Interesting thread from the Sermo boards (needs registration to view).
A physician suggests using Google to find out more background about difficult patients. What are the ethical and HIPAA implications here?
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{ 14 comments }
If I can find it with google, it’s in the public domain.
HIPPA doesn’t apply (to me, it might apply to whoever put it in the public domain).
And as far as ethical questions, anything that tells me more about my patient is a good thing – for the patient.
I just wish I had time to look them up, but in the ED….
I’d agree with anonymous above – as long as the docs aren’t the ones PUTTING patient info online, accessible by Google, they wouldn’t be violating HIPPA, no? Whoever put it there to begin with may have, true – in that case, I would justify using the information to help the patient because A) It’s already out there through no fault of my own, and B) I’d feel ethically obligated to use all available information to help patients under my care.
A problem I can think of: How to be sure that John Markson you found on Google is the John Markson in your ED? Very few people have a completely unique name, so unless they have very identifying characteristics and one can be quite sure you’ve found information relating to the same individual, this might not be very helpful at all.
though ubiquitous – difficult patients, may not be famous or notorious enough to be “google-able”; but if they’re that notorious to be googled, i have no problem using information in public domain, however i see fit
this capability is what opponents of EMR’s are afraid of – and harp on HIPPA and privacy cover; somehow when there are “single” payors, eg. Medicaid, for certain population’s services, eg. prescriptions, some tabs are kept within state, that alerts are issued to pharmacies regarding utilization; but abusers still would offer to pay cash for prescriptions they obtained by doctor shopping; this was a big problem in the VA for travelling veterans who get meds from 1 VA to the next, until computerized records were maintained, the vets could not get meds for non-veteran spouses any longer; this really got a lot of vets m-a-d; still there are those who are able to game this system between clusters of VAs; it would perhaps be totally quashed if there gets in place nationwide, totally compatible and communicating information systems; perhaps in next century or when there are no more greedy pharmacies who will sell prescriptions out of plan[s] as long as the customer will pay cash!
There’s a bit of a paradox here.
The physicians who would google to find a patient with negative characteristics is the type who will be more upset at having an unpleasant patient that fails the “google test.”
So googling is more of a test of the googler than the googlee.
..and why would you want to google your patient? What could you learn that could be useful or relevant to the treatment? I suppose if you learn of a criminal tendency, that might be something, but what if all you learn is something that doesn’t affect their healthcare?
I don’t think the rewards can balance the time needed to research the patient.
It is good to know if someone has a history of fraudulent, violent, or substance abusing behavior.
I am sure some sick people would have a hard time getting care were it easy to do so, but if the information is available and helps me do my job better as a physician, secure my personal safety as a human being, or protect my assets for my family, then I would be irresponsible to fail to seek use it.
problem I can think of: How to be sure that John Markson you found on Google is the John Markson in your ED?
ITA.
I have a fairly common last name, and a first name that is common in Russia, but relatively uncommon in the US except among Russian immigrants. But to an American my first name sounds rare, so I’d imagine if you find my name on google you’d think it is me.
Out of curiosity I did just that. I have a couple of published papers, so there are a few immediate hits for conference proceedings. But a couple of pages later, there is some girl with exactly the same name who is listed as a TA for a course in my field. It could’ve easily been me 20 years ago, except for the hit is from 2002 and for a class I’ve never TAd. Then, there is somebody with the same name who signed some petition for Bush – the last thing I am likely to do.
Thankfully there are no hits to worry about, but one never knows.
Interesting dilemma – bypassing HIPPA.
Very strange subject. Disagree completely with the comment that “anything that tells me more about my patient is a good thing — for the patient.” Suppose you’re staunchly conservative and pro-life, and your little Google dance turns up suggestions that your patient favors abortion rights. Now you’ve got a conflict that never needed to be there.
Any info you need should be in the medical record. No reason to go anywhere else except out of voyeurism.
This is silly. When I google my own name, page after page comes up. None of these people are me.
So, if you google someone and find them to be undesireable then you are going to make the assumption that this is your patient when it very well may not be? This is dangerous and if you have time to google all your patients and read everything you find that most likely isn’t even about them then surely you have time to call “next patient” rather than keep a full waiting room waiting for hours on end.
It is ethically no different than hearing rumors and stories about people in the community, from other patients, etc and then having them come to your office for care. As a physician, you have a deep appreciation for the full range of human character, lifestyle, opinion, etc and, unless you are disqualified by an excess of judgementalism for the profession, are not perturbed by it excess where it impacts the illness and your treatment of it. You also have the good sense to consider everything you hear and read about people to be of questionable reliability and possibly blatantly untrue.
I can’t imagine anyone who isn’t a psychologically impaired physician letting a patients political opinions affect him. The idea that everything you need to know is in the medical record is absolutely silly. Nothing is in the medical record until a profesional discovers the information and puts it there. You need to know if someone is a habitual liar or prescription drug abuser, you need to know if someone is reliably compliant or self-destructive in planning treatment. How many people come in and announce that they have Munchausen’s? That they have a history of insurance fraud? That they have prior convictions for forging prescriptions. Google is not a good way to find out these things but in principle, the the usage of collateral sources of information when they can be found is good medicine. Limiting your history to what is already in the medical record is substandard care without seeking to extend, add to, and access the accuracy of the history is sloppy sloppy medicine.
As a private investigator, I’d never ‘google’ a person anyway – what a waste of my time! Docs, stick with what you know best – MEDICINE and leave the investigations to those of us trained to do so.
It never hurts to follow your gut feelings about your own safety, however – if a patient ‘feels’ like a baddie, they quite likely are. You ARE the most educated bunch around, use your marbles. If in doubt, call a PI!
Or better yet, TALK to the patient and LISTEN to the patient. What is a ‘difficult’ patient to one doctor may be the one who makes the next doctor laugh and brightens his day! I’ve seen it.
So, pull up your britches, boys, your paranoia is showing.
except they use Google local search (not Google on the web) installed on their intranet site to find their employee data..
If problem patients zare such a big issue in this new p4p world, why not start an anonymous site called, http://www.ratethepatient.com instead???
The domain is there.
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