Should doctors ever Google their patients?

I recently read an article in the New York Times titled “When Doctors ‘Google’ Their Patients,” which details one physician’s thoughts on whether or not doctors should look up their patients on the Internet.

What struck me was the fact that despite growing up with the Internet and being able to find information about practically anyone using Facebook, LinkedIn, Google, or Instagram,  I have never once been tempted to find out more about my patients online. For me, our relationship was one that was contained within the confines of the hospital, and I never thought to “double check” on anyone’s history after the initial patient interview.

But this article made me think, are there circumstances in which I should Google my patients, to better patient care?

The most obvious cases I can think of for Googling patients are one in which the doctor suspects that the patient is lying to abuse the healthcare system. Malingering is intentionally faking illness for secondary gain, whether it is to get time off work, narcotics, disability insurance, avoiding jailtime, etc.

The article’s author shared a story of an elderly female patient he took care of whose drug screen came back positive for cocaine. She denied drug use, but then a quick Internet search revealed that she had been detained for cocaine possession decades earlier. The author doesn’t go into specifics but I imagine this could change how he approaches the patient’s narcotics regimen or how he speaks to her about drug cessation.

Then there are those with factitious disorder, where patients fake being sick in order to play the patient role. I have heard stories about patients who secretly ingest feces in the hospital, inject themselves with insulin, contaminate their central lines, or intentionally cut themselves in order to stay in the hospital and get treated for self-inflicted injuries. These red flags should be in the medical record, but sometimes these patients are not easy to track down and it is painfully hard to get outside hospital records depending on where you work.

recent news story uncovered a man in Washington who faked work injuries under multiple names and social security numbers to repeatedly obtain Vicodin, Percocet, and other powerful painkillers.

A field that I think Googling patients can sometimes be helpful in is psychiatry. In some of these patients, an accurate history is difficult to obtain, and if someone has an extensive history of suicide attempts, there may be more than meets the eye. The Internet may uncover additional information that may add to the story behind the complex psychiatric pathology that the patient suffers from.

This is a slippery slope though, because I can also foresee instances in which a physician uncovers something he or she doesn’t like or has an implicit bias against in a patient. In these cases, what the physician discovers on the Internet may alter his attitudes towards the patients and even negatively affect patient care. (Although physicians everywhere, especially at county hospitals, do take care of patients in jail, and what I’ve been taught is to not ask about the crime(s) committed). I think it is important in today’s day and age, with technology so accessible and so very revealing, for physicians to remember to treat patients to the best of their ability.

All in all, I think physicians should be wise in choosing to look towards the Internet for more background information on patients. If a doctor suspects something fishy is going on, or that medical care is being hindered by lack of information, then perhaps it isn’t such a bad idea to ask Google for a few more details.

Joyce Ho is a medical student who blogs at Tea with MD.  She can be reached on Twitter @TeawithMD.

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  • guest

    Actually, in psychiatry, the gold standard for getting information on a patient who is too ill to provide a history is to contact their family. Contact with family members without a signed release is permissible in an emergency, which for psychiatric patients includes situations where there is any reason to be concerned that the patient is a danger to himself or others, or unable to properly care for him or her self. Checking local law enforcement databases is also sometimes helpful, but usually not nearly as helpful as tracking down a family member and speaking to them.

    • DoubtfulGuest

      I think it’s okay to do whatever you need to do to find out if a patient has a history of violence. You all have a basic right to personal safety and you have to get much closer, risk wise, than most of the rest of us do.

      As far as contacting family, I’m concerned about potential abuse/domestic violence situations…how does a doctor know if spouse/parents/siblings are telling the truth about a patient?

      • guest

        Could you be more specific and describe a scenario in which that would be a concern? Most of the patients I am talking about are visibly ill, we just need more specific information about their history, responses to medications, medical conditions we need to be aware of, etc. The most common domestic violence scenario we encounter involves the patient having been aggressive towards family.

        • DoubtfulGuest

          Your questions all sound okay and reasonable. Maybe it wouldn’t be a problem after all? I just wondered if “family” is the patient’s identified next of kin in their records, or if the patient is sick enough, the contact info is found through a Google search or similar means? For example, if a patient is estranged from an abusive spouse or parent, but their names would come up together in a Google search? On the surface that person may seem like the right one to contact, but it may actually be a friend, cousin, or someone else with whom the patient is safest and who could give you accurate information?

