I remember when I first looked up a patient on Google. It was my last day on the bone marrow transplant unit, back when I was an intern. As I stood before the patient, taking her history, she told me she had been a painter and suggested I look up her work on the Internet. I did, and I found her paintings fascinating. Even though our paths crossed fleetingly, she is one of the few patients I vividly remember from that time.
Google has taught me other things, too, things that don't come up during the routine history-taking or medication checks of my usual doctor-patient interactions. I learned recently, for example, that one of my patients had been an Olympic gold medalist and world-record holder in the 1960s. Knowing more about my patients as people helps build empathy.
Doctors do "Google" their patients. In fact, the vast majority of physicians I know have done so. To my generation, using a search engine like Google comes as naturally as sharing pictures of our children or a recent vacation on a social networking site like Facebook. But it surprises me that more physicians don't pause and think about what it means for the patient-doctor relationship.
What if one finds something that is not warm and fuzzy? I recently read about a case in which a 26-year-old woman went to a surgeon wanting to have a prophylactic double mastectomy, citing an extensive history of cancer in her family. However, she was not willing to undergo any work-up, and her medical team noted several inconsistencies in her story. When they searched online, it turned out she had set up multiple Facebook accounts soliciting donations for malignancies she never had. One page showed her with her head shaved, as if she had already undergonechemotherapy. The surgeons immediately decided to halt her care.
I was once taking care of a frail, older patient who came to the hospital feeling very short of breath. It wasn't immediately clear why, but her breathing was getting worse. To look for accidental ingestions, I sent for a drug screen and, to my great surprise, it came back positive for cocaine. It didn't make sense to me, given her age and the person lying before me, and I was concerned she had been the victim of some sort of abuse. She told me she had no idea why there was cocaine in her system.
When I walked out of the room, a nurse called me over to her computer. There, on MugShots.com, was a younger version of my patient's face, with details about how she had been detained for cocaine possession more than three decades earlier. I looked away from the screen, feeling like I had violated my patient's privacy. I resumed our medical exam, without bringing up the finding on the Internet, and her subsequent hospital course was uneventful.
I am tempted to prescribe that physicians should never look online for information about their patients, though I think the practice will become only more common, given doctors' — and all of our — growing dependence on technology. The more important question health care providers need to ask themselves is why we would like to.
To me, the only legitimate reason to search for a patient's online footprint is if there is a safety issue. If, for example, a patient appears to be manic orpsychotic, it might be useful to investigate whether certain claims the patient makes are true. Or, if a doctor suspects a pediatric patient is being abused, it might make sense to look for evidence online. Physicians have also investigated patients on the web if they were concerned about suicide risk, or needed to contact the family of an unresponsive patient. In my state, Massachusetts, doctors can also use a specialized database to track every pharmacy a patient took controlled drugs from — an especially useful tool when drug abuse is suspected. But if the only reason a doctor searches online is to gather personal information that patients don't want to share with their physicians, then it is absolutely the wrong thing to do.
Recently, one of my primary care patients was back in clinic, with some worrisome news. In spite of increasing the dose of his medication, his panic attacks were getting worse. He had told me that as he saw his business success grow, so did his stress, and the frequency of his panic attacks.
I stepped out of the clinic to speak with my supervising physician. I related the patient's history, telling him about the growing success of the patient's business.
"What sort of business?" he asked. When I told him that I had forgotten to ask, he quickly flipped the window on the computer before us from an electronic medical record to Google and typed in the patient's name.
But before he pressed return, he paused.
This was unusual — most doctors I know don't pause. Then, with the cursor blinking before us, he pressed the backspace key, keeping it pinned until there were no more letters for the cursor to gobble up. And he proceeded to do what has worked for physicians for eons. He sat down next to the patient and asked.
Haider Javed Warraich is a resident in internal medicine and Katherine Swan Ginsburg Fellow in Humanism at the Beth Israel Deaconess Medical Center in Boston and author of the novel "Auras of the Jinn."
http://well.blogs.nytimes.com/2014/01/06/when-doctors-google-their-patients-2/
