How to Handle Online Harassment, Cyberstalking by Patients

Several studies have concluded that as many as 75% of workplace assaults and violent attacks occur in health care settings. Furthermore, as many as 20% of physicians surveyed reported being the victim of at least one instance of stalking or harassment by a patient.

Unfortunately, predicting who may exhibit this type of behavior is difficult. In addition, the internet allows perpetrators to harass their victims, such as health care professionals, more frequently, easily, and anonymously than ever before. Both male and female physicians report stalking events with almost the same frequency. Mental illness and fear are two of the top reasons cited as why patients act out against their health care professionals. Transference is another potential cause for cyberstalking and harassing behavior; a patient may redirect some of his/her feelings for others onto the psychiatrist, enhancing their need to interact with his/her psychiatrist in unhealthy ways.

Online harassment is defined as using online media (such as social media platforms, websites, apps, emails, and text) to cause emotional distress to an intended victim. Cyberstalking is the repeated use of electronic communications to harass or frighten someone, for example, by sending threatening emails. APA has a resource document that addresses stalking, intrusive behaviors, and related phenomena by patients (see link below). It provides key information related to personal safety, prevention, and intervention. Depending on the level of threat, psychiatrists may need to seek personal counseling to deal with the stress of being harassed or intimidated by a patient and determine if the patient requires hospitalization or transfer of care to another psychiatrist. Moreover, consider if there is a duty to warn others who may be in danger. It may be important to inform staff members if there is a credible threat to their safety as well.

• Maintain clear boundaries with patients. Do not accept friend requests on social media platforms.

• Maintain professionalism to avoid blurred lines in the doctor/patient relationship.

• Report threatening behavior to law enforcement; consider filing a civil protection order for stalking behavior.

• Provide the minimum necessary information to law enforcement/court to comply with the Health Insurance Portability and Accountability Act (HIPAA).

• Document the details of the event both in the patient’s medical record and in your personal records.

• Block the telephone number of the harasser and/or change your personal telephone number if necessary.

• Contact patients through HIPAA-compliant privacy apps or a patient portal that encrypts your telephone number and email address.

• Use separate cell phone numbers and email addresses for work and personal use.

• Dismiss the patient from the practice if necessary. Follow proper termination procedures.

• Consider safety precautions such as panic buttons installed in the office, protective barriers where possible (patient session rooms, waiting areas, private staff areas), and other security measures.

• Consult your risk management professional or practice attorney for guidance. ■

This information is provided as a risk management resource for Allied World policyholders and should not be construed as legal or clinical advice. This material may not be reproduced or distributed without the express, written permission of Allied World Assurance Company Holdings Ltd, a Fairfax company (“Allied World”). Risk management services are provided by or arranged through AWAC Services Company, a member company of Allied World. © 2021 Allied World Assurance Company Holdings, Ltd. All Rights Reserved.