          • guest

            We typically don’t ever google to find the name of next of kin, that information is generally in our records or the patient is able to provide it.

            Also, again, could you describe a situation in which it would be harmful to a patient to have a family member from whom they are estranged, contacted for basic information?

            If a person reports that they are involved in a domestic situation where they are being abused, we usually don’t contact that family member.

            Also, I think the public may have a very dramatic view of the prevalence and nature of abuse/violence in the psychiatric population, at the least among the severely mentally ill. There is no doubt that many people with mental illness are victims of domestic violence and abuse; however, in the vast majority of cases that I see, the abuse took place many years ago in the patient’s childhood; current abuse is much more likely to have occurred in jail or prison than in the patient’s home.. Again, the most common abuse situation I see in my patient population is that the patient himself or herself is aggressive or threatening towards an elderly/frail parent.

            In terms of family members who are “psychologically abusive” a popular term these days, we use a little common sense. Even a “psychologically abusive” parent can provide basic information such as whether the patient has been hospitalized previously, or was recently seeing a psychiatrist. In situations where we suspect that a family member may be giving us falsified/ negative information about a patient, we contact other family members to develop a more complete picture of the family situation.

            I guess I would also point out that in the type of situation I think you might be thinking of, like “Sleeping with the Enemy” where an abused wife is hiding from her husband, that type of patient is generally cooperative, coherent and suffering from types of illnesses (depression, PTSD) where it’s less important to get collateral from family. Most importantly, the patient is usually voluntarily seeking help in which case, unless we suspect they are faking symptoms to get shelter or social services, we don’t contact family for information.

          • DoubtfulGuest

            Having never seen “Sleeping With The Enemy”, I had no preconceived notions about prevalence. I also didn’t mean to put you on the spot about your own patient care responsibilities. I thought the issue might be relevant for any doctor who reads this post, conducts a search for information on a patient and then decides what to do with that information. You alleviated most of my concern by telling me the kinds of questions you ask in these situations. Doctors can only do so much in the time they have, especially regarding patients’ psychosocial difficulties. You address another of my concerns by clarifying that you ask the next of kin identified to you by the patient, not by a Google search. This allows the patient to tell you with whom they have a primary relationship, instead of Google or law enforcement records showing the name of spouse or closest biological relatives. I wasn’t sure if all your patients are incarcerated, or only some of them? If it’s the first, then I can see how my questions might be inappropriate.

            You have a point about “psychological abuse”. As far as I know, this became a pop culture phenomenon in the late 90’s, when I was an undergrad? An unfortunate side effect of abuse and domestic violence being less taboo topics, was for many to go around claiming that a loved one forgetting a birthday or slightly raising their voice, was akin to “emotional battering”. On the other hand, I feel concerned that generally accepted examples of psychological abuse (name-calling, shame-based discipline) are still common practice in medical training. Previously, we’ve not seen eye to eye about what’s an appropriate distribution of attention on people or issues…I may not come across well, sometimes. My interest in minority experiences, so to speak, is to help me understand issues more completely and also to see if I can help someone. For example, I’m interested in doctors who are struggling financially. Even if there were only four or five scattered over the country, I’d want to know how many, and why this is happening to them.

            I can’t think of one complete scenario, actually. You’re right that most people who have an unsafe domestic situation would be able to give you the information you need. I’ve noticed different degrees of personal disclosures on this blog, and I’m honestly not sure what’s appropriate. I think one typical feature of abuse is isolation from others? This could include giving inaccurate information to anyone outside the family or limiting a patient’s access to medical care. This could happen to children, like you say, or to adults who are not fully independent. Like Munchausen’s in reverse? I don’t know…My own experience with this is long past. It didn’t involve a psychiatric emergency, so it’s not the best example. I’m concerned this sounds a little dubious, so maybe I should add that I’m referring to a mitochondrial disease with a probable genetic basis. There’s a strong family history of psychiatric illness and it’s not yet known how that all fits together. I just had this gut response when I saw your comment, that contacting family might pose a danger for a few patients. It sounds like you’re prepared for a variety of scenarios and I appreciate your thoughtful response.

  • DoubtfulGuest

    I appreciate your careful assessment of these issues so early in your career. I was accused of malingering based on no evidence of faking, and a serious disease was missed for a long time. I have some reason to believe that one doctor involved did a Google search on me. On the other hand, I doubt he had time to do so.

