The New York Times has a recent piece on the practice of doctors Googling their patients. The author, Dr. Warraich, intimates that essentially all doctors have done it at some time. He also writes:
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.
A variety of reasons for looking someone up online are presented in the article, such as verifying histories, safety concerns, arrest histories to confirm suspicions about drug use etc. I was flummoxed. Really. My chin must have been on the floor the entire time, because it has never occurred to me to Google a patient.
I finished residency in 1995, long before “Google” was a verb and at the age of 47 I am definitely older than most students and new physicians, so I get that I might be considered “old-fashioned” by some (many?). Except, I have an active online presence and am not one of those doctors who has never heard of Tumblr, can barely log on to Facebook, or who doesn’t quite get “the Twitter.” I am digitally savvy enough that looking people up might be a logical extension, except of course that it feels wrong.
I know that not every history I take is 100% accurate. People forget, they may not have understood me correctly, and sometimes the facts are distorted (sometimes intentionally, sometimes by omission, and sometimes because people desperately want to believe an alternative version). However, most often the disconnect we encounter in patient care is just human nature and not born of malice or a willful desire to deceive.
Getting part of the story is simply part of medicine. Even the most honest of patients with the best of intentions is hampered by his or her own bias and desires. I told my own childrens’ pediatrician just last week that they flossed every night. Every night we set out to accomplish that goal, so in my mind it’s 7 nights a week. It’s difficult for me to admit that it’s really 5 nights (O.K. maybe 4), because that makes me feel like I’m a bad parent and am dooming them to a lifetime of gum disease and then dentures. Sometimes the truth is just really hard. (As an aside, I assume pediatricians have some kind of equation they use to come to the truth, like divide the number of reported vegetable units consumed and nights flossed by two and multiple the number of soda units by 3).
How many of us have been told by a patient, “Yes, I’ve quit smoking,” only to be floored by the smell of cigarette smoke in the exam room or heard, “Yes, I finished those antibiotics,” only to see when the patient hands you their bag of pills (because they can’t remember everything they are taking) to see 6 capsules of Keflex rattling around in the bottle. And then of course many have heard the tales of lost opioid prescriptions, however, I just have to use my clinical skills, common sense, and the medical record to sort out each one of these conundrums. Maybe Googling is a way to avoid what one might assume is a difficult conversation, but I have found that simply asking about a disconnect yields invaluable information and no matter how difficult the discussion, patients typically respect that you made the effort.
Some people offer up, “Well patients Google their doctors…” Doctors are in the power position, so I just don’t buy that argument. Patients are going to look me up that’s one reason I maintain an active online presence, but I do hope everyone knows that online reviews are frequently rigged. I have had requests from services offering to target a patient list to pump up my online reviews and Yelp is far from unbiased. Regardless, me Googling my patients doesn’t fix that problem.
What about social media? I have never looked a patient up on Twitter or any other platform, although given many people use pseudonyms it could happen. If it’s unintentional then I think that’s O.K., but I would never intentionally follow a patient on Twitter or any other social media site. Some of my patients have told me they follow me on Twitter or that they follow this blog. I am honored that they take the time to read what I write as I hope I raise the quality of medical information online. And hey, if reading my tweets or posts helps a patient decide that they do (or don’t) want to see me, that’s great. I wrote those tweets and these posts, so it’s unfiltered me as opposed to some bio on a hospital web site over which I had little to no control.
Would any of us follow a patient outside to see if she is still smoking or go to the pharmacy to see if the line was really too long for her to wait to pick up her medication? Would anyone go to the police station to check on arrest records or knock on the door at 9 p.m. to make sure a medication is really being taken twice a day? To me, a search engine seems just as intrusive.
If I have a safety concern that meets the legal requirement for reporting (such as suicide risk, child abuse, or domestic violence), then I report it. However, I maintain that I am the doctor, not a fact checker or the police. While we are detectives of sorts, our tools are different and you just have to accept that getting every puzzle piece up front just isn’t part of the job. Googling a patient might be easier than clandestinely following them around in a trench coat, but it’s essentially the same thing.
If I need additional information I’ll just ask.