Have you ever searched for your patients online? And is it the right thing to do?

Guidelines about use of social media in health tend to relate to the public and shareable aspects of online networks, with associated issues of identity and professionalism. But what about hidden practices online, such as seeking out information about a patient? Is this an acceptable practice? And is it a common one? How would you feel if you found out your clinical practitioner had been checking out your web presence and social media profiles?

In this New York Times article Warraich suggests that searching for patients is commonplace amongst doctors. This sort of surprises me, given how much pressure busy clinicians are under, but I also can imagine that it does happen.

Earlier this year I spoke at a UK Clinical Ethics Network conference on the topic of social media and ethics. I gave an example of an inpatient whose mobile phone was confiscated, apparently as a result of clinicians finding out they had a blog. I asked the question ‘is this ethical practice?’ and it excited a lot of conversation – views ranged from believing that anything in the public domain is fair game through to those believing that searching out patients online is highly unprincipled.

My thoughts have come back to this topic whilst reading the fascinating It’s Complicated: the social lives of networked teens (Boyd, D. 2014) in which the author considers issues of privacy in relation to teens and social networks. Whilst on the surface a very different topic, I noticed similarities with a healthcare context – as with teens and adults, the relationship between patients and clinicians is imbued with power and complexity.

Boyd found that many adults believe they have a right to access their teen’s content on the grounds that it is ‘functionally accessible’. Many teens disagree: ‘I wouldn’t go on my teacher’s page and look at their stuff, so why should they go on mine and look at my stuff?’ (p.58). To make her arguments, Boyd draws on the notion of ‘civil inattention’ which was coined by the sociologist Erving Goffman in The Presentation of Self in Everyday Life (1959).  He uses the term to describe how social norms compel us to respectfully negotiate each other in public spaces – to look away when sharing a lift, to pretend we can’t hear a heated argument. It’s not about whether it is possible to listen or watch but whether we should.

To actively search for a patient online could be seen a breach of trust and a transgression of this social norm. As with most current professional guidelines, The Royal college of General Practitioners Social Media Highway Code focuses on the public and visible aspects of the Internet. It does make reference to finding out information about patients online but more in the context of something stumbled upon rather than searched for:

Rarely, you might encounter information in social media sites that places you under a professional obligation to break confidentiality. Examples include information relating to child safeguarding concerns or criminal acts. In these situations, you should follow the appropriate professional guidance and seek expert advice (2013, p.16).

Respecting patient privacy is a core ethic of clinical professionalism, but it may not feel like an invasion of privacy to search for what is already in the public domain. Searching on the Internet is a hidden activity with quite different qualities to breaching privacy through a conversation between two people. Context is important, but even if it is done with a positive intent, information can be taken out of context and misunderstood. Of course we are still learning about and codifying behaviours in social media space,s and attitudes will vary. There may well be circumstances in which it is appropriate, but as a general rule I believe that searching for patients online oversteps a boundary that compromises the clinical relationship.

I am not a clinician and I am not steeped in ethics, but I do find this issue of boundaries on the Internet and social networks a fascinating one. If you have a view or are aware of literature relating to this topic, I’d be very interested to hear from you.

I will add any further literature on the topic that I become aware of below:

Navigating the Google Blind Spot: An Emerging Need for Professional Guidelines to Address Patient-Targeted Googling http://link.springer.com/article/10.1007/s11606-014-3030-7/fulltext.html