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Social networking: An ethical hazard?
Is searching for online patient information ethical?
Online social networking sites have fans ranging from the very young to the very old. Some physicians, including psychiatrists, are not immune to a curious peek into the lives of their patients or at least what they can find online but is that a line that should be crossed in the physician-patient relationship?
Two recent articles explore that topic, one in the Journal of Medical Ethics in 2009, and the second, focused primarily on psychiatrists, in the Harvard Review of Psychiatry earlier this year.1,2 David H. Brendel, MD, PhD, a physician at McLean Hospital in Belmont, MA, where he is assistant professor of psychiatry and assistant medical director of The Pavilion, as well as co-chair of the McLean Institutional Review Board, was a co-author on each of these published papers.
The second article, focusing on psychiatrists, is titled "Patient-Targeted Googling: The Ethics of Searching Online for Patient Information." The study notes that attention has been given in previous literature to such topics as the "pros and cons of online searches for information regarding diagnosis, treatment and research" patients' searches online for health information, as well as patients' searches to learn information about their own physicians "both professional or personal."
The authors write that "little consideration has been given, however, to the converse situation namely, to physicians' searching online for information about patients.
"We believe that this practice which we call patient-targeted Googling (PTG) is widespread and deserving of professional and ethical consideration," the authors write.2
"I think before our paper, it had not received any consideration. I am not aware of any papers in the medical or psychiatric literature that actually addressed the question," Brendel tells Medical Ethics Advisor.
Relying on informal surveys and observations with colleagues, the authors found that "most psychiatrists have engaged in PTG," something that crosses a broad range of practice settings, including "emergency rooms, inpatient units, and long-term outpatient psychotherapy relationships."
By searching online, the paper indicates, physicians potentially have access to a broad range of "personal information about patients: photographs, videos, news stories, criminal records, and details of substance use, intimate relationships, sexual activity, and finances."
But the authors also point out that "content may also include clinically important material, such as suicide plans."
The important question may come down to: What is the motivation for the online search by the physician?
Motives must be checked
"There's a wide range of things that may be driving [PTG]; those . . . come out in the concerns we developed," Brendel tells MEA. "On the one hand, people are looking for more information," which he notes could be considered praiseworthy and an ethical thing to do.
"It's information that's in the public domain, and it could be really helpful to the treatment to obtain that information," he says. "On the other hand, there are situations that we are aware of where it seems to be driven more by curiosity or voyeurism. And sometimes, it's a combination of both things there's both a voyeuristic interest, but there's information that may help with the treatment."
Brendel says that the researchers "tried to focus on different aspects of the moral psychology [as to] whether to search for information online, and again, to develop some guidelines, which really don't provide an answer as to whether you should or should not Google a particular patient.
While Brendel says that "the emotional dynamics within the patient-psychiatrist relationship are often intense . . . in any doctor-patient relationship, the concern, I think, could be there."
Harm to patient-physician relationship?
Brendel explains why there may be a downside to PTG, especially as it relates to a psychiatric physician-patient relationship.
"I think there are a couple of different things," Brendel says. "First of all, the patient may feel that it was intrusive or a breach of privacy, if the physician obtains information online and either intentionally or unwittingly reveals that information to the patient.
"The patient [might] say, 'Well, how do you know that? I didn't tell you that!' And then you may be forced to tell the patient, 'Well, I was doing a Google search. And then the patient may [say], 'Well, who told you you could do a Google search? I didn't give you permission.' So, it feels like a violation of respect for privacy in this relationship," Brendel explains.
If the physician found out something about the patient in the course of his or her PTG that was negative, "it could feel like a breach of privacy to the patient and lead to medical/legal questions about documentation in the medical record," Brendel suggests.
This could be helped by physicians psychiatrists or other physicians employing the guidelines outlined in each of the papers, Brendel says.
Potential benefits of PTG
As an example of how PTG could benefit the treatment of a patient, Brendel uses an emergency room scenario. He suggests that in some cases it may be life-saving to get additional information about a patient who may be unconscious, if "you can learn something about where the patient lives, family members, or friends that might be able to assist in medical decision-making.
"In that case, patient Googling might be ethically obligatory," Brendel says. "Regardless of the setting and regardless of the medical specialty, the considerations are very context-dependent, and very much involve the moral psychology of the physician."
"Physicians need to be self-reflective about what's driving the search," he says.
David H. Brendel, MD, PhD, Assistant Professor of Psychiatry; Assistant Director of the The Pavilion; Co-chair of the Institutional Review Board, McLean Hospital, Belmont, MA. E-mail: email@example.com.