The Other Exam Room: When Doctors 'Google' Their Patients

theodp writes "Writing in the NY Times, Dr. Haider Javed Warraich shares a dirty little medical secret: doctors do 'Google' their patients, and the practice is likely to only become more common. And while he personally feels the practice should be restricted to situations where there's a genuine safety issue, an anecdote Warraich shares illustrates how patient search could provide insight into what otherwise might be unsolved mysteries — or lead to a snap misdiagnosis: '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.'"

"feeling like I had violated my patient's privacy"

[east coast]

Why would he feel that way?

To me, if a doctor can find something about a patient without going to crazy lengths to do it then he shouldn't feel bad about it. It would be like me telling my doctor I've given up smoking and he sees me smoking in front of my local Starbucks a month later. On my next visit should he really ignore that I'm smoking again or should he ask about it or come outright and say "I caught you in the act."

Granted, I'm an adult and I can decide but for medical guidance to be accurate and worthwhile you have to be honest with your doctor and his pointing out the embarrassing truth might be what it takes to get a patient to straighten up and fly right.

Re:So....

[Vitriol+Angst]

I feel more confident in a Doctor having more information than a for-profit insurance company -- which already KNOWS MORE than the doctor in many cases.

Re:"feeling like I had violated my patient's priva

[Lemmeoutada Collecti]

Just remember as you say things like that, the doctor doesn't work for you. He works for the insurance company, the one who is paying him and with whose policies he either complies or goes unpaid. It's been a long time since the doctor was really in charge of his practice.

Hmmmm ...

[gstoddart]

Wouldn't doctors googling their patients essentially violate HIPAA rules?

Because you've now let the fact that you are a doctor treating a specific patient bleed out around the corners, and since Google is keeping track of who you are and what you searched for, they know it too.

Unless you are doing this in such a way that you can guarantee you're not causing patient confidentiality to be breached (which Google sure as hell isn't), I'm of the opinion you've demonstrated a lapse in ethics, and a breech of the law.

And, even if you search in a manner you know was anonymous, if those searches come from something which is identifiable as being the anonymous search of doctors, the content of those searches can still leak information out.

Because when Google see that Dr. Joe Quack has searched for Bob Skippy Smith followed by a quick refresher on the symptoms of herpes .... Google knows (or can infer) that Bob Smith has Herpes.

Doctors are not information theorists, and quite possibly not well educated enough about this technology to be using it in conjunction with their medical practice. Because clearly, if they understood this a little better, they'd realize they've more or less violated their ethics (and possibly the law) by doing this.

Doctors Googling their patients is a terrible idea, and has every possibility of violating the privacy of the patient, as well as the laws meant to protect it.

Re:So....

[gstoddart]

... adoctor will fondle and touch and examine your most intimate body parts, yet they shouldn't look at publicly available information? STUPID.

Except when doctors look at this publicly available information, the fact that they looked at it also becomes information which, while not publicly available, is still available to Google and, by extension, the government. Because the search engine knows who did the search (possibly exactly who if you're logged in) and where it came from.

The simple act of the search allows someone to say "this doctor's office looked for this person, and they also looked at this information". You don't think big data can't then determine that "this person has that condition and is being treated by that doctor"?

And then you've violated HIPAA laws and your obligation to patient confidentiality.

Unless you can prove no 3rd party could glean information from you doing that search (and I assure you, the doctors can't), you pretty much have to assume that someone actually could.

Which means the default position here has to be "no, you can't do that". Because it has more potential to cause harm than people realize.

Re:"feeling like I had violated my patient's priva

[MozeeToby]

Wait, so this doctor now knows that his patient has a decades old history of drug abuse, at least one near overdose, and the rest of her stay was uneventful and he never brought it up... Am I the only one who says "WTF" to that? That seems like a much, much larger failure on the part of the doctor than googling a patient.

Re:Patients Lie

[Anonymous Coward]

If she tells her doctor, the topic may end in his records, and be mentioned on the phone. State authorities steal medical records and break into confident communication. She'll likely not survive getting "busted".

Why the fuck should she put the rest of her life on the line to make her doctor happy? It's probably bad enough as it is with the tests being on medical record.

Re:It's the sign of our times

[Johann Lau]

Well, fuck that guy, and all the other hypocrites parroting similar views. Either mankind is doomed, or those bootlickers will be identified and despised as such - funny how they never get over that, huh? As in, fuck you, you chose your bed, now sleep in it. Forever.

Somebody is saying this is inevitable - and whenever you hear somebody saying that, it's very likely to be a set of businesses campaigning to make it true.

--Richard Stallman

I've heard quite a lot of people that talk about post-privacy, and they talk about it in terms of feeling like, you know, it's too late, we're done for, there's just no possibility for privacy left anymore and we just have to get used to it. And this is a pretty fascinating thing, because it seems to me that you never hear a feminist say that we're post-consent because there is rape. And why is that? The reason is that it's bullshit.

We can't have a post-privacy world until we're post-privilege. So when we cave in our autonomy, then we can sort of say, "well, okay, we don't need privacy anymore, in fact we don't have privacy anymore, and I'm okay with that." Realistically though people are not comfortable with that. Because, if you only look at it from a position of privilege, like, say, white man on a stage, then yeah, maybe post-privacy works out okay for those people. But if you have ever not been, or if you are currently not, a white man with a passport from one of the five good nations in the world, it might not really work out well for you, and in fact it might be designed specifically such that it will continue to not work out well for you, because the structures themselves produce these inequalities.

So when you hear someone talk about post-privacy, I think it's really important to engage them about their own privilege in the system and what it is they are actually arguing for.

-- Jacob Appelbaum ( http://www.youtube.com/watch?v=Y3h46EbqhPo&t=7m46s [youtube.com] )

There is no reason to accept the doctrines crafted to sustain power and privilege, or to believe that we are constrained by mysterious and unknown social laws. These are simply decisions made within institutions that are subject to human will and that must face the test of legitimacy. And if they do not meet the test, they can be replaced by other institutions that are more free and more just, as has happened often in the past.

-- Noam Chomsky

Re:Patients Lie

[demonlapin]

MD here. They lie. They lie all the time. Usually not all that important, sometimes it is. We almost always know anyway.

Re:So....

[sharkette66]

Uh, no. This is a feeble understanding of HIPAA. HIPAA would only be involved with the information in the medical record, and violations occur when information in the medical record is shared in a way that HIPAA does not allow. There are many exemptions.

Googles records of a person's search, even a doctor's search, would not constitute sharing a patient's personal medical information(PMO) in a way prohibited by HIPAA.

The idea that google knows something has been searched, then by extension 'the government knows it', therefore an inference can be made about the subject matter of the search, therefore something was illegally shared in violation of HIPAA? No way....

The google searches occur because the PMI in the record doesn't match the physical evidence in front of the health care professional. If a doctor learns something about a patient's medical condition on the internet, the privacy afforded by HIPAA should apply, of course.