The ethics of researching patients on the web

The current healthcare environment offers a multitude of options to patients for researching their physicians. Between websites such as Healthgrades.com, RateMDs.com, and even Medicare’s Physician Compare website, as well as general Google searches, patients are now more able to peer into the backgrounds of their doctors than ever before.

The reverse scenario, wherein a physician Googles a patient, is more controversial. While patients may appreciate the opportunity to research their doctors, often they are less enthusiastic about having the doctor research them. This article examines the legal, ethical, and practical considerations regarding researching a patient online.

The legalities

Legally speaking, there is nothing to prevent a physician from searching for information online about a patient (assuming the use of otherwise legal methods). The information a physician would find through a simple Google search or scan of the patient’s social media accounts is not confidential; to the contrary, it is publicly available for anyone to see. Thus, there is no issue regarding a breach of confidentiality.

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Moreover, the information is not subject to the restrictions of the Health Insurance Portability and Accountability Act (HIPAA). It does not fall within the definition of “protected health information” (PHI). By definition under the HIPAA regulations, PHI must be created by a healthcare practitioner; patient-created public information falls outside this definition. Thus, the physician is not engaged in any breach of HIPAA by researching a patient online.

Where patients are noncompliant, or even belligerent and confrontational, it would be reasonable to find out if the patient has been a plaintiff in a lawsuit.

However, even though there is no legal impediment to researching a patient online, the ethical implications must be considered.

NEXT: Ethical concerns

Ethical concerns

To be an effective clinician, the physician must have the trust of the patient. However, it is easy to envision circumstances whereby a physician researching a patient online would erode or destroy the patient’s trust were the research to become known to the patient.

Consider a scenario where a patient claims to have stopped smoking, but the physician has seen the patient’s Instagram account that featured a picture of the patient smoking at a bar with friends. If the physician confronts the patient about the falsehood, it is easy to see that the patient might resent the intrusion into their private life and be even more reluctant to be honest with the physician when it is clear that the physician does not trust the patient.

On the other hand, under some circumstances it may be in the patient’s interest for the physician to Google him or her. For example, a psychiatrist monitoring a patient’s blog, when the patient has consented, might be appropriate if the purpose is to determine if the patient intends self harm or to harm someone else.

Likewise, there could be circumstances where a physician has received conflicting information about a patient’s condition and/or history, both from the patient and the patient’s other healthcare providers, and certain background information may be necessary to determine an appropriate course of action.

In one article, a woman presented at a medical center, requesting a preemptive double mastectomy and citing a dubious family history of cancer, but refusing to undergo any genetic testing in advance. Consultations with the woman’s primary care physician yielded inconclusive information. An online search for information about the woman showed that she had given interviews, spoken at non-professional conferences, and was attempting to raise funds to attend a national cancer conference. As a result, the surgeon informed the woman that he was unwilling to perform the operation without her first undergoing genetic testing.

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Unfortunately, professional societies such as the American Medical Association have not yet established clear policies regarding when it is appropriate to research a patient online. As a general matter, however, some guidelines seem prudent. Physicians should not investigate a patient online out of idle curiosity. An investigation should be conducted only when the physician reasonably believes that:

• the research is necessary for the benefit of the patient,

• the research is likely to yield information that will actually assist the physician in the treatment of the patient, and

• the patient has been consulted and has consented to the research.

If the patient has not consented, then the physician should carefully consider whether the benefits of Googling the patient will outweigh the potential risks of doing so, and whether not Googling the patient will cause more harm than doing so.

NEXT: Practical considerations

Practical considerations

While one can easily concoct hypothetical scenarios in which it would be beneficial or even necessary to research a patient online, the actual results of such research and their use are far more likely to prove ambiguous at best.

The bulk of such results will likely be a mix of public record research websites (mostly designed to entice the viewer into paying for access to additional information), social media and/or professional networking website accounts, and, in rare circumstances, news items.

Consequently, online searches may yield information of limited value. For example, the clinical information offered by the contents of a patient’s LinkedIn account likely is minimal at best. Likewise, basic information such as the patient’s previous addresses, age, and other relatives is also unlikely to be of much use to a physician.

Social media accounts also rarely offer information of much value, because generally they are isolated snapshots of a patient’s life. For example, if a patient has been counseled about high cholesterol, and subsequently posts a picture of themselves at “Burger Bash 2015” on their Twitter account, what value does this information really offer to the physician?

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As a single moment in time, absent any additional context (e.g., what the patient actually consumed at the event and in what quantities, whether the patient was merely attending with friends or actively eating at the event, etc.) the picture by itself provides very little information and gives the physician no real sense of the clinical impact of the behavior displayed in the picture.

Moreover, the damage of such behavior would be better confirmed through clinical methods, such as a lipid panel, rather than engaging in an adversarial confrontation with the patient based on the photograph. Even if the image is part of an overall pattern of behavior evident on the patient’s social media account, if the patient has not given consent to the physician to research him or her, the physician has very few avenues available to bring the information to the patient’s attention without damaging the patient’s trust.

Conclusion

In the absence of clear guidance from professional societies and/or state medical licensure boards, physicians are left to use their best judgment with respect to whether to research a patient online.

While there are certain specific circumstances in which doing so may be appropriate, in most instances, it is inadvisable to Google a patient, at least without the patient’s consent. Much of what might be discovered from the results of such research can just as easily be confirmed through clinical testing or simple observation of the patient during a visit.

Physicians are trained to employ their clinical judgment and observational skills to determine, for example, when a patient may be lying or “rounding down” information about their behavior (e.g. weekly alcohol consumption or smoking habits), seeking drugs, or “doctor shopping.”

While Googling a patient might provide more definitive information in some situations, it is just as likely to provide ambiguous results that muddy the waters, or yield no useful information at all. Given the potential harm to the physician-patient relationship that can occur through using information found in an online search, it is probably better to trust your skills as a physician rather than to turn to the internet in all but the most specific circumstances.

Daniel F. Shay is a healthcare attorney with Alice G. Gosfield and Associates, P.C. in Philadelphia, Pennsylvania.