Today's psychiatrists face a problem that was unheard of 10 to 20 years
ago: with the explosion of online information and social media, how does one
manage all the Internet-related complications that could profoundly affect the
At a workshop during the 2009 APA annual meeting in May, Damir Huremovic,
M.D., director of psychosomatic medicine services at Nassau County University
Medical Center (NCUMC) in New York, and colleagues discussed the potential
pitfalls and transgressions in the patient-psychiatrist relationship within
The Internet offers physicians "an inviting opportunity to collect
collateral history" on their patients that may reveal a lot about their
patients and potentially influence treatment, said Huremovic.
If a patient has scattered personal information in cyberspace for all to
see, can it be interpreted as his or her choice to relinquish confidentiality
on this information? What if a patient denies suicidal ideation but posts
suicidal messages on an online blog? Because real-life pathology is often
reflected in a patient's online persona, the psychological clues gleaned from
a patient's online presence may help the psychiatrist conduct the assessment
more quickly and thoroughly, he suggested.
In one instance, Huremovic decided to read the blog of a patient who was in
a coma because of a suicide attempt. He did not know the patient and, as the
consulting psychiatrist, needed to understand and assess the risk of
suicidality for the patient quickly once he awoke. Nevertheless, he had mixed
feelings about the decision to look at the blog and is still uncertain about
whether it was the right thing to do.
Recently, APA's Ethics Committee gave a brief recommendation on whether it
is ethical for psychiatrists and residents to Google their patients:"
'Googling' a patient is not necessarily unethical. However, it should
be done only in the interests of promoting the patient's care and well-being
and never to satisfy the curiosity or other needs of the psychiatrist"
(Psychiatric News, May 1).
On the other side of the coin, patients may Google their psychiatrists and
not only uncover their professional credentials but also dig into their
personal information, opinions, and attitudes. Many psychiatrists have blogs,
Facebook pages, and a chat-room presence that patients could uncover,
Jacob Sperber, M.D., discusses the ethical and therapeutic pitfalls that
appear when psychiatrists and patients Google each other.
Credit: David Hathcox
"Patients and psychiatrists secretly Googling each other raises all
kinds of legal, ethical, ideological, and personal concerns," Jacob
Sperber, M.D., director of the psychiatry residency training program at NCUMC,
told the audience. He believes that searching and gathering information about
a patient behind the patient's back potentially violates the patient's
autonomy and dignity and breaks the trust the patient has in the psychiatrist.
It may be a violation of the patient's privacy, even if the psychiatrist's
intention was to provide "zealous
Furthermore, this practice outside of direct, face-to-face communication is
potentially detrimental to the therapeutic efficacy of treatment. Unlike other
medical specialties, the "psychotherapeutic work ... places maximum
importance on the doctor-patient relationship," Sperber pointed out.
Just as psychiatrists Google their patients, some patients are online
searching for information about their psychiatrists. "Relationally, a
patient's going to the Internet for information about the therapist robs the
patient of the opportunity to work on fears he or she may have of offending
the therapist by asking directly," Sperber said. This avoidance of
direct communication may constitute "marked resistance." In a
relational model of psychotherapy, the process of the patients' narrating
their own stories is itself a valuable treatment, which cannot be achieved,
and may even be negatively affected, if both parties take the shortcut of
Googling each other.
Huremovic pointed out that the online behaviors and patterns in the
patient-psychiatrist relationship can be a lot more complex than searching for
personal information. According to Nielsen Online statistics, Americans spent
an average of 75 hours online (at work and at home) in the month of March.
"The use of social networking tools has really exploded over time and
is just gearing up," Huremovic said, citing survey data that indicate
people are spending more time on Internet social media such as Twitter,
Facebook, MySpace, LinkedIn, YouTube, and blogs. As a result, more personal
information ends up online, sometimes anonymously but often not. In addition,
the lack of accountability in online interactions can lead to people behaving
differently from the way they would in the "real" world.
Today's psychiatrists have to understand and recognize the manifestation of
psychopathology in the virtual world, which could "seep into reality,
often with devastating consequences," according to Huremovic. He cited
the cases of a girl committing suicide after continued cyber-bullying and
harassments and an online suicide pact among youth thwarted by South Korean
police. Virtual interpersonal relationships can have a significant impact on
people's mental well-being and relationships in real life, he said.
From e-mail correspondence with patients to telepsychiatry and remote
consultation, psychiatrists spend a large amount of time online at work and at
home just like patients and the public, Huremovic pointed out. They
participate in professional and social networks, have formal and casual
interactions, and sometimes may not be fully aware of their own online image
and how it may be perceived by patients who "see" them online (see
Cyber-Sleuthing Goes Both Ways).
Finally, Huremovic emphasized a generational difference among the general
population as well as between supervisors and trainees, who may have a
drastically different view of privacy and identity in the online context."
Trainees are well versed in the online realm," he said to a
chuckling audience, "while supervisors lag behind." ▪