Executive Summary
Ethical concerns involving providers performing online searchers on patients include patient confidentiality, dignity, and consent. Some ethical considerations include the following:
- Online searching could negatively affect the provider-patient relationship.
- Providers don’t always disclose the online search to the patient.
- Providers must decide whether to document the information in the patient’s medical record.
Of 530 medical students, residents and physicians, 64 used Google to research a patient, and 10 had searched for patients on Facebook, according to a recent survey.1 A quarter of physicians surveyed considered using Facebook to learn about a patient to be “very unethical.” Patient confidentiality, dignity and consent were the most frequent ethical concerns reported.
The study’s lead author, Maxim Ben-Yakov, MDCM, FRCPC, a resident physician in the Department of Emergency Medicine at University of Toronto, Ontario, was surprised that a fairly large number of both trainees and faculty had looked up patients. The study also revealed that the practice was prevalent among all levels of emergency practitioners.
“If information is sought after for voyeuristic reasons, it cannot be ethically or clinically justified,” says Ben-Yakov. “But in an emergency situation, the only avenue to obtain pertinent patient information may be to search their public profile on a social media site.” In this case, a Google search may be ethically justifiable, he concludes.
The researchers suggest that providers use offline interactions as guiding principles for whether online searches on patients are ethical. “One would not go sifting through a patient’s wallet or look for his or her social or demographic information without a clinical indication,” says Ben-Yakov. “The same could be applied to engaging in online searching for patient’s information.”
Only 14% of providers who did online searches disclosed this to patients, while 83% disclosed it to senior colleagues.
“If the provider performed a search without first obtaining consent, then an ethical dilemma about disclosure exists,” says Claire Zilber, MD, chair of the Denver-based Colorado Psychiatric Society’s Ethics Committee and clinical assistant professor of psychiatry at University of Colorado Denver. It is preferable to ask the patient’s permission before performing a search, she adds. This is consistent with the practice of obtaining informed consent before doing an intervention that may have consequences for a patient.
In an emergency situation, however, information obtained by an online search could provide clues to the patient’s underlying medical conditions, substance use, history of violence, or other relevant data. “In an emergency room or an acute hospitalization where the patient is unable to provide information, and there are no identified third-party sources of information, an online search may be appropriate,” says Zilber.
Trust is central concern
The main concern with online searching of patient information is that it could negatively affect the provider-patient relationship, which is founded on trust, says Maria J. Baker, PhD, FACMG, associate professor of medicine at Penn State College of Medicine in Hershey.
“If information is learned outside the traditional office setting, the provider must then decide whether to introduce this newfound information at the next appointment,” says Baker. This risks jeopardizing the professional relationship established with the patient.
“Regardless of whether or not the provider confronts the patient, they must also decide whether or not to document the information in the patient’s chart/medical record at the risk of being discovered by the patient,” says Baker. In a recent paper, Baker and colleagues outlined a number of potential situations that might justify patient-targeted Googling:2
- Duty to re-contact/warn patient of possible harm,
- evidence of doctor shopping,
- evasive responses to logical clinical questions,
- claims in a patient’s personal or family history that seem improbable,
- discrepancies between a patient’s verbal history and clinical documentation,
- levels of urgency/aggressiveness incommensurate with clinical assessment,
- receipt of discrediting information from other reliable health professionals that calls a patient’s story into question, and
- dissonant or incongruent statements by the patient, or between a patient and their family members.
“It is clearly unethical to Google a new patient, simply out of curiosity, to learn where she lives or socializes with friends or whether she currently is in a relationship,” says Baker. Information gained from this type of search has no relevance to the provider-patient relationship or the provider’s ability to address the patient’s medical issues.
“In contrast, if a new patient invites you to read her blog to better understand how her disease impacts her life on a daily basis, the information gained can enhance the provider’s understanding of the patient’s situation,” says Baker. This can help solidify a working relationship toward a common goal.
“If, however, after reading the blog, the provider looks at other information or pictures that are freely available, the provider may have lost sight of the original intent of the search,” says Baker.
Is the search being done specifically to retrieve information that may be used in the treatment of the patient? If not, it should be carefully reconsidered, says Zilber.
“It is unethical to search a patient merely to satisfy our own curiosity,” she says. “Be mindful that our relationship with a patient always hinges on the premise that we are placing their needs above ours.”
REFERENCES
- Ben-Yakov M, Kayssi A, Bernardo JD, et al. Do emergency physicians and medical students find it unethical to ‘look up’ their patients on Facebook or Google? West J Emerg Med 2015; 16(2):234-239.
- Baker MJ, George DR, Kauffman GL Jr. Navigating the Google blind spot: An emerging need for professional guidelines to address patient-targeted Googling. J Gen Intern Med 2015; 30(1):6-7. doi: 10.1007/s11606-014-3030-7.
SOURCES
- Maria J. Baker, PhD, FACMG, Associate Professor of Medicine, Division of Hematology/Oncology, Penn State Hershey (PA) Medical Center. Phone: (717) 531-3849. Fax: (717) 531-0822. Email: [email protected].
- Maxim Ben-Yakov, MDCM, FRCPC, Department of Emergency Medicine, University of Toronto, Ontario. Email: [email protected].
- Claire Zilber, MD, Clinical Assistant Professor of Psychiatry, University of Colorado Denver. Email: [email protected]. Web: www.clairezilbermd.com.
Of 530 medical students, residents and physicians, 64 used Google to research a patient, and 10 had searched for patients on Facebook, according to a recent survey.
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