"Googling" Guidelines: The Ethics of Physicians Investigating Patients Online

Formal guidelines which address physicians’ use of the internet and social media should be updated to include the ethics of physicians conducting online searches to learn more about their patients, say Penn State College of Medicine researchers. At the moment, there is a “Google blind spot” which is not discussed in professional guidelines such as those provided by the American Medical Association and the Federation of State Medical Boards.

When is it appropriate for physicians to “Google” their patients, and what should doctors do with the information they acquire online? Associate Professor of Medicine Maria J. Baker was prompted to raise the issue in a paper which appears in the Journal of General Medicine. A genetic counsellor and medical geneticist, Baker encountered a patient whose personal and family histories of cancer could not be verified. An internet search yielded evidence that the patient was capitalising on being a cancer victim, although she did not have cancer.

“As time goes on, googling patients is going to become more and more common, especially with doctors who grew up with the Internet," Baker said. However, physicians who turn to search engines to learn about their patients risk losing the trust that should exist between patient and provider. Professional guidelines could assist physicians who are unsure about whether online searches are appropriate.

“Under certain circumstances – when carefully thought out – it may be appropriate to Google a patient," said Baker. Future guidelines might include the following situations in which internet searches of patients may be justified:

• Physicians are duty-bound to warn patients about possible harm.
  
• Physicians suspect physical abuse or substance abuse.
  
• There are concerns about the risk of patient suicide.
  
• Patients are evasive in their responses to logical clinical questions.
  
• Patients make improbable claims in their personal or family history.
  
• There are discrepancies between the patient’s verbal history and available clinical documentation.
  
• The patient provides inconsistent statements, or their statements contradict those of family members.
  
• There is evidence of “doctor shopping”, with patients visiting multiple doctors until they acquire a particular outcome.
  
• Patients display an unjustified level of urgency with respect to what is shown in clinical documentation.
  
• Other health professionals report discrediting information about the patient’s story.
  

"We're hoping that by offering scenarios that raise important ethical questions about the use of search engine technology, we can initiate a conversation that results in the eventual development of professional guidelines. What are the justifications? How is this information that you might potentially learn going to impact the patient-provider relationship and how are you going to document the information about the patient that you might learn?” Baker said.

Penn State College of Medicine Assistant Professor Daniel R. George and Professor and Vice Chair of Surgery Gordon L. Kauffman co-authored the paper with Baker.

Source: Penn State Hershey Medical Center 

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