To Google or Not to Google: Patient Online ‘Footprint’ Is Easily Accessible

Are you Googling your patients’ names? You may not be alone.

A pilot survey of 48 attending and 34 resident physicians at a large academic medical center found that 43 attendings said they had considered Googling a patient’s name and 40 had actually done so, while 33 residents said they had considered Googling a patient, and 32 said they had done so.

The survey was reported by Liliya Gershengoren, M.D., M.P.H., at APA’s 2017 Annual Meeting in San Diego in the session “Patient Targeted Googling: Oh! What a Tangled Web We Weave, When First We Practice to Deceive.”

The practice of Googling a patient’s name may be too easy to resist and may seem innocuous. Among both attendings and residents, “curiosity” was prominently cited as the reason for Googling a patient, and among attendings, it was the most cited reason in outpatient and private practice settings. “Patient care” was most often cited as the reason among attendings in emergency department settings.

The same pattern was true for residents. “Patient requested” was the least often cited reason for Googling a patient among both attendings and residents and across all practice settings. These are among other reasons cited:

• “To learn if an outpatient who stopped coming had died.”

• “Patient reported being on TV, but I was suspicious that this might not be true.”

• “To get a sense of the plausibility or implausibility of what the patient reports.”

• “This is a basic form of collateral.”

• “Validate public information.”

• “In all cases it can actually provide important information about the patient’s interaction with the world and their projection onto the world.”

• “Famous problem in the news.”

• “Criminal background.”

Moreover, when asked if they had informed patients either before or after Googling their names, a majority of both attendings and residents responded “never.”

‘Everybody Does It’

“Curiosity is a double-edged sword,” Gershengoren told Psychiatric News after the symposium. “I think it requires further research. Curiosity can be a good thing if the physician is truly concerned about the patient and wants to find out information that can help patient care. On the other hand, curiosity can be a more serious concern if a clinician is seeking online information solely for personal reasons that aren’t related to advancing patient care.

“After I saw these data, I realized we need to have a more detailed research survey just looking at that question alone—what does ‘curiosity’ mean—and how it may be employed in different treatment settings,” she said. “I also want to look at how other specialties may or may not be using online information about patients.”

When asked if the results from the survey surprised her, Gershengoren responded, “Not much. I did this survey as a fourth-year resident, and I already knew anecdotally that Googling information about patients was common.”

Quoting an iconic line from the 1999 movie “Cruel Intentions,” Gershengoren said, “Everybody does it; it’s just that nobody talks about it.”

She added, “Hopefully, the symposium has given us a way to talk about it.”

Digital Phenotype Is Permanent Record

At the symposium, four other experts explored how Googling, and other forms of collecting collateral information, may raise a host of questions—ethical and clinical—about how that information can affect the physician-patient relationship and clinical care.

Psychotherapy expert Glen O. Gabbard, M.D., discussed the impact of the Internet on the doctor-patient relationship and potential boundary violations. Robert Boland, M.D., past president of the American Association of Directors of Psychiatric Residency Training (AADPRT), presented a model curriculum for teaching residents about professionalism and the Internet as well as recommendations from the AADPRT Task Force on Professionalism and the Internet. (For further coverage, see an upcoming edition of Psychiatric News.) John Luo, M.D., an expert on psychiatry and informatics, concluded the session by Googling the name of a volunteer from the audience to show how revealing the Internet may be, for better or worse.

Surfacing information about a patient through a simple Google search is only the beginning of how accessibility of patients’ online information may affect the relationship between psychiatrist and patient and patient care, whether in a positive or negative way—or in no way at all.

David Hathcox

Past APA President Paul Appelbaum, M.D., explored the ethical and legal implications of using a patient’s “digital phenotype”—which refers to the entirety of an individual’s online presence—as well as emerging technologies that may be used to track patients online in real time. He outlined five areas of concern that individual psychiatrists, and the profession generally, must think about with regard to use of a patient’s digital phenotype: accuracy of online information, clinical effectiveness and impact on patient care, efficiency in terms of the time and effort required to collect and assimilate online information, privacy concerns, and boundary considerations.

(Appelbaum and Carl Fisher, M.D., explored these topics in an article in Harvard Psychiatry Review titled “Beyond Googling: The Ethics of Using Patients’ Electronic Footprints in Psychiatric Practice.”)

A digital phenotype can include Facebook and other social media postings, emails, and comments on blogs and other websites. Appelbaum said the potential effect of all this new information on patient care is far reaching. “We are creating a new kind of medical record with all this information,” he said. “It creates a permanent record that once would not have been accessible, but now can be accessed by insurers or in legal procedures.”

Some patients may actually ask their psychiatrist to monitor their Facebook posts. “It is not at all inconceivable that a patient could tell his or her psychiatrist, ‘I get into these online arguments, and I get very, very angry. I want you to see what happens,’ ” Appelbaum said.

But doing so could open a door that psychiatrists had never anticipated, he suggested. “People are wondering if we might see a legal duty to monitor patients’ online presence,” Appelbaum said. “Legal duty depends on a standard of care. The standard of care is in the hands of our profession. To the extent that we begin routinely Googling or otherwise collecting collateral online information, we may be establishing a standard of care that will be enforced against us.” ■