|
 The authors of a new paper in the Journal of General Internal
Medicine write that sometimes, the practice is acceptable. Most
other times, in their opinion, it isn’t. They hope their paper
sparks conversation among colleagues and the American Medical
Association about the possibility of guidelines for providers in the
digital age, one in which most medical students can't remember a
world without search engines.
“The motivation is to protect patients and prevent harm,” said Maria
Baker, a Penn State Hershey Cancer Institute genetics counselor.
Her paper lists 10 situations when physicians are justified in
“googling” patients – for example, when they have a duty to warn of
possible harm, if patient’s story seem improbable, if information
from other professionals calls a patient’s story into question, if
there are suspicions of abuse or concerns of suicide risk.
“There is something worth protecting in the physician-patient
relationship,” said co-author Daniel George, an assistant professor
in Medical Humanities at Penn State University College of Medicine.
While the AMA has issued guidelines regarding physician
professionalism and social media, George calls patient-targeted web
searches a “blind spot” among providers.
The authors detail actual situations at Penn State when they felt
“googling” was warranted. In one case, a 26-year-old requested that
both of her breasts be removed to prevent breast cancer, although
she hadn’t undergone genetic testing to see if she was at risk for
the disease, and didn’t want to. She reported an “almost
unbelievable” family history of breast, ovarian and esophageal
cancer and had sought the same surgery at other hospitals.
The genetic counselor “googled” her and found that this patient “was
presenting her cancer story at lay conferences, giving newspaper
interviews, and blogging about her experience as a cancer survivor.
Additionally, the patient was raising funds, perhaps fraudulently,
to attend a national cancer conference.”
“Armed with this information,” the authors write, “the genetic
counselor informed the surgeon, who subsequently told the patient he
felt uncomfortable performing the surgery in the absence of formal
genetic and psychological testing.”
Conversely, the authors argue, web searches can undermine trust
among patients and providers. “You have a patient wanting to adopt
healthy lifestyles, and the doctor helps him on a course of exercise
and non-smoking,” Baker explained. “But the doctor ‘googles’ him and
sees pictures he posted on Facebook smoking a cigar.”
[to top of second column] |
Mildred Solomon, president of the Garrison, New York-based bioethics
institute The Hastings Center, said she applauds the authors for
raising such questions, but their “acceptable” reasons for
“googling” patients are far too broad.
One scenario, “incongruent statements by the patient, or between a
patient and family members,” occurs too frequently in clinical
settings to justify Internet searches, Solomon said. “There’s too
much wiggle room,” she explained, noting that “intention” is what
should matter.
“Why is the physician motivated to do this? Is it going to bring
benefit to the patient, or is it something self-serving or out of
personal curiosity?” Solomon asked.
A spokesperson for the AMA declined to comment to Reuters Health,
citing the issue as “unresolved” by the organization.
However, a 2013 policy statement from The Federation of State
Medical Boards notes that physician use of digital tools must evolve
as do technology and societal trends. It acknowledges the use of
“patient-targeted googling” in medical crises, such as attempts to
identify unconscious patients in emergency departments. But,
according to the policy: “it instead can be linked to curiosity,
voyeurism and habit. Although anecdotal reports highlight some
benefit (for example, intervening when a patient is blogging about
suicide), real potential exists for blurring professional and
personal boundaries.”
Authors say they wish only for more dialogue about this digital
practice.
“I think this is just a starting point,” George said. “Every
conversation has to start with something. This is the raw clay that
we hope the field sculpts into set guidelines.”
The paper, which first came online in September, appears in the
journal’s January print issue.
SOURCE: http://bit.ly/1yyc6Ox Journal of General Internal Medicine,
online September 17, 2014.
[© 2015 Thomson Reuters. All rights
reserved.] Copyright 2015 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed. |
