Despite multiple ethical concerns raised regarding providers searching for online information about their patients, specific recommendations have been lacking. On behalf of the American Psychiatric Association’s Ethics Committee, a group of authors developed a guidance on this practice.1
“Growing concerns about the potential for problematic physician interactions with patients in the relatively new platform of social media was the motivation for the guidance,” says Charles C. Dike, MD, MPH, the paper’s lead author. Dike is an associate professor of psychiatry and associate program director of Yale University’s law and psychiatry fellowship program. The recommendations include the following:
• Except in emergencies, it is advisable to obtain a patient’s informed consent before performing such a search;
• Psychiatrists should be aware of their motivations for performing a search and should avoid doing so unless it serves the patient’s best interests;
• Information obtained through such searches should be handled with sensitivity regarding the patient’s privacy;
• The psychiatrist should consider how the search might influence the clinician-patient relationship;
• When interpreted with caution, internet- and social media-based information may be appropriate to consider in forensic evaluations. “It is important for physicians to respect patients’ autonomy in deciding what information about themselves to release,” says Dike.
It is highly possible the physician could learn negative, or even positive, information before the patient is ready to disclose it. “This could damage trust and ultimately cause harm to the patient-physician relationship,” says Dike.
Online information also could cause the physician to respond, consciously or unconsciously, in ways that could be detrimental to the patient. “These observations are compounded by the fact that the information obtained online could be inaccurate,” says Dike.
There is the added question of the ethical obligation of the physician who finds information that suggests the patient or someone else is in danger. Even when conducted with the patient’s consent, findings could be unearthed that end up complicating the patient-physician relationship.
“This highlights the need for caution,” says Dike.
Ethics committees should discuss the circumstances under which it would be appropriate to search a patient’s information online, according to Dike. A targeted internet search could be appropriate if a patient is mentally compromised and needs urgent intervention. Institutions should consider developing policies addressing these issues, says Dike:
• circumstances under which to conduct an internet search;
• where to house information obtained (in patient’s chart or not);
• if (or when) to disclose findings to the patient or patient’s family.
“This would likely require discussions with the hospital leadership and attorney,” says Dike.
1. Dike CC, et al. Ethical considerations regarding Internet searches for patient information. Psychiatr Serv 2019; Jan 17:appips201800495. doi: 10.1176/appi.ps.201800495 [Epub ahead of print].