    It was weird…I had a diagnostic procedure (normal — as is often seen with the disease I turned out to have). The doctor was present for the whole test, which gave us the opportunity to talk quite a bit. He asked me questions at 90 miles an hour for 45 minutes straight. In a way, it seemed nice, like he was trying hard to figure out what was wrong with me. At the same time, it felt like a police interrogation. I’ve never been in trouble with the law, but I’ve seen stuff on TV. It especially seemed like he was trying to make me fatigued with the rapid fire questioning. Given the disease I turned out to have, it’s very easy to make me tired, so that shouldn’t have been a strike against me. He asked me the full name of the person with whom I was in a relationship at the time, and other stuff that sounded like maybe a Google search in the works.

    When I search for my name, I find only my professional stuff. Nothing unsavory. No duck faces on social media, even. There are a few other people with my not-very-common name. Still, I’m concerned that the malingering assumption might have been based on something someone found back then. I have no opportunity to defend myself, or refute the accuracy of any information, because no one will tell me anything.

    My concluding thoughts:

    1) Anyone can Google anyone, but should they?
    2) How do you know the information is accurate?
    3) Should you tell the patient what you found?
    4) Might a Google search lead to an adversarial relationship? (i.e. Why don’t you just talk with the patient?)
    5) Where do the search associations end? e.g. if the patient has a relative who committed a crime, do you hold that against the patient herself?
    6) How qualified is the doctor to evaluate information turned up in a Google search?

    This comes down to how qualified is a doctor to assess a patient’s character at all? Not very, in my experience. You all need to be really conscientious about this or you can hurt someone badly. Thanks for your thoughtful post.

  • John C. Key MD

    The essence of practicing medicine holistically is to know all relevant aspects of a person’s life. Google information is after all already public, and if it is helpful in “rounding out the picture” it is hard to see where the problem is.

    • querywoman

      You are absolutely right. See my post above. If you have the time and want to do it, do it! You sound like you really want to know your own patients.

    • DoubtfulGuest

      You have a good point, about the information being public already. If a doctor approached the search with the right attitude, I suppose I’d appreciate that s/he took an extra minute to learn about me. My concern is the time constraints on our interactions. Doctors are under pressure to sort of put us under the microscope and judge the most personal aspects of our lives without ever really getting to know us as human beings. Some of you treat us with dignity and respect despite these constraints. Since you’re people, too, you can’t be 100% objective. The post gave examples of Google searches for suspicion of malingering. My concern is that the time constraints + a doctor’s personal experiences/biases + incorrect information could be disastrous for a patient. Just like with patients consulting Dr. Google, information literacy is crucial for doctors. Consider the source of information you find and be prepared to cross-check for accuracy.

      • querywoman

        DoubtfulGuest, people simply aren’t aware of how much info is available on the net. ZabaSearch and Spokeo have tons of info, compiled from freely available public info.
        Some people are just shocked that stuff like their home address and home value is available from a property tax roll. I think the reason property tax records are public is that what you do on your property might affect your neighbor.
        I took a noncredit course on how to find out anything about anyone before the net became so popular.
        Perhaps Dr. Key has his practice fixed where he can take some real time to get to know his patients.

  • querywoman

    What’s on the web is public info. Let ‘em google me. I google them.
    If they have the time, it’s fine with me. Of course, I usually post anonymously.
    I was livid when I saw my nonpublished number on the net that I had paid for years to keep private. I now have VOIP, and can keep my phones very private.
    A lot of people aren’t aware of just how public everything is now. You can tell sites like Spokeo to limit your info.
    I left a state welfare job in 2001. In my last few years, we increasingly relied on internet sites to verify info. Example, a woman gave me a note that claimed a child lived with her. I looked up the address of the person who allegedly signed the note on the county tax roll and it didn’t exist.
    After that, I worked for the IRS briefly. My IRS coworkers were used to extreme anonymity. They had no idea how much public info is on the net,
    Personal income tax records are confidential info. Property records, driver’s license, etc., are public info. Some states put more on the net than others. Don’t expect your state to protect your info well. The State of Texas sold too much of its vital statistics info to two companies. There was way too much info on Texans on the net, like birth days and parent names. It was too easy to get enough info like a mother’s maiden name and enable ID fraud.
    Fortunately, most of that info has been taken off now. I can still get a lot of info if I push into it because I know how to search.
    Texas still has more than any other public info on the net. I think the voter rolls are more protected now. I would have to go to the courthouse to see the most recent voter records, which is kind of hard for someone on the other side of the world.