Google: Valuable Source of Information or Pandora’s Box?

| August 15, 2014 | 0 Comments

Risk Art July August 2014by Ann McNary, JD
Senior Risk Manager, PRMS, Inc., Arlington, Virginia

Innov Clin Neurosci. 2014;11(7–8):47–49

QUESTION

“I’ve had several conversations with colleagues lately on the topic of “Googling” patients. Many patients speak of their various social media accounts, and it seems like it might be beneficial to have access to some of the information they are posting. On the other hand, I’m concerned about invading my patient’s privacy. Under what circumstances might it be acceptable to do an internet search on a patient?”

ANSWER

“I’ll just Google it.” What started out simply as the name of an internet search engine, “Google” has now become an everyday part of our lexicon and our lives. It is no longer necessary to spend time trying to remember mundane facts or to go to a library to obtain information. One need only grab the nearest internet-enabled device and “Google it” to find more information about any topic than anyone could possibly ever want.

This ease in obtaining information can, however, prove to be a dilemma to physicians in general—and to psychiatrists in particular—when it comes to the question of whether this ease in access to information should also extend to information regarding patients. What only a few years ago would have been considered confidential (and arguably off limits) is now available to the general public—much of it having been posted by the individuals themselves. If the whole world can access a patient’s information, shouldn’t his or her psychiatrist have it as well?

Googling a patient. While anything your patient has posted on the internet is considered to be in the public domain, viewing information that your patient hasn’t specifically shared in a treatment setting requires careful ethical consideration.[1] Thus, before reaching for your laptop or smartphone, consider the following questions:

1. What is my purpose for this? Although the internet can be a rich source of important collateral information, there exists great potential for blurring professional and personal boundaries.[2] If you have a legitimate treatment purpose, e.g., a third party has informed you that a patient has been posting thoughts of suicidal or homicidal ideation on his blog, proceed, but with caution. If your purpose is more along the lines of curiosity, step away from the keyboard—fast!

2. What specific information am I looking for? Take care in defining your search terms to help ensure that you have a legitimate purpose for viewing the information returned. Searching by only your patient’s name and location is apt to provide you with a plethora of information, much of which may be well beyond the scope of what you need to answer your specific questions. Unless you are able to exercise extreme self-restraint, it may be difficult not to click on hits that sound intriguing.

3. Should I first obtain my patient’s informed consent? Absent a safety issue that requires an urgent response, advising your patient of your desire to obtain information and asking for his or her consent to do so helps to maintain the patient’s trust and prepares the patient for possible ramifications. According to Clinton et al,[1] “The process of informed consent for PTG [patient-targeted googling] would include discussion of all possible risks, including breaches of patient privacy and the potential for harm to the psychotherapeutic relationship, along with an acknowledgement of possible unpredictable and unknown consequences.”

4. Should I access the information only in the presence of my patient? This will depend largely upon your purpose for accessing the information. For example, if you are treating a patient who has been the victim of cyberbullying, it might be beneficial to discuss the comments being posted and the effect they are having on your patient. If, on the other hand, your patient was the victim of a heinous crime and you believe knowing more about the incident would help you to better treat your patient, you should consider the impact revisiting this information would have upon that patient. Another important consideration is the fact that people often misrepresent themselves online. By reviewing the information with the patient, you will be better able to ascertain what is truth and what is fiction.

5. What will I do if I find out information that is offensive to me and causes me to think less of my patient as a person? You might also ask yourself the following: What if I learn that my patient has filed multiple lawsuits against previous physicians? What if I learn that my patient who won’t pay my fees comes from a very wealthy family? What if I see that my patient is engaging in activities I may be required to report? What if I see my patient who is claiming disability engaging in extreme physical activity? Before hitting “search” you have to be prepared for what you might find. Avoiding some of the information may be possible by using narrow search terms as discussed above and exercising extreme willpower. But you may still stumble across information that would make you uncomfortable and you must consider how this would impact your treatment relationship.

