Only after my first international medical mission have I come to fully appreciate the ethical challenges that missions carry with them, including those related to practice standards, informed consent, ongoing care, and privacy.
One day, during my visit to Facebook, I perused photographs taken on my recent mission. I was surprised to find an image of myself, wearing scrubs and holding a thyroid gland. As a surgeon, photographer, and heavy consumer of social media, I try my best to control the content of, and access to, my online profiles. As I browsed, I felt increasingly uncomfortable with the pictures I saw of our 12-day trip, which did not belong to me. They included a diseased body part without any identifying features, a portrait of a clothed patient (he had requested the photograph) next to me who could easily have been mistaken for a friend, and a young woman with a very large goiter smiling widely at the camera. I had serious concerns about the nature of the photographs and consent to their being shared, particularly online. Should I ask the people posting to remove only the images I was in, or were they all inappropriate for a social networking site? I knew with certainty that my colleagues meant no harm, but felt I harbored the responsibility to protect patient confidentiality as well as the public image of our profession .