You’ve just started treatment with a new psychiatrist, whom you like very much. Should you “friend’’ her on Facebook?
If she says yes, what if she finds those pictures of you dancing drunkenly with the lampshade on your head — after you told her you don’t drink anymore? Or what if you discover pictures of her snuggled up with her husband and two adorable kids, when the reason you went into therapy in the first place was that you’re sad about being single and childless?
If she doesn’t respond, will you feel rejected, distanced, hurt?
And what about using search engines like Google and Yahoo? What if your shrink Googles you to see if you’re delusional, or if you really are that famous astronaut you claim to be? What if she discovers that you have a posh address even though you pleaded for reduced fees? If she does Google you, should she tell you? If so, before or after? Should the search results go into your medical record?
Welcome to one of the newest medical ethics dilemmas, the collision between the Internet and the traditionally strict boundaries between patients and doctors. Caregivers, especially psychiatrists and therapists, have historically disclosed personal information only when it might benefit a patient — as when a patient is struggling with the loss of a child, and the therapist discloses that he, too, has experienced such a loss. Likewise, patients have typically disclosed personal details in their own time, as therapy continues and trust develops. The Web challenges that model head-on.
Facebook, founded in 2004, has more than 400 million active users. MySpace, founded in the same year, has 100 million. Google, the search engine founded in 1998, handles 100 billion searches per day.
There’s no question that Internet searches can be an important tool for health care consumers. “Patients should Google their doctors, to check on credentials, training, scholarly articles, and the like,’’ says Dr. Daniel Sands, a director of clinical informatics for the Internet Business Solutions Group at networking giant Cisco Systems.
But what about the reverse, doctors searching patients? “Why would they ever want to?’’ asks Sands, also a physician at Beth Israel Deaconess Medical Center in Boston.
Actually, there may be times when it’s appropriate for doctors to Google patients, says psychiatrist Dr. Benjamin Silverman, chief resident of McLean Hospital’s adult outpatient clinic.
