Psychiatric Times, October 12, 2016
This article has conflated a discussion about the legal, ethical, and alliance-building aspects of whether a clinician may or may not search up and then share information about a patient. Questions 1,2,3 are limiting because they ask about ethics only.
The internet is a public data base and anyone can legally look up anyone else on it. Regardless of the veracity of the information on the internet (which should be highly suspect), or whether “free-speech”, and private information should or should not be so easily available for the perusal of anyone else, it is legal for a psychiatrist to look up anything that is publicly available on a search engine (except some parts of the “deep net”. See: https://www.quora.com/Is-it-illegal-to-surf-browse-the-deep-web).
Any psychiatrist can make it completely ethical to search public data about any patient as long as they openly state they may do so on their terms of service, i.e., on the clinician’s web site or informed consents patients may sign when they register as a patient. It may sometimes be prudent to search the criminal history of a patient that you are sharing a small private room with a closed door. Any patient who does not wish to be searched up can freely decide not to engage with this doctor. It may still not be unethical to search up about a patient even if it is not specifically stipulated in their terms of service or informed consent, it depends on how broadly we would like to define a clinician’s freedom to use the internet or other public data bases. It could be said to be “common knowledge” that anyone may ethically search up about anyone else, although having a terms of service and informed consent before therapy makes the ethics clear.
Alliance building concerns are only an issue if the clinician decides to hint at or tell the patient they have done a search about the patient. It is not far-fetched, however, to conclude that the alliance may likely suffer when it becomes known to a patient that the clinician did a search. The veracity of much of the information on the internet is a big question, patients may feel their privacy has been breached, and helping a patient gain insight should not depend on a clinician’s search results, patients will likely just get defensive. If doing a search in a session together with a patient, or sharing a search result that the clinician has found would help a patient gain insight, they wouldn’t need to be receiving psychiatric care to begin with.
The conclusion of all of this is that:
1. Clinicians should have a terms of service and informed consent procedures that include the possibility of looking up public information on patients regardless of whether they would actually do a search.
2. There are probably very few instances where a clinician would want to share the results of a search about a patient with that patient.
3. The questions as posed in the article are not answerable under the suppositions of the case that do not specify the clinicians terms of service or informed consent except to say the clinician should have them, search results are not the same as facts, and clinicians should not bring up search results unless they wish to have a tearful or angry patient who may likely quit the therapy, write bad reviews about the doctor, or even self or other harm.
I’m sure there are anecdotes of a “happy ending” to a clinician sharing a search result about a patient with that patient, there are always rules and exceptions to rules in psychiatry.
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