Doctors Who 'Google' Their Patients

These days, savvy patients check out their doctors on Google and other search engines. Perhaps it's no surprise then that some doctors 'Google' their patients. Critics call that unethical. I say do it if your conscience says there's a good clinical reason for doing so.

I couldn't find any published surveys of how often doctors 'Google' patient.  Anecdotally, it happens all the time. The author of an  article published last week ago (Jan. 6th) in the New York Times said the vast majority of physicians he knows have 'Googled' their patients.  The doctor, a resident in internal medicine, said that to his generation, using a search engine like Google comes as naturally as sharing photos on Facebook.  But it may not be generational thing.  A 2010  article published in the Harvard Review of Psychiatry by Dr. Brian Clinton and co-authors said the practice among psychiatrists of searching for information about patients was widespread.  Back then, the practice even had a name:  it was called 'patient-targeted Googling' or PTG, a sure sign that it was established practice.  A book chapter by the same authors said it's also common in the ER and on in-patient wards.

I have 'Googled' patients from time to time.  My story is quite similar to the one by the author of the New York Times article.  He was on the last day of a rotation on the bone marrow transplant unit when he met a patient who said she had been a painter and suggested that the young doctor check her out on Google.  He did so and found her paintings.  I recall that an artist of some note was a patient in my ER.  I recognized the patient but my colleagues weren't familiar with the artist's work or reputation.  I remember showing the artist's Google results and watching the reaction of my colleagues that this person was indeed quite famous. So I guess you can say I was motivated in part by curiosity.  Perhaps I wanted to prove to my colleagues that I was cultured enough to be familiar with a famous artist.  Perhaps I wanted to enrich my colleagues understanding of the story of the patient.

 

There are good clinical reasons for searching online for patient information. In their article in the Harvard Review of Psychiatry, Dr. Brian Clinton and colleagues gave an example of treating a patient admitted to hospital with dementia who had lost contact with his family and using Google to locate and get in touch with them. On more than one occasion, we have incorrect information on patients who have left the ER.  When it's urgent to reach them, I've 'Googled' to find out their correct address and phone number.  There are reports of using Google as a lie detector.  There was a case cited in the New York Times of a young woman who went to a surgeon to have a double mastectomy because of an alleged family history of breast cancer.  The surgeon became suspicious when the woman refused any tests.  The surgeon Googled the patient and found multiple Facebook accounts in which she was pretending to have cancer to solicit donations.

 

It's unethical to search a patient online when it's clearly not in the patient's interest to do so. Using Google to see what kind of house the patient lives in and to check out their lifestyle are clear boundary violations. But what about a doctor checking social media to see if a patient who promised to quit smoking has kept their promise, or using social media to see if they the patient takes drugs or engages in high risk sex? How about a doctor paid by an insurance company or workers' compensation board to do an independent medical evaluation of a patient's disability using an Internet search to see if the patient is truly disabled?  These kinds of searches can undermine the trust in a doctor-patient relationship.

Earlier this year, experts on medical ethics and professionalism in the U.S. released a position paper governing online behavior by MDs.  The paper points out that while online searchers can be helpful - especially when the patient is in danger - they can also be used out of curiosity or voyeurism.  It recommends that MDs consider the intent of the search before searching.  Instead of sneaking around, the paper recommends asking the patient for permission to do the search and sharing the results with the patient.  Given the power of 'Googling' to gain information anonymously, I think that recommending self-policing is naïve.  

This is a case of search technology moving leaps and bounds ahead of ethical guidelines. We may be reaching the day when patients may have to fight back by using technology to find out when doctors are 'Googling' them.