Internet Social Media Present New Quandaries for Psychiatrists

Is it ethical for a psychiatrist to Google a patient? There are no established policies about this, and perhaps there should be, contends Damir Huremovic, MD, co-chair of a session on cyberspace at the American Psychiatric Association meeting.

His fascination with the question arose when he read the printout of an e-mail suicide note, as he stood beside the patient who lay intubated and unconscious in the ICU. There was a link to a blog in the e-mail footer.

“My dilemma was whether or not to open it,” said Huremovic. “I finally did, considering that his blog may yield critical information about his attempt.” The information, and the e-mail, may have saved his life.

“As I skimmed over his personal musings in chronological order,” Huremovic recalled, “I could get an almost instant insight into the course of his drama, his aspirations and hopes, and his big disappointment which culminated with the suicide attempt. I found this way of learning about the patient so easy and almost seductive.” At the same time, he was uneasy about trespassing in a realm of intimacy and privacy-even though the patient had willingly posted the information in the most public of places

Untold amounts of personal information about patients may be freely available on the Internet, but Huremovic urges psychiatrists who might want to go there, to address the issue with patients at the outset. “It’s not a matter of ethics,” he added. “You should tell them in advance to minimize any kind of fallout. In fact, it may be an interesting point of therapy. If they don’t want you to go there, why not?”

On the other hand, he points out, patients may be just as likely to Google a psychiatrist as the other way around. It may be prudent to be aware of what’s out there about yourself, and perhaps also to anticipate this as a point of discussion at the start of a relationship.

The issue arose 3 years ago when Philadelphia psychiatrist Geoffrey Neimark and others¹ wrote a letter to the American Journal of Psychiatry describing an earlier example of using Google for background information about a patient who attempted suicide. “What about other potentially useful, although perhaps more controversial, sources of information on the Internet?” they wrote.

“Many states now have websites that list parole absconders and wanted fugitives and offer online registries of sex offenders. In addition, elements of patients’ financial, criminal, and civil histories can be obtained on the Internet. What, if any, role could and should this sort of information have in clinical evaluations, and what are the ethics of this?”

Other issues are whether it is wise to visit Internet forums about mental health issues in search of insights, or even to follow the lightning-speed posts on the new medium of Twitter. People have been known to post successive distressing notes on Twitter in which they threaten suicide, generating immense concern among their followers. (A quick example posted on Twitter 7 seconds before writing these words: “If next Tuesday doesn’t go well . . . I’m going to f---ing commit suicide. No f---ing joke.”)

Humerovic, who practices in East Meadow, NY, writes a blog, but he avoids social media sites such as Twitter and Facebook, because he believes in “certain elements of privacy.” He urges psychiatrists to beware what they click on.

“You may not want to get involved,” Humerovic says. “God forbid something should happen. How would you feel?”

In a separate workshop at the APA meeting, L. Mark Russakoff, MD, of Sleepy Hollow, NY, will be chairing a discussion [Thursday 5/21 at 11 AM] of the use of Internet tools by psychiatric administrators, including the impact of electronic medical records.

He anticipated a wide-ranging conversation directed largely by the interests of the audience, but reflected that some responses are predictable.

“Our experience is that there are generational differences,” he told Psychiatric Times. Younger psychiatrists and administrators are much more receptive to adopting new technologies, he said, but these may alter clinical practice-which older practitioners view as a disruption, not as useful progress.

References:

Reference

1. Neimark G, Hurford MO, DiGiacomo J. The internet as collateral informant.

Am J Psychiatry

. 2006;163:1842.