Wednesday, July 9, 2014

The Further Adventures of Rick From Downingtown

A story from ABC, related to the reality show New York Med, describes a nurse fired for an Instagram post:

The story is thorough enough for you to see that it misses the crux of the matter. The story focuses on the photo the nurse posted, but tells you enough to realize that the nurse was actually fired for the caption. The four-word caption was witty but came perilously close to criticizing the patient who had just been treated in the empty trauma room that the photo depicts. To someone who doesn’t know the context, the message is probably most easily understood as a veiled criticism of the patient for having become injured. Such a criticism coming from a hospital staffer would, at best, be based on hearsay. Even if accurate, it would obviously be better left unsaid at least as long as the ultimate fate of the patient remains uncertain.

But it is worse than that. The caption, quite unintentionally I believe, effectively identifies the patient. This is the real problem. It is one thing to lament the foibles of the human condition using a specific case from your workday. It is quite another if many of the people who read your commentary know exactly who you are talking about. Unfortunately, we don’t have a cultural history that prepares us for how easy it has become, in the last few years, to identify people based on a few scraps of information. To makes matters slightly worse, the caption is written as a hashtag. That too is witty but has the disadvantage of making it appear that the post is intended to identify the patient. A hashtag, after all, is a kind of a name; the entire purpose of a hashtag to allow people to put together information from one source with related information from another source. This hashtag was meant ironically, but only a reader who was savvy with social media could be expected to know that.

Obviously, a medical professional knows better than to leak any part of a patient’s name in public, but highly distinctive information of any kind can be as good as a name. The caption indicated that the cause of injury was a train. Even in New York, with trains everywhere, train-caused injuries are relatively rare; on a given day, there might be only one. The timing of posting provides the public with the approximate time of the incident, and the scattered trauma-room supplies shown in the photo allow even someone who has never been inside a hospital a general sense of the extent of injuries. Nothing that involves a train happens in private, so there probably would be hundreds of people who, given just this much information, would know instantly who the patient was. With the identity not a secret, the hospital photo gives away too much detail about the patient’s experience, and the caption becomes too pointed as a commentary.

This is the crux of this story as I see it and a challenge for this moment in history: it is harder than it seems to make a story anonymous, and it is also harder than it was a few years ago. A common technique, going back a couple of decades, was to obfuscate by providing only the first name and town of residence of a person — so, for example, I would be “Rick from Downingtown.” In the Internet era, this doesn’t even serve as a mask. Anyone who knows me can check off or look up one or two colorful details from the story to verify that “Rick from Downingtown” is referring specifically to me. Of course, if “Rick” is not anonymous, then “Dixie” or “Garth” is that much easier to recognize.

We now know to fully fictionalize names in stories, but many personal details are just as distinctive as first names. We all know that a date of birth is sensitive personal information, but not everyone realizes how distinctive it is. If you were born in the United States on a specific day, that information puts you in a group of roughly 10,000, so it is not that far away from identifying you. Some details are far more telling than others, even if they seem equivalent. You probably would guess, for example, that green is currently a more popular color of car paint than purple is, but it might not immediately occur to you that purple is 20 times as rare and therefore distinctive as green is. In some towns, then, if you tell a story that includes a purple car, you are identifying the person, because there is only one purple car in town. Social media makes a difference in this connection because anything you put into social media goes out and mixes with all the known information in the world. If you are just talking to your friends, they may not know who drives the one purple car in town, but someone within the broad reach of the Internet does know.

Twenty or thirty years from now I think we will have more common sense about keeping our stories anonymous. We’ll all have the experience of identifying people from disconnected scraps of information, so that when we see an old woman playing a blue tuba on the boardwalk who does something unexpected, we won’t tell the story quite that way. We’ll realize that there could be just one musician in the world who fits that description. Then we’ll either look up the name of the tuba player and add that to the story, or we’ll leave enough details out of the story to keep it anonymous. But in the meantime, until that kind of thinking becomes second nature, we’ll make a lot more mistakes, telling stories that we think are anonymous as we tell them, but that actually refer to a specific identifiable person.