Health IT, Hospitals, Policy

When is it OK for doctors to google patients?

As physicians are increasingly asked to embrace patient engagement strategies that could spur more healthful […]

As physicians are increasingly asked to embrace patient engagement strategies that could spur more healthful behaviors and better coordination between visits, an interesting, but controversial “blind spot” has emerged: should doctors google their patients?

The practice of googling individuals exists in many corners of our daily lives – potential bosses and job applicants, first dates, siblings, co-workers, etc. And patients google information on health and diagnosis all the time, so why not let the doctor do the same?

At first blush, most responses to the idea express a wariness and that such a practice would be a violation of patients’ privacy. But authors of a recent paper, appearing in the Journal of General Internal Medicine, argue that there are exceptions, and that the ambiguity of the idea should be addressed by the American Medical Association in the digital age.

Authors note that the practice can be acceptable in some cases, but that it should be used sparingly. So what are some such situations? They list 10 possible scenarios:

— A duty to recontact or warn a patient of possible harm
— Evidence of doctor shopping
— Evasive responses to logical questions
— Improbable claims in personal or family history
— Discrepancies between patients’ verbal and clinical documentation
— Levels of urgency/aggressiveness incommensurate with clinical assessment
— Receipt of discrediting information from other trusted health professionals that calls into question a patient’s story
— Dissonant or in-congruent statement by patient
— Suspicions regarding physical and/or substance abuse
— Risk of suicide

The authors are careful to note that these are mere suggestions, and that their hope is to spur a conversation that will assist physicians going forward.

An example is provided within the article of a 26-year-old female patient who requests that both of her breasts be surgically removed to prevent cancer, despite having never undergone genetic testing that would help determine risk. She declined such testing, and relayed an “almost unbelievable” family history of cancers, including breast, ovarian and esophageal. She had sought surgery at other hospitals, as well.

Upon hearing this, the genetic counselor took to google and found the patient had a history or recounting her story of being a cancer survivor at conferences, newspaper interviews and in her own blogs. She was also found to be raising money to attend a national cancer conference.

With that knowledge, the genetic counselor told the surgeon, who then declined to perform the operation without more formal genetic and psychological testing.

The AMA declined to comment on googling patients, telling Reuters that the issue is “unresolved.”

Yet the Federation of State Medical Boards issued a 2013 policy statement that notes “patient-targeted googling,” and says, while there may be proper uses, “it instead can be linked to curiosity, voyeurism and habit. Although anecdotal reports highlight some benefit (for example, intervening when a patient is blogging about suicide), real potential exists for blurring professional and personal boundaries.”

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