The Grapevine

Medical Ethics Faces New-Age Concern: When Is It OK For Doctors To Google Their Patients?

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The line between concerned research and outright snooping isn't always well-defined. A few physicians want to change that. Reuters

Given the advent of Google and other Internet search engines within the last two decades, more questions are being raised about the ethics of doctors learning more about their patients than what they hear directly. Now, a new study suggests many of the guidelines that offer physicians a moral toolkit may need revising.

Patient records aren’t confined to clipboards hung on exam room doors anymore. In today’s Information Age, people are migrating their lives online, which means doctors have nearly limitless opportunities to learn about the people they care for. Sometimes that means changing direction in treatment. Sometimes it means denying it altogether. Until now, drawing the line at what is acceptable to look up has been a perplexing task.

"As time goes on, Googling patients is going to become more and more common, especially with doctors who grew up with the Internet," said Maria J. Baker, associate professor of medicine at Penn State College of Medicine lead study author, in a statement. Baker found inspiration for the recent report from a woman who had faked a cancer diagnosis in order to drum up fundraising money. Since the patient’s family history couldn’t be verified, Baker, a medical geneticist, turned to Google to see if she could shed any light on the issue. That’s when she realized the scam.

Not all cases will end this way. It’s entirely possible a curious doctor could find nothing but personal details about the patient, in which case the doctor may be undermining the patient’s assumption of trust. "Health care providers need guidance on when they should do it and how they should deal with what they learn," Baker said. In the report she co-authored with two of her colleagues, the team calls for a clearer set of prescriptions for deciding when physicians should and shouldn’t Google.

They outline 10 criteria:

  •          Duty to re-contact/warn patient of possible harm
  •          Evidence of doctor shopping — visiting different doctors until a desired outcome is acquired.
  •          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 are not justified by clinical assessment
  •          Receipt of discrediting information from other reliable health professionals that calls the patient's story into question
  •          Inconsistent statements by the patient, or between a patient and their family members
  •          Suspicions regarding physical and/or substance abuse
  •          Concerns regarding suicide risk

Behind the dilemma of “To Google or not to Google” is a decidedly more complex change in how doctors interact with their patients. Before the Internet gave physicians such robust access to their patients’ lives, they had to rely on what they were told. From these self-reports they formed hard opinions on which diagnoses they could rule out, which treatment methods were superior, and, ultimately, how the patient’s future might look. That dynamic is changing.

Google has produced a “blind spot,” Baker says. The Hippocratic Oath demands that doctors do no harm, but what happens when patients’ own inconsistencies, however intentional, put them in harm’s way? "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," Baker said. "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?"

While most medical societies do have rules on the books that outline how doctors should use social media and the Internet, they lack a set of formal guidelines specific to patient information. The addition Baker and her colleagues suggest is overdue, they contend.

"Any professional medical society's policy statements on the use of the Internet and social media — which they should all have — should undergo revision to help provide guidance to their various health care providers."

Source: Baker M, George D, Kauffman Jr. G. Navigating the Google Blind Spot: An Emerging Need for Professional Guidelines to Address Patient-Targeted Googling. Journal of General Internal Medicine. 2015.

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