Wednesday, October 21, 2009

Googling and Oogling

We've been talking about Psychiatrists and Facebook here on Shrink Rap and it got me thinking about psychiatry and technology. I always think of the internet as kind of public turf. Can it be "wrong" to Google someone? It's not illegal, it's not hard, and the stuff is all in the public domain. People will sometimes mention they've Googled me to find my phone number. I don't often Google patients, but once in a while. Someone once told me about their brother's murder in an international scandal and it sounded a bit weird, so I Googled (--the brother had been murdered and there was some mention of the international issue). But is "wrong?" I'm perplexed.

In a Psychiatric News story from July, Jun Yan writes in Psychiatrist Must Beware the Perils of Cyberspace:

Recently, APA's Ethics Committee gave a brief recommendation on whether it is ethical for psychiatrists and residents to Google their patients: "'Googling' a patient is not necessarily unethical. However, it should be done only in the interests of promoting the patient's care and well-being and never to satisfy the curiosity or other needs of the psychiatrist" (Psychiatric News, May 1).

On the other side of the coin, patients may Google their psychiatrists and not only uncover their professional credentials but also dig into their personal information, opinions, and attitudes. Many psychiatrists have blogs, Facebook pages, and a chat-room presence that patients could uncover, sometimes anonymously.

Figure 1
Jacob Sperber, M.D., discusses the ethical and therapeutic pitfalls that appear when psychiatrists and patients Google each other.

Credit: David Hathcox

"Patients and psychiatrists secretly Googling each other raises all kinds of legal, ethical, ideological, and personal concerns," Jacob Sperber, M.D., director of the psychiatry residency training program at NCUMC, told the audience. He believes that searching and gathering information about a patient behind the patient's back potentially violates the patient's autonomy and dignity and breaks the trust the patient has in the psychiatrist. It may be a violation of the patient's privacy, even if the psychiatrist's intention was to provide "zealous care."

Hmm, I'm not so sure about this. Why is it okay for a patient to Google me, but not okay for me to Google them out of curiosity? Shouldn't there be some control over what's up on the internet about us (meaning all of us humans)?

What do you think?


HappyOrganist said...

I think it's all fair if everyone wants to Google anyone else. That's just the way it is. People are curious. I'd hardly call it a mortal sin. I suppose it could lead to such.. but only in interesting cases!


moviedoc said...

It seems unlikely the APA ethics position would ever be enforced, but I like it in principle.

Dr. Sperber, on the other hand, sounds like he might be talking ethics of a particular psychotherapy method which should be distinguished from psychiatric ethics. If that's the case he should have (yes, from an ethics perspective) said so.

Your murder case, assuming you're referring to a patient, I would not describe online if it were me. I would worry the patient might think I was referring to them as "wierd." And it certainly seems they could tell you're talking about them.

I once searched for a patient after I was told their name was mentioned in a media report. I found their blog and we briefly discussed what it said. No problem. Not the same name as the media report after all. (I think this patient could not identify with my description here, and if they did, no harm.)

Maybe we should talk to patients about such things up front or include it in office policy.

BTW: This all gets more interesting in forensic arena. Dr. Recupero wrote about it in the issue of AAPL Newsletter I rec'd today.

BTW2: This is not a new issue with the Web. What about watching your patient acting in a TV series or commercial, reading an article or book they wrote, shopping at a store they own?

And who has time to search patients when you could be tweeting or blogging?

Anonymous said...

Moviedoc, I've talked about this before, but all my patient scenarios are distorted. This didn't really happen but something quite similar did. I think I'll take out weird anyway.

Ladyk73 said...

I had an interesting situation. There was a client that claimed with an interesting forensic history. Some of the treatment team wondered if the client's claim was delusional. In our state, you can look up inmates and their charges. I looked him up (using public record)...his "delusion" was not unreal. Much debate on the ethics of my actions.
I still stand behind my actions.
Public knowledge is public knowledge.

And...most importantly it was done for the benefit of the client. And the saftey of others in our care.

Jennifer said...

I can see both sides, I think, but I think the most important part would be (ideally) to talk about it. If a doctor googles the patient, tell them, and you avoid the broken trust (though perhaps not the incredulousness). On the other hand, I think it's a given that an informed patient will google his doctor. When I was picking a psychiatrist, I googled every one listed in my insurance to see what his/her specialty, research interest, potential reviews by other patients, etc are. Exactly as I googled my PCP when choosing her, too! (btw, PCP turned out great, psychiatrist not so great - just goes to show, I guess...)

moviedoc said...


Yeah, I just saw that in your header about confabulation. We should all probably say it each time.

Anonymous said...

Well it's more than just Googling--there are public records available electronically on the Internet. And you can find out someone's entire life by using those. It just takes a few mouse clicks.

