Confidentiality
Electronic communication is not confidential: it is viewed by others (eg, hospital IT staff, the company that owns the software); remains accessible on servers (despite the terminology “in the clouds”); and is subject to copying and pasting, forwarding, hacking, leaking, human error, and professionalism lapses. HIPAA prohibits the release of patient information without the patient’s written consent.7 Thus, detailed information about patients should never be posted online.2
Conflict of interest
Psychiatrists often play multiple roles; they can be clinicians, researchers, published authors, advocates, teachers, board members, or investors. These roles can easily come into actual or potential conflict, and when they do, such conflicts need to be explicitly disclosed. Endorsing a book on Amazon.com to which one has contributed a chapter, soliciting online donations for a patient advocacy organization without identifying oneself as a member of the agency’s board, or blogging a treatment recommendation when one owns shares in the company that produces the treatment all represent conflicts that need to be revealed.2
Mandated reporting
Although state laws vary, psychiatrists are often legally mandated to report potential harm to patients and vulnerable populations, such as children and the elderly. The availability of patient information through online searches and social media opens the door for greater knowledge of threats to patient safety. However, where the responsibility to report begins and ends is unclear. For example, a child psychiatrist who looks up a teenager’s Facebook page outside of a session and discovers alarming content about potential statutory rape or parental abuse is left with the dilemma of whether to contact child protective services.
In general, unless the situation is an emergency, the psychiatrist would do well to discuss the discovered content with the patient to verify the content. He also needs to discuss the clinical decision to look at the site, because such an act may be perceived as voyeurism.
Privacy
The personal information of psychiatrists and patients, from sexual orientation to political affiliation to real estate assets, can be easily found online.8 Psychiatrists should expect to be Googled by patients and need to be prepared to respond when patients have questions about information found online. It is critical to avoid posting any personal information online that you would not want a patient to see.
Whether psychiatrists should Google their patients is a complicated question. In general, psychiatrists should only conduct online searches about patients when, after careful thought, they feel they are driven by the need to help the patient (as opposed to curiosity or voyeurism) and are clear about necessary consent and what they will do with the information once they have it.9
Libel
False written comments about a person that are stated as fact and lead to harm for that person constitute libel. The definition does not preclude online communication.10 Thus, psychiatrists should avoid making derogatory comments about others online. Online physician rating sites as well as sites such as Yelp and Angie’s List offer patients the opportunity to provide online reviews, and disgruntled or unwell patients may post comments that psychiatrists feel are inaccurate. If the psychiatrist feels the content is truly harmful, he should obtain legal advice.
“Netiquette”
Electronic communication can be unprofessional not only by virtue of its content but also by virtue of its form. Tone, word choice, and punctuation should be professional. For example, notice the difference between “MEETING TODAY AT 2 PM. BE THERE OR ELSE!!!” and “Reminder: Meeting today, conference room. Important agenda attached.” Although the content of the messages is the same, the threatening tone and inappropriate use of all capitals and exclamation marks makes the first message unprofessional.
Using electronic media to vent is never appropriate. When affectively “stirred up,” psychiatrists should pause before sending a message—sensitive conversations should almost always take place in person. Finally, electronic messages are easily disseminated. Before adding a “bcc” or hitting “Reply to all” in an e-mail, or “retweeting” to multiple recipients, think twice and respect the boundaries of confidentiality and professionalism.11
