Issue link: https://viewer.e-digitaledition.com/i/298548
P ERHAPS PHYSICIANS HAVE always been curious about patients, or perhaps it's just a sign of the times — the accounts of physicians Googling or using social media to investigate patients. Inevitably, responses to such reports range from skepticism … "My colleagues and I don't have time to Google our patients." … to resignation: "I don't think I know a single physician who hasn't Googled at least one patient. Everyone knows there's no privacy on social media." Does a "community standard " exist regarding ad hoc searches for patient information via social media? And how does a social media sighting differ from an in-person encounter? For instance, if a workers' compensation physician sees his patient participating at a horseracing event where he's in attendance, is it ethically comparable to tracking her down on Facebook to ascertain whether she's still performing strenuous physical activity? Real-World Implications While hard data regarding whether, and how often, physicians Google their patients is scarce, anecdotal evidence suggests the practice can lead both to benefi ts and harms. NBC News reports that a team of physicians "in all likelihood" denied a liver transplant to a candidate when a provider searched for him online and found an image on Twitter in which he appeared to be drinking heavily. (Arthur Caplan, PhD, who heads the Division of Medical Ethics at New York University Langone Medical Center, recounted the story without names or identifying information.) The Hastings Center Report describes a patient who faked a family history of breast cancer and requested a prophylactic mastectomy. Physicians Googled her and found Facebook pages on which she portrayed herself as already having cancer. In this case, the patient was spared the potential harms of unneeded invasive surgery. In other cases, benefi ts and harms may be less corporeal. Psychiatric News reports a psychiatrist lost a patient after Googling him and seeing a picture of a mansion at the patient's A Quick Peek: The Ethics of Researching Patients via Social Media IS THE PATIENT YOU CERTIFIED AS UNABLE TO RETURN TO WORK DUE TO BACK PAIN SPENDING HER WEEKENDS THROWING HAY IN THE BARN AT HER HORSE FARM? By Jennifer Webster address. The provider confronted the patient about payment reductions he'd granted him, pointing out that he lived in a man- sion and should have ample funds to pay. However, the patient merely rented a basement room from the mansion's owner. In this case, patient-provider trust was irrevocably broken. In Search of an Apt Analogy Is an electronic sighting — based on a search or not — the same as a live encounter? Molly Cooke, MD, FACP, President of the American College of Physicia ns (ACP), argues that bedrock values hold true no matter the context. "The issues [on electronic media] are not new issues," she says. "It's just a new platform they're playing out on. The fundamental principle of protecting patients' privacy and confidentiality — that is a venerable principle. We will continue to encounter these novel ways or novel tests to fundamental values, but the values are evergreen." E x t rap olat i ng f rom t he case of the psychiatrist whose Googling resulted in the loss of a patient, the crossing of boundaries that would be involved in driving past a patient's house parlays into the electronic world as well. There are almost no situations in which a physician should conduct an electronic search on a patient, Dr. Cooke says, though she acknowledges that in a very few cases — a mental illness such as Munchausen syndrome, for example — it might be appropriate. Still, "you don't like to make rules about practice around exceptions," she cautions. Kevin Pho, MD, internal medicine physician and co-author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices, argues against online snooping. "If physicians want to screen for dangerous behavior, they should do what they've always done: Ask the patient," he says. Developing Standards Do patients believe their online identities and activities are regularly perused by their physicians? If they read any of a variety of media sources, they might. In 2010, psychiatrist David Brendel, MD, PhD, told The Wall Street Journal that he had "witnessed other physicians conduct searches," and he and other authors of a paper on using social media to Google patients "had done it themselves." More recently, British general practitioner (GP) Kate Adams told The Guardian, "When I ask colleagues and GP friends whether they [Google patients], there's a resounding 'Yes.'" And, in the account that may have garnered the most publicity, Haider Javed Warraich, MD, wrote in The New York Times that "the vast majority of physicians I know" have Googled their patients. W h e t h e r or n o t t h e s e accounts are representa- tive, physicians associations advocate restraint. The ACP issued a position paper in 2013 that cautioned, "digi- tally tracking the personal behaviors of patients, such as determining whether they have indeed quit smoking … may threaten the trust needed for a strong patient-physician relationship." Dr. Cooke, a co-author of the position paper, describes the thought process behind the document as weighing generational and technologi- cal change in the context of underlying values. "I think we have all heard that employers and admissions of f icers may ex a m ine what applicants look like online," she says. "It is a sign of the times. We started with the feeling that we wanted to provide thoughtful adv ice to our members about managing themselves in this new world of social media." Senior and junior physicians worked together on the physician paper, Dr. Cooke notes. "It was our council of early-career physicians who were the impetus behind the policy in the fi rst place," she says. "They were asking for the assistance of the College thinking their way through this." Dr. Pho, who may be the physician most strongly associated with social media, is known for his popular blog at KevinMD.com and his suggestions that physicians use social media as a way of endorsing sound health messages. Perhaps because of his Internet savvy, Dr. Pho takes a hard line in favor of caution when it comes to seeking out patients electronically. "There are very few, if any, cases where doctors should Google their patients," he says. "For me, the overriding question should be, 'Will researching my patient online improve their care?' If the answer is yes, only then, perhaps, is there legitimate reason to do so." Does your organization's social media policy strike the right balance? Join the discussion at www.mdnews.com. ■ CORE CORE 1 2 | Central New York MD NEWS ■ M D N E W S . CO M