SAN ANTONIO – Your patients are likely "Googling" you; is turnabout fair play?

The question is a popular one these days. A quick Internet search reveals numerous articles, editorials, and blog posts on the topic. Some authors focus on potential positive aspects of the practice, while others decry it as unethical.

Attendees at an interactive session on "Professionalism and Psychiatry in the Online and Digital Age" held during the annual meeting of the American College of Psychiatrists were similarly divided. One admitted to Googling a patient to verify whether stories the patient told were true or were evidence of grandiosity. Others said they could see value in learning information about a patient that they might not otherwise know.

Another knew of a program where routine Googling of patients was expected.

Some said it’s best to avoid the temptation altogether – that obtaining information online about a patient can be harmful to the therapeutic relationship.

Most agreed there are important ethical implications to consider.

It will take some time before the ethical – and legal – implications of Googling and other online and digital activities are defined and standards established, but one of the session leaders, Dr. Sandra M. DeJong of Cambridge (Mass.) Health Alliance recommended an article from Harvard Review of Psychiatry as an excellent resource for decision-making about Googling patients.

In the article, entitled "Patient-Targeted Googling: The Ethics of Searching Online for Patient Information," Dr. Brian K. Clinton of McLean Hospital, Belmont, Mass., and his colleagues acknowledge that "the Internet has changed the way that medicine and psychiatry are practiced, as patients and physicians now routinely search online for medical and personal information," and they believe that patient-targeted "Googling" – a term they consider to be synonymous with "Internet searching" – is "widespread and deserving of professional and ethical consideration."

While the practice occurs among all types of physicians, it is "especially complicated in a relationship between a patient and a psychiatrist (or other mental health clinician)," they wrote, explaining that what they referred to as patient-targeted Googling, or PTG, has the potential to enhance or interfere with processes inherent in therapeutic relationship (Harv. Rev. Psychiatry 2010;18:103-12).

In some cases, a search can garner useful information. An example involves a case in which collateral information obtained aided in the safety assessment of a suicidal patient in an emergency room. Conversely, ethically problematic motivations for PTG might include curiosity, voyeurism, and habit – and these motivations can result in behaviors that would be considered boundary violations in another setting (for example, Googling a patient’s address and viewing a photograph of her home, which might be analogous to driving by her house).

"Before searching online for patients, psychiatrists should consider the intention of the search, its potential value or risk to the patient, and the anticipated effect of gaining previously unknown information. The psychiatrist is obligated to act in a way that will respect the patient’s best interests and that adheres to professional ethics. However, the results and the potential danger of PTG are not always intuitive or consciously available prior to searches," they wrote.

To aid in the decision making, they propose a pragmatic model for "considering PTG that focuses on practical results of searches and that aims to minimize the risk of exploiting patients."

The model, which provides an approach to clinical ethics that specifies core values that should be balanced in patient care – specifically, the psychiatrist should focus ethical deliberations on the results of the decision both for the patient in question and on general moral principles.

"The psychiatrist must consider how PTG would affect the treatment relationship and the progress toward treatment goals – a thought process that may involve discussions with the patient, the patient’s family, and a clinician’s community of supervisors, colleagues, and consultants," they said.

The model urges clinicians to – at the very least – consider the following six questions on a case-by-case basis before searching online for a patient:

• Why do I want to conduct this search?

• Would my search advance or compromise the treatment?

• Should I obtain informed consent from the patient prior to searching?

• Should I share the results of the search with the patient?

• Should I document the findings of the search in the medical record?

• How do I monitor my motivations and the ongoing risk-benefit profile of searching?

If the answers to these questions suggest that patient-targeted Googling would not serve a particular patient’s best interest or that PTG would not promote the therapeutic process, the psychiatrist should not go forward with the search, the authors said.

Dr. DeJong reported having no disclosures. Dr. Clinton and his colleagues also reported having no disclosures.

Patient-targeted Googling: Consider patients’ best interests