tumor surgery is larger, because the difficulty of such surgeries is high, especially for young doctors. In addition, ophthalmology, plastic surgery and other non-traditional sense of the disease surgery live broadcast, and is for the general public, in view of the sharing and surgical cost concessions and other factors, patients are more willing to participate in the live broadcast, such as pediatrics and other departments of surgery although the difficulty is not large, involving children's privacy protection, parents and other factors are rarely live broadcast. ”
The most important demand scenario for live surgery is to solve the problem of cross-regional communication. First, doctors in first-tier cities operate, and doctors in second- and third-tier cities can learn online. The second is to conduct multi-local expert consultations on certain cases.
"Professional surgical live broadcasts require significantly higher camera clarity, network stability, and the professional ability of live broadcast technical engineers than ordinary live broadcasts, and all equipment is disinfected according to hospital standards." The director of the above-mentioned medical live broadcast brand introduced that after confirming with the doctor in advance the pictures and links that need to be focused on shooting. To determine the position, angle and switching of multiple cameras, it is generally necessary to investigate the live broadcast environment and network testing one week in advance, and a mature team needs to go to the hospital at least four or five hours in advance to prepare for the live broadcast on the day.
An industry insider introduced that the same is the live broadcast of five or six hours, the cost of ordinary conference live broadcast is 10,000 yuan, then the cost of live operation is three to five times.
There have been cases abroad to regulate the live broadcast of surgery. In 2006, a Japanese patient died after a live broadcast of aortic aneurysm repair, and the medical community was in an uproar. Subsequently, the Japan Thoracic Surgery Association and the Japanese Urological Society banned live broadcasts of surgery. Immediately afterward, the American College of Surgeons and the American College of Obstetricians and Gynecologists also banned live broadcasts. In 2014, the European Urology Association (EAU) published a code on live broadcasting of surgeries.
However, there is still a gap in this area at home.
According to an industry insider, most doctors choose to broadcast live with low-risk and sure surgeries, and rarely ask for delays. In other words, there is no clear limit on what kind of surgery can be broadcast live, and it is entirely up to the doctor himself.
For special circumstances, the brand director of the above-mentioned medical live broadcast platform introduced that the live broadcast platform can choose to delay the live broadcast according to the requirements of the hospital, "for example, in some special circumstances, it will be required to delay the live broadcast by 10 minutes, so once any emergency occurs during the operation, it will also reserve space for the live broadcast." ”
A number of respondents told "Finance and Economics Big Health" that the academic value of the live broadcast of surgery within the scope of doctors and as an academic exchange must be affirmed, provided that the privacy of patients is fully protected and the patient's authorization is clear and unambiguous. However, for some controversial points, it needs to be further regulated by the regulatory authorities.