Recently, I came across some information and it led to a search engine frenzy. I found out a lot of personal information about my psychiatrist AND I FELT DIRTY AFTERWARD. I think I'm better off not knowing. It happened innocently enough. I was reading a free community newspaper aimed at seniors. They pile these up on the window sill at the coffee shop. On pg. 6, I see a 1/4-page tall photo spread of an older doctor with the same last name as my shrink. He's speaking at some event. I wonder if the guy could be my shrink's dad, as they are both doctors. I was interested to know his medical background, so I Google the name and within 5 minutes, find out all sorts of stuff--including the Town he lived in. This led me to search property deeds, which gave me the name of his wife, and then from there, quotes about her son(s)from the Mom's business page, and so on, and so on.

This psychiatrist's whole life is available to me on the Internet and he doesn't even realize it. The hysterical thing is that soon after this I saw him in action trying to safeguard personal info from me. A police officer came in at the end of our session to inquire as to why the silent burglar alarm had been tripped/ improperly turned off 1 hour earlier. The officer said, "I'll need your name and date of birth." My psychiatrist had to take the cop around the corner and get out of earshot because he didn't want his birthdate revealed to me. Joke's on him: I have that data and so much more. But I feel dirty.

Anonymous said...

My psychiatrist works way too hard to sit and google me and a bazillion other patients. Given the googly bits of info that are available about patients that they may not have mentioned, the psychiatrist needs to take great care not to let it slip they have this extra knowledge. The doc-pt relationship is not an equal one. When pt wants to know all about doc they call it transference. When doc wants to google pt it is called curiosity. Imagine saying to doc, I found out such and such personal info about you from an internet search. The doc would ask what meaning that had for the pt and probably wouldn't accept --oh just curious.

Anonymous said...

I can't imagine anyone cares enough to make a policy on this. Seriously - who doesn't google a new doctor before going, if only to get directions to the place or whatever. And I think most patients would be flattered that they were thought interesting enough or whatever for someone to look them up.

Mindful said...

The beauty of the internet is that it democratises information. There are no rules and in this day and age, we are all well aware that we leave an electronic footprint. We can take precautions so we are not easily found - see Dinah's previous post about steps you can protect your privacy on Facebook. It doesn't matter who googles who and my psychologist knows way more about me than she will ever be able to find on Facebook.

itsjustme said...

I Googled my psychiatrist before I went to my first appointment, as I would any other doctor. I think it's important to check out your doc's credentials.

I would have no problem if my pdoc Googled me. It would be a pretty boring read, as I just Googled myself to see what's out there. It just lists Facebook stuff, which she already knows about. I do find it odd that it lists some of the applications that I use. So much for security settings. Oh, least it isn't anything too damning. Does anyone really care that I use the Visual Bookcase or Stage Door?

talesofacrazypsychmajor said...

I google every therapist I meet with.
But I would feel extremely violated if the therapist googled me.

talesofacrazypsychmajor said...

I'd like to clarify that. I am totally fine with my legal name being googled and situations where I was in the newspaper etc coming up. My problem would be if they tracked down my Internet identities and were googling my screennames. For example I have given my therapist some excerpts from my blog. I chose only ones I was comfortable sharing. If he wanted theoretically he could google a line from those exerpts and find my blog. That would be crossing a line in my opinion.

Fordo said...


I think its inappropriate for me to google any doctor and refer to that information during a clinical visit. I think its inappropriate for the doctor to do so as well because we would no longer be talking about medical issues. It seems stalkerish to me, somehow.

There's a difference between saying- "I saw you in the newspaper yesterday. You did well in the marathon." (or whatever)

If you instead said, "I googled you yesterday and found out you're a Democrat and have 3 children."

Its creepy. One says you came across them in your life. The other says you were thinking about them and deliberately researched them. The same would be true no matter which side of the clinical fence you're on.

Maybe the axiom should be- you can look, but don't talk about it.

Marie said...

Interesting discussion!

I googled my therapist before I went in for my first appointment, like others who have commented. I'm a published writer, and my therapist asked if he could find any of my work online. I said "Sure, just google my name." As a writer, I don't think of my online presence as being anonymous at all. I expect people to google me.

Back to me googling my therapist...about six months into the therapy, I began to think about my therapist all the time and wanted to google him and find out about his life. It was weird. Weird enough that I took a deep breath and brought it up in a session. In talking about this weird "obsession," it actually gave me some good insight into myself and my issues. As I worked through those, the thoughts about my therapist settled down.

I'm not sure there need to be "rules," but ideally in a therapeutic relationship these issues are discussed openly.

Anonymous said...

I googled my therapist. I found out way too much information, much of which I'm sure he doesn't know is out there and available. Of course, I'm far too chicken to tell him, as it feels somewhat voyeuristic to me. Interestingly enough, knowing the 'personal information' about him has totally ended any curiosity I have about him. He's a closed book kind of dude.

I have no problem with being googled. I expect it, and regularly google myself to see what information is out there. Googling is just expected in this day. But I do think some older psychiatrists and therapists may not know quite how to make their information secure. This may be a total generalization, but it's what I've found.

Anonymous said...

