Sometimes it's ethical for the doctor to Google you

Patient-focused online searches can uncover health risks, but may erode confidence in a doctor

A Google Glass wearer

Wearables, such as Google Glass, will make patient-oriented Internet searches even easier for healthcare workers.

Credit: Creative Commons Lic.

The medical community needs ethical guidelines for doctors who Google their patients for information because such a move can erode confidence and trust.

That's the recommendation of a recently published research paper by professors at the Penn State College of Medicine. The study highlights how physicians have been left to navigate search engine waters on their own -- and it points out the moral ambiguities involved in the practice.

"In some ways, it could be viewed by patients as somewhat weird that a medical provider might be trolling their online profile to get more information about them," said Maria Baker, a Penn State associate professor of medicine and co-author of the research paper. "Googling a patient can undermine the trust between a patient and his or her provider, but in some cases it might be ethically justified."

The research comes at a time when young physicians and doctors in training are more often using Internet search engines in connection with their work. In addition to that, wearable devices such as Google Glass are being used more often in the healthcare industry.

For example, Stanford University's medical school plans to start using Google's head-mounted display to help train surgical students. Meanwhile, emergency room doctors at Beth Israel Deaconess Medical Center in Boston are using Google Glass to help treat patients.

The Penn State research paper recommends guidelines for using search engines on patients, all of which revolve around patient safety to include concerns regarding suicide risk and whether there's a suspicion of substance abuse.

Baker has dealt with the question first hand in her role as a genetic counselor and medical geneticist.

A female patient of Baker's was pursuing cancer predisposition testing based on her diagnosis of breast cancer at age 27. The initial testing revealed a mutation in a gene, but the clinical relevance of it had yet to be determined. Years later, the genetic lab issued an amended report revealing the gene was responsible for a rare form of anemia, which also had cancer risks. The risks applied not only to the primary patient but for her relatives on both sides of the family.

Unable to find the patient, Baker went online to get her contact information.

It was a second patient case, however, that inspired Baker to write the research paper, "Navigating the Google Blind Spot." That patient consulted Baker about prophylactic mastectomies. The patient's family history of cancer could not be verified and then a pathology report revealed that a melanoma the patient listed had actually been a non-cancerous, shape-changing mole.

Baker Googled her patient and found evidence she'd been capitalizing on being a cancer victim for a cancer she didn't have. The question, Baker said, is in what circumstances is it appropriate for a doctor to research a patient using online search engines?

Imagine, however, that you see a physician for a lifestyle change, perhaps eating less, exercising more or to quit smoking. Later, you find out that your doctor visited your Facebook page and found photos of you smoking and confronts you with them on your next visit. Some patients, Baker said, could get "bent out of shape" over the online snooping.

"This is not something we’re recommending be done all the time, but only in rare situations," Baker said.

The research, performed by Baker and two colleagues, contends that professional medical societies such as the Federation of State Medical Boards (FSMB) and the American Medical Association (AMA) are responsible for developing search engine guidelines.

While medical societies have developed "general" guidelines on appropriate Internet and social media use, they have yet to address patient-targeted Web searches.

The FSMB did not reply to a request for comment from Computerworld. The American Medical Association declined comment, saying the issue has "not been resolved by the AMA."

Other health professionals have urged caution with patient-targeted Googling. The American College of Physicians (ACP) and the FSMB have encouraged physicians to consider the intent of an Internet search and how it might affect ongoing patient treatment. The organizations also encouraged healthcare workers to document online search findings with implications for ongoing care.

Daniel George, an assistant professor of medical humanities, and Gordon L. Kauffman, a professor and vice chair of surgery, both at Penn State College of Medicine, co-authored the research paper.

In all, the Penn State research paper recommends Googling patients in 10 situations, including the obligation find a former patient to warn them about possible future issues as new information arises.

The paper also says it's appropriate for doctors to Google a patient to find evidence of doctor shopping, or visiting different doctors until a desired outcome is acquired. If a patient is evasive to logical clinical questions being asked by their physician, that too is Google appropriate.

This story, "Sometimes it's ethical for the doctor to Google you" was originally published by Computerworld.

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