Online Searches and Professionalism

I am responding to the article “Online Searches and Professionalism” by Dr. Claire Zilber in the August 5 issue concerning the professional boundaries of Internet searches for psychiatrists.

While I agree in substance with the urge to question the motives to Google a patient, and I agree that a psychiatrist should ask himself or herself the questions that Dr. Zilber lists when the impulse to search arises, I do not believe that a search violates a patient’s autonomy and privacy.

It seems to me that any information on the web that has been published with the implicit or explicit consent of the interested individual should be considered public, and hence expecting privacy and autonomy about that material is preposterous.

A psychiatrist conducting an Internet search on a patient is imprudent maybe and should certainly consider why there is a wish to do so, but in my opinion calling that behavior unprofessional or, worse, unethical is a step too far under any circumstance, and particularly if the treatment is limited to psychopharmacology.

Pietro Miazzo, M.D. (Philadelphia, Pa. - Dr. Miazzo is a member of the Ethics Committee at Temple University’s L. Katz School of Medicine.)

I am writing in reference to the ethics column by Dr. Claire Zilber in the August 5 issue. Dr. Zilber mentions that Google searches of a patient violate patient/client professional boundaries. I do not agree. The Internet is a sort of public commons, and just as she states that patients are free to search for information about their psychiatrist, I would argue that seeking collateral information about a patient via the Internet, a public information source, is not a breach of this relationship.

As health professionals, we are taught that what is placed on the Internet stays on the Internet, and this applies to patients as well. If my patient writes a blog about a breakup with his or her partner and posts it on the Internet for all to see, there is no way to make this accessible to only one individual, and not others. It is not as though one is contacting a relative for collateral without the patient’s consent.

Addressing information found on the Internet with the patient, if appropriate, could help strengthen the therapeutic relationship: why hasn’t the patient disclosed this information? Does he or she recognize that it is available for all to see? If, as Dr. Zilber states, patients look for personal information regarding providers, the therapeutic relationship is already affected.

Dr. Zilber provides no research data or experience to back up her claim that a Google search of a patient violates the patient/provider relationship or why the relationship needs to be treated as “asymmetrical.” This is not to say that I Google my patients, but if I did, it is my opinion that it would not make me a worse psychiatrist.

Seth Rosenblatt, M.D., M.P.H. (PGY-3 Psychiatry Resident - George Washington University)

Response from Claire Zilber, M.D., chair of the Colorado Psychiatric Society Ethics Committee and corresponding member of the APA Ethics Committee:

Drs. Miazzo and Rosenblatt raise interesting questions. I agree that online information is public. The issue is whether a psychiatrist ought to look at such public information without the knowledge of the patient. Psychiatrists strive to foster trust in their patient relationships. Except in emergencies or forensic settings, this includes allowing patients to determine what they disclose. If one does gather information from a public forum, how does the psychiatrist share that with the patient so that transparency and openness are supported in the therapeutic relationship? A survey of patients’ expectations about their psychiatrist’s online search behavior would add valuable data to this discussion. Do they expect privacy? Conversely, if they learn they have been searched once, might some expect ongoing monitoring of their online activity? ■