It's something we do to job applicants, first dates, former lovers and the quiet co-worker in the next cubicle. The practice of “googling” others for professional reasons or out of personal curiosity is so ubiquitous that the name of the popular Internet search engine has turned into a verb. In healthcare, patients often head online for diagnoses, drug information and details about their doctors. But do professional standards prevent physicians from doing the same to patients?
The authors of a new paper in the Journal of General Internal Medicine write that sometimes, the practice is acceptable. Most other times, in their opinion, it isn’t. They hope their paper sparks conversation among colleagues and the American Medical Association about the possibility of guidelines for providers in the digital age, one in which most medical students can't remember a world without search engines.
“The motivation is to protect patients and prevent harm,” said Maria Baker, a Penn State Hershey Cancer Institute genetics counselor.
Her paper lists 10 situations when physicians are justified in “googling” patients – for example, when they have a duty to warn of possible harm, if patient’s story seem improbable, if information from other professionals calls a patient’s story into question, if there are suspicions of abuse or concerns of suicide risk.
“There is something worth protecting in the physician-patient relationship,” said co-author Daniel George, an assistant professor in Medical Humanities at Penn State University College of Medicine. While the AMA has issued guidelines regarding physician professionalism and social media, George calls patient-targeted web searches a “blind spot” among providers.
The authors detail actual situations at Penn State when they felt “googling” was warranted. In one case, a 26-year-old requested that both of her breasts be removed to prevent breast cancer, although she hadn’t undergone genetic testing to see if she was at risk for the disease, and didn’t want to. She reported an “almost unbelievable” family history of breast, ovarian and esophageal cancer and had sought the same surgery at other hospitals.
The genetic counselor “googled” her and found that this patient “was presenting her cancer story at lay conferences, giving newspaper interviews, and blogging about her experience as a cancer survivor. Additionally, the patient was raising funds, perhaps fraudulently, to attend a national cancer conference.”
“Armed with this information,” the authors write, “the genetic counselor informed the surgeon, who subsequently told the patient he felt uncomfortable performing the surgery in the absence of formal genetic and psychological testing.”
Conversely, the authors argue, web searches can undermine trust among patients and providers. “You have a patient wanting to adopt healthy lifestyles, and the doctor helps him on a course of exercise and non-smoking,” Baker explained. “But the doctor ‘googles’ him and sees pictures he posted on Facebook smoking a cigar.”
Mildred Solomon, president of the Garrison, New York-based bioethics institute The Hastings Center, said she applauds the authors for raising such questions, but their “acceptable” reasons for “googling” patients are far too broad.
One scenario, “incongruent statements by the patient, or between a patient and family members,” occurs too frequently in clinical settings to justify Internet searches, Solomon said. “There’s too much wiggle room,” she explained, noting that “intention” is what should matter.
“Why is the physician motivated to do this? Is it going to bring benefit to the patient, or is it something self-serving or out of personal curiosity?” Solomon asked.
A spokesperson for the AMA declined to comment to Reuters Health, citing the issue as “unresolved” by the organization.
However, a 2013 policy statement from The Federation of State Medical Boards notes that physician use of digital tools must evolve as do technology and societal trends. It acknowledges the use of “patient-targeted googling” in medical crises, such as attempts to identify unconscious patients in emergency departments. But, according to the policy: “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.”
Authors say they wish only for more dialogue about this digital practice.
“I think this is just a starting point,” George said. “Every conversation has to start with something. This is the raw clay that we hope the field sculpts into set guidelines.”
The paper, which first came online in September, appears in the journal’s January print issue.
SOURCE: bit.ly/1yyc6Ox Journal of General Internal Medicine, online September 17, 2014.