Jigsaw identification: don’t be puzzled

Sharing case details with colleagues has been a long-recognised method to help with a diagnosis or improve treatment regimes.

The joy of the internet now is we can share photos and videos, as well as clinical history, within seconds – and get as quick a response. What’s not to like?

Well, even when sharing information is in the best interest of the client and patient – and when so many amazing people share great information for free within the community – we still need to meet the legal criteria for sharing another person’s information.

Consent

Under data protection – and now under GDPR – you need consent from the client for sharing ANY information. In reality, I feel every vet clinic now needs to have a consent section on its admissions forms that covers taking images of a pet and sharing them for diagnosis and treatment, and training, and also an option about sharing on social media.

A great template for consent form wording is available in one of my 2017 blogs.

As a minimum, written consent for taking images, and sharing for diagnosis and treatment, should be included on consent forms and not left to a verbal discussion in an already information-filled consultation or follow-up telephone call.

There needs to be as much clarity as you would give for consenting to a treatment or procedure given to consent for sharing information. I wrote a little about this in the pre-GDPR days, and it’s still relevant now.

Where does the jigsaw come in?

According to the Collins English Dictionary online, jigsaw identification is “the ability to identify someone by using two or more different pieces of information from two or more sources – especially when the person’s identity is meant to be secret for legal reasons”.

The term has appeared recently, and been used most commonly in the sad cases of people involved in court cases who had had their identity protected being identified by different papers revealing key parts of information.

Hence, the definition sets out that the information comes from two or more sources – as the cases involved usually involved two or more newspaper sources. Yet, the definition is applicable to medical cases and the use of social media.

Finding the pieces

I think we sometimes still don’t realise how much information you can find with a five-minute internet search – especially if several people are sharing information from the same case.

Unique or unusual cases are often the “cool”ones to share, yet by their very nature are going to be identifiable. Specific breeds or types of pet we rarely see are also easily identifiable. Your location and the vet clinic you work in is very easy to find, no matter how much you think you’ve covered your tracks. All of these are jigsaw pieces that, if put together, may lead to a case being identified.

While I’m sure we are all good about not sharing clients’ names and details, patient details can be enough for others to identify where this pet is located and for others to recognise the case.

I’ve had this situation online where, in a non-veterinary forum, a client was using an anonymous account to describe a dog attack on their pet. They were seeking financial and legal advice. Yet, I knew the case from three features, and knew it was being shared on the vets’ social media – I assume with the owner’s consent.

Between the two platforms, I knew an acrimonious divorce was affecting the ability to pay for care, and other very personal matters that I really shouldn’t have been able to link to the case on veterinary social media.

In this instance, part of the information jigsaw was from the client, but I suspect they didn’t realise an overlap may occur in that a person on one platform would also see their vets’ social media. Yet, a very informative picture of the situation was openly online.

What can we do?

In that situation, while little can be done if the client chooses to share information, all staff should be made aware of jigsaw identification and it may be worth reviewing your clinic’s social media policy to see if you cover anything on sharing information.

I know most clinics cover this with staff not sharing on their private social media, but with the rise of online groups to support diagnosis and treatment, legitimate reasons exist for sharing identifiable case data.

For clarity, it would be ideal to discuss what is going to be shared and where with colleagues – this would stop repeat posts in different groups that could provide the opportunity for jigsaw identification. You may also wish to have nominated spaces your clinic posts in – general advice spaces exist, but also clinically relevant groups.

I would then advise that it is recorded on clinical notes where and when information was shared. The benefit of this is three-fold. Firstly, you are leaving information for the future about where this case was shared – so if there were any questions of identification, you have a way to demonstrate your actions. Secondly, you can review the quality of information you receive to see if that space is one worth posting in again.

Thirdly, you could elect to focus on clinically based support and advice, and while you need permission to email other clinicians, the jigsaw identification is less of an issue.

Permission to post?

If – and really when – you post, it may be worth using the RCVS advised phrase “permission to post”. This was advised to a vet nurse group some time ago and lets people see you have permission to share the information or images you are using. You don’t need to add why or how you have permission, but stating it is enough.

We’re all learning as we get to use new ways of obtaining information – don’t be scared to share, but do be safe. Remember your ABC – airway, breathing and consent.