Ethics Case Quiz
If we were to conduct a survey of readers’ responses to the quiz that follows, we would likely find a marked generational divide between those who believe that “patient-targeted Googling” is just another form of collateral information and those who think that Googling is just a new type of boundary crossing.1 The etiquette and ethics of the electronic revolution have been styled “digital professionalism,” and it is a field in flux as we see when we analyze the case consultation from the October 2016 issue.2
The case presented a mid-career psychiatrist, Dr. R, with a predominantly psychotherapy practice who is treating Ms B, a woman in her thirties who purports to have been a famous academic musician until she unjustly lost her career after a student accused her of sexual misconduct. Initially, the psychiatrist believes the patient is suffering from an adjustment disorder, but as the sessions proceed he begins to doubt the patient’s narrative. His best efforts to engage Ms B in more critical reflection on the events, or even offer up more factual details, fail. He entertains the idea of Googling Ms B to find out what really happened—ostensibly to move the stalled therapy forward. But first he seeks advice from his former psychology professor, who assures him that there is nothing unethical about the practice.
The quiz asks you to think about whether you agree with the professor’s advice and how in your own practice you would handle information about a patient obtained from an Internet search.
1. Assume you are the psychology professor. What do you tell Dr. R about the ethics of “Googling” Ms B?
Option A: Go ahead and Google; the Internet is public domain. This is one of the most common reasons or rationalizations—depending on your perspective—in favor of Googling a patient. It is technically true that the Internet is mostly public domain, but this assumes that the person conducting the search is “the public” with the prevailing mores and morals of their society and not a mental health professional who many ethicists believe should be held to a higher standard of conduct.
Option B: Don’t Google the patient; it’s a violation of HIPAA. This is often used to mechanistically intimidate practitioners into not Googling, although the psychiatrist is technically not “exchanging information” in that he is not disclosing any protected health information about the patient. But this reflexive turn to HIPAA shows the ambivalence of many who contemplate Googling, yet who instinctively believe it is intruding on a patient’s privacy or who fear the legal consequences of a violation.
Option C: Don’t Google the patient; it is a breach of the patient’s trust in the therapeutic alliance. This is the answer of many older psychiatrists as well as those who have strong psychoanalytic training or orientation. How and when the patient reveals her psyche in the therapeutic relationship is at least as significant as what is revealed, and taking such a shortcut betrays not only the patient’s trust but the integrity of the process.
Option D: Don’t Google the patient; instead search the major newspapers from the city where Ms B purports the events occurred. This raises a fascinating question. How is Googling ethically better or worse than searching the newspapers, the latter inarguably being public domain? Ask yourself if you picked up the morning New York Times and found a story about one of your long-term patients: would you read it, or would you first ask the patient for her permission? A survey published this year found that nearly 40% of psychotherapists had searched online for information about a patient, especially when—as in the case of Ms B—they felt they had been deceived. About the same percentage knew or supervised someone who had engaged in patient-targeted Googling.3 Earlier surveys that focused on psychiatrists found similar percentages.4 One study found that 60% of psychiatrists questioned in New York believed that patient-targeted Googling could be constructively utilized in psychiatry.5
Dr. Geppert is Professor of Psychiatry and Director of Ethics Education, University of New Mexico School of Medicine; and Chief, Consultation Psychiatry and Ethics, New Mexico VA Health Care System, Albuquerque, NM. She reports no conflicts of interest concerning the subject matter of this article.
1. John NJ, Shelton PG, Lang MC, Ingersoll J. Training psychiatry residents in professionalism in the digital world. Psychiatr Q. October 2016; Epub ahead of print.
2. Geppert C. To google or not to google? This is the question. Psychiatric Times. October 2016;33:57, 58.
3. Eichenberg C, Herzberg PY. Do therapists google their patients? A survey among psychotherapists.J Med Internet Res. 2016;18:e3.
4. Koh S, Cattell GM, Cochran DM, et al. Psychiatrists’ use of electronic communication and social media and a proposed framework for future guidelines.J Psychiatr Pract. 2013;19:254-263.
5. Deen SR, Withers A, Hellerstein DJ. Mental health practitioners’ use and attitudes regarding the Internet and social media. J Psychiatr Pract. 2013;19:454-463.
6. Genes N, Appel J. The ethics of physicians’ web searches for patients’ information. J Clin Ethics. 2015;26:68-72.
7. Clinton BK, Silverman BC, Brendel DH. Patient-targeted googling: the ethics of searching online for patient information. Harv Rev Psychiatry. 2010;18:103-112.
8. Ethics Committee of the American Psychiatric Association. Opinions of the Ethics Committee on the Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry. Arlington, VA: American Psychiatric Association; 2016.