I Know That Guy: Balancing Confidentiality With Sharing Knowledge

Abstract

Some of you may remember a fashion magazine that ran a special feature called Do’s and Don’ts. People unfortunate enough to be called out as a “don’t” were wearing not only some hideous outfit, but they also sported a thin black bar over their eyes. So what’s the problem with that? Well the main thing is, those black bars don’t protect identity. For example (and I am not condemning this fashion choice, by the way), how anonymous is the man in the image? Publishing Illustrative Content and Protecting Patients’ Rights Editors who work with clinical content, especially case reports, are familiar with the challenges of balancing patient confidentiality with the dissemination of important clinical information. Photographs are useful to show unique manifestations of a condition, to illustrate new techniques or procedures, and to help clinicians quickly visualize anatomic landmarks or other important details. Until the late 1980s, placing black bars over the eyes in photographs was often accepted as a way to protect patient identity. However, some journals discontinued this practice when it became apparent that bars across the eyes do not preserve confidentiality. The International Committee of Medical Journal Editors recommendations on the protection of research participants notes that “masking the eye region in photographs of patients is inadequate protection of anonymity.”1 But the risk of patient identifiability is not limited to black bars over the eyes. Individuals can be identified in photographs that may have been cropped to remove faces but reveal other identifying features (e.g., hair, scars, […]