Considering the whole point of psychiatry, isn't forbidding shrinks from Googling their patients akin to telling physicians that must take their patients' word for their medical history and make no attempt to discover if it's true? The idea that if you think a patient is fibbing about his past, you can't look it up -- that hardly seems to be in the patient's best interest.

Yes, a physician does have to get permission to seek old medical records or run tests. But Google isn't a catalog of hidden records, it's fully public. Saying Google is off-limits is like saying that shrinks must not live in the same region as their patients, lest they observe them at the grocery store.

As far as a patient Googling a shrink -- I'm stunned anyone would think that's inappropriate. This is, after all, a business transaction.

And talking about it -- I assume that long before the Internet, psychiatrists had rules for themselves about how much of their own lives they chose to discuss with patients, and whether they considered it proper to bring up information about the patient that they learned outside of therapy. No reason for Google to be different in that regard, is there?

moviedoc said...

I'm surprised to hear patients talking about whether it's "OK" to google their professional. While there may be some general kind of ethics that applies, and either direction it's a "business transaction", but professional ethics really applies to professionals, not to their clients or patients. It may "feel dirty" to google your professional, but I would never presume to tell my patients it was not absolutely OK.

Celeste said...

It's perfectly legal to Google, but as to whether it's "okay", I guess you have to consider emotional intelligence. You are in some kind of relationship with this person and have taken it upon yourself to dig up information. Some it will be very straightforward, some of it will be illuminating, some of it will be bothersome, and some of it you will draw a completely incorrect impression of.

You will find out things that the person chose not to tell you themselves. Then you own the fact that you know these things and need to police yourself so as not to bring them up in conversation. People are really good at knowing what personal information they have shared; I think most would feel violated if you let on what you learned.

Also, I think you would have to face that this searching isn't truly the same thing as knowing somebody. Little bits of information taken out of context don't come close to portraying the whole of a person's identity, and it takes a lot of time to know somebody.

Anonymous said...

I'm left with the issue of "Unethical". It's a strong word. It's not "creepy" or weird, or something that one might rather not do.

Once something is in the public domain, I believe it's fair game. People mention they've googled me from time to time. I sort of assume it. I don't google my patients because...well...why would I? But if I wanted to, or I was checking the veracity of a story for a concern about a diagnostic issue, That's wrong? It's on the internet.

I suppose if one has things on the internet under an alias, then getting to it entails a degree of snooping and digging that feels unseemly. ?Unethical?

Pressing google is one thing, but I have to say, I rather my patients didn't go digging in to property tax sites, or whatever...

Mindful, I agree that the rules remain fuzzy.

Is it creepy to think about your doctor or patient between sessions and be curious about them?
Maybe it's part of being human.


Pleochroia said...

One thing no one has mentioned is we don't always choose what information about us is available through Google. For example, except for my LinkedIn profile, everything public about me on the internet has been put up by someone else.

moviedoc said...


Also perhaps unmentioned is that while validity of what someone else posted about you might be questionable there's no guarantee of veracity of information one posts about oneself. Of course it's like info obtained by torture: only some of it can ever be validated.

Anonymous said...

I think that perhaps people should be more careful about what they put up online under their own names. There is, of course, a significant difference between simply googling somebody's name, and putting a great deal of research into connecting the person with an online persona.

Of course, my psychiatrist has a website. At my first appointment, she told me I should check out her website, and I told her that I already had, that it was quite interesting, and that my mother thought so as well. She said that that was good. But googling somebody's name to find professional information about them isn't the same as spending hours and days cyber-stalking them.

Usually when I post anonymously it's because I'm afraid I sound stupid.

Anonymous said...

I wish I had done an indepth search of my former psychiatrist before making my first appointment. I checked the state board website to see if there had been any action against him, but that was it. There wasn't anything there other than the fact that he didn't pay his fees on time. So, I made an appointment.

But, when I caught him in a couple of lies I started to do some research and it really creeped me out. For example, he shares the same name as another doctor. My former shrink would brag about this and that, only he was taking credit for what this other doctor did. My own shrink wasn't the one being recognized for various things as he claimed, this other guy was. Creepy.

Then, there were the multiple arrests he had had. He got arrested while a psychiatrist for drunk driving, arrests for speeding (which means he probably got mouthy with the officer), etc.

Had I known all of this before walking into his office I would have saved myself a world of hurt, because I never would have made an appointment with him.

Anonymous said...

I am pretending I am sitting in your living room. ;)

So, I just googled my therapist after 6 years of being with him. It was starting to get to me. All I could visualize was his head. It was kind of a weird image to have of him. I couldn't place him anywhere in the world.

My family had tons of secrets and things unspoken. I'm trying to move away from that and have more "authentic" relationships. It seemed to makes sense that our relationship would be better if I could just ask him my questions instead of googling him. This led to my confession that I googled him.

It did not go well. He was VERY upset with me, felt I disrespected him knowing how private he is.

It just seems like a very odd outcrop of the therapeutic relationship. There you are working on relationship issues, trying to have better relationships but you can't ask questions of the person helping you. I'm still trying to wrap my head around it.