6. How will I know that the information I’m reading is accurate? While the internet can be a valuable source of collateral information, you must keep in mind that a good deal of what you find may not be current or accurate. This can be particularly problematic if the information is being sought for clinical purposes. Consider carefully the source of the information (e.g., a government site listing sex offenders vs. someone’s Facebook page), and determine whether further steps must be taken to corroborate that information.[3]

7. Should I print out the information and put it in the patient’s chart? If it is information that was relied upon in making treatment decisions, arguably yes but you must consider the long-term ramifications for the patient. Remember that whatever is placed in the chart becomes a part of the patient’s permanent record and must be released whenever records are requested, which supports the idea of gaining the patient’s consent before accessing information. You would not want a youthful indiscretion to later become the basis for a patient being turned down for life insurance or employment. Consider exactly what portion of the returned information is pertinent and how this is best documented.

8. Can accessing this information increase my liability exposure? Consider the following scenario. What if, with your patient’s knowledge, you are reading his blog and after months of relatively benign entries, you decide to skip a few weeks and thus don’t notice when your patient outlines a plan to commit suicide, which he then implements? Have you imposed a greater duty upon yourself when you undertook to monitor your patient’s web activities? As currently there is no consensus as to whether psychiatrists may be medicolegally responsible for monitoring and acting upon information posted by patients online,[4] you must carefully weigh the risks versus benefits of this type of activity.

Googling yourself. Googling patients opens a Pandora’s box of ethical and liability issues. As such, our conservative risk management advice is that, unless presented with a compelling and/or urgent need to obtain information for the purpose of protecting your patient’s safety or that of another, Googling patients is best avoided.

That having been said, there is one person you absolutely should Google—yourself. Even if you have never even accessed the internet, there is no doubt that you have an online presence. If there is an “MD” or “DO” after your name, you can rest assured that someone, somewhere, will have posted information about you. Perhaps it is your business contact information or the fact that you attended a conference or a link to a published article you wrote. On the other hand, it could be that embarrassing photo of you from medical school that a friend posted on her Facebook page or a negative review from a disgruntled patient. In any case, it is important that you know what is posted about you so that you can take necessary steps to protect your reputation. According to a policy statement from the American College of Physicians and the Federation of State Medical Boards,2 “Being proactive by controlling posted content, using privacy settings, and limiting access to personal information is in the best interest of both the profession and the individual physician.”

Certainly if friends have posted embarrassing personal information or photos of you, you will want to ask that they be removed. It is more difficult to deal with negative reviews, but you are not powerless. Some ideas to consider:

• If you can identify the patient, you may wish to contact him or her to see whether any problems can be resolved that would then cause the patient to reconsider his or her review.

• If you believe the information to be false, contact the company posting the review and ask that it be removed.

• Remember that just because a patient posts information about your care online it does not mean that he or she has waived confidentiality. Do not attempt to counter a bad review by posting your version of the care rendered.

• Set up a LinkedIn page or a simple practice website. That way, when someone Googles your name, one of the first links they will see in the search results will be information provided by you.

Summary. The internet provides a wealth of information and, for many of us, is an innovation that is a part of our everyday lives to which we give little thought. When it comes to its use in conjunction with your medical practice, however, you must think of it as a tool and consider whether its use is appropriate for furthering your treatment and other professional goals.

References

1. Clinton BK, Silverman BC, Brendel DH. Patient-targeted googling: the ethics of searching online for patient information. Harv Rev Psychiatry. 2010;18(2):103–112.
2. Online Medical Professionalism: Patient and Public Relationships: Policy Statement From the American College of Physicians and the Federation of State Medical Boards. Ann Intern Med. 2013;158(8):620–627.
3. American Psychiatric Association. Opinions of the Ethics Committee on the Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry. Opinion A.1.h. 2014 Edition.
4. Brendel, DH. Monitoring blogs: a new dilemma for psychiatrists. Virtual Mentor. 2012;14(6):444.

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Category: Past Articles, Psychiatry, Risk Management, Suicidality

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