The Other Exam Room: When Doctors 'Google' Their Patients

theodp writes "Writing in the NY Times, Dr. Haider Javed Warraich shares a dirty little medical secret: doctors do 'Google' their patients, and the practice is likely to only become more common. And while he personally feels the practice should be restricted to situations where there's a genuine safety issue, an anecdote Warraich shares illustrates how patient search could provide insight into what otherwise might be unsolved mysteries — or lead to a snap misdiagnosis: 'I was once taking care of a frail, older patient who came to the hospital feeling very short of breath. It wasn't immediately clear why, but her breathing was getting worse. To look for accidental ingestions, I sent for a drug screen and, to my great surprise, it came back positive for cocaine. It didn't make sense to me, given her age and the person lying before me, and I was concerned she had been the victim of some sort of abuse. She told me she had no idea why there was cocaine in her system. When I walked out of the room, a nurse called me over to her computer. There, on MugShots.com, was a younger version of my patient's face, with details about how she had been detained for cocaine possession more than three decades earlier. I looked away from the screen, feeling like I had violated my patient's privacy. I resumed our medical exam, without bringing up the finding on the Internet, and her subsequent hospital course was uneventful.'"

Comments

Go Ahead, Google Me

[Anonymous Coward]

I don't care if my doctor Google's me. They'll have to weed through millions of results for Anonymous Coward.

Re:Go Ahead, Google Me

[telchine]

I don't care if my doctor Google's me. They'll have to weed through millions of results for Anonymous Coward.

http://en.wikipedia.org/wiki/Dissociative_identity_disorder

As House Says

[Cornwallis]

"Everybody lies."

Re:As House Says

[wonkey_monkey]

That explains why he failed to diagnose that guy with chronic truth-telling syndrome.

Re:As House Says

[Chemisor]

Including Google.

Re:As House Says

[bmxeroh]

It was lupus.

It's the sign of our times

[MindPrison]

Everyone google everyone. When someone is asking for employment, seek a job, seek a position, ask for marriage, new neighbors etc...you'll get googled. This isn't good, in fact - it's very bad, for everyone, including yourself. Because at some point, you'll have no privacy anymore. Sure - the one who GETS the information will be empowered by what he or she THINKS is facts, because it's out there - in plain text for everyone to see. But what you DON'T see, is the context, context as in "the other information", we're talking the "real" story here...not what someone PUT out there for everyone to see. I have a friend that have done nothing wrong afaik. His son is a police officer, and one day this police officer happen to catch "the wrong guy to mess with", the one he caught is still a criminal, but now the cop has been targeted by this criminal. The criminal happen to own a "BLOG" about his hate towards law enforcement, and he got really angry with my friends son. He decided to make my friend suffer, his wife, his daughter and his son suffer. So he went public with ALL their information and put it up on his blog. One day, when my friend needs to talk to officials, they too will google him, and they will see his name and details on the criminals page, except...they probably won't investigate the fact that the page with the information, comes from a criminal that has a hen to pluck with my friends son. This is why, this is a bad thing.

Re:It's the sign of our times

[Anonymous Coward]

You know what a good thing is? Paragraphs, dude. Paragraphs.

Re:It's the sign of our times

[MindPrison]

You know what a good thing is? Paragraphs, dude. Paragraphs.

I was momentarily autistic when I wrote that, you insensitive clod!

Re:It's the sign of our times

[Anonymous Coward]

they probably won't investigate the fact that the page with the information, comes from a criminal that has a hen to pluck with my friends son. This is why, this is a bad thing.

Cults, like scientology, is also using this method of slander towards their enemies. (Google "dead-agenting" for more information about the method)
http://en.wikipedia.org/wiki/Scientology_controversies#.22Attack_the_Attacker.22_policy

Re:It's the sign of our times

[KingOfBLASH]

Google is like a knife: neither inherently good nor inherently evil.

Some people will do the equivalent of SEO and actually create lies about themselves that people will find. Literally, if you're smart about it when people google your name all they will see is that you are some sort of awesome human being. Link to press releases of you donating a kidney to some poor schmuck who couldn't afford it. Link to how Jesus washed your feet. Link to positive stuff.

Other people won't get it and the picture your ex girlfriend posted of you pissing yourself will make the front page of google.

Re:It's the sign of our times

[KingOfBLASH]

Autism is not an acute illness

Re:It's the sign of our times

[MindPrison]

Autism is not an acute illness

I know...it was sort of a joke ;) But point taken, autism is no joke, no joke at all. In fact, some of my best friends are autistic, and very intelligent btw.

Re:It's the sign of our times

[Johann Lau]

Well, fuck that guy, and all the other hypocrites parroting similar views. Either mankind is doomed, or those bootlickers will be identified and despised as such - funny how they never get over that, huh? As in, fuck you, you chose your bed, now sleep in it. Forever.

Somebody is saying this is inevitable - and whenever you hear somebody saying that, it's very likely to be a set of businesses campaigning to make it true.

--Richard Stallman

I've heard quite a lot of people that talk about post-privacy, and they talk about it in terms of feeling like, you know, it's too late, we're done for, there's just no possibility for privacy left anymore and we just have to get used to it. And this is a pretty fascinating thing, because it seems to me that you never hear a feminist say that we're post-consent because there is rape. And why is that? The reason is that it's bullshit.

We can't have a post-privacy world until we're post-privilege. So when we cave in our autonomy, then we can sort of say, "well, okay, we don't need privacy anymore, in fact we don't have privacy anymore, and I'm okay with that." Realistically though people are not comfortable with that. Because, if you only look at it from a position of privilege, like, say, white man on a stage, then yeah, maybe post-privacy works out okay for those people. But if you have ever not been, or if you are currently not, a white man with a passport from one of the five good nations in the world, it might not really work out well for you, and in fact it might be designed specifically such that it will continue to not work out well for you, because the structures themselves produce these inequalities.

So when you hear someone talk about post-privacy, I think it's really important to engage them about their own privilege in the system and what it is they are actually arguing for.

-- Jacob Appelbaum ( http://www.youtube.com/watch?v=Y3h46EbqhPo&t=7m46s )

There is no reason to accept the doctrines crafted to sustain power and privilege, or to believe that we are constrained by mysterious and unknown social laws. These are simply decisions made within institutions that are subject to human will and that must face the test of legitimacy. And if they do not meet the test, they can be replaced by other institutions that are more free and more just, as has happened often in the past.

-- Noam Chomsky

Re:It's the sign of our times

[stealth_finger]

Everyone google everyone. When someone is asking for employment, seek a job, seek a position, ask for marriage, new neighbors etc...you'll get googled. This isn't good, in fact - it's very bad, for everyone, including yourself...

That implies everyone has loads of information about them online for all to see. If you google my name (and I imagine it's the same for most people) you'll get links to a few moderatly famous people with the same or similar names. The usual batch of profile sites with a few people with the same name none of which are actually me. I looked through the first few pages of images and I'm not there either.

Re:It's the sign of our times

[bickerdyke]

Would your friends son have found out about that blog without Google? Would he have been able to take any actions against that blog?

Re:It's the sign of our times

[mark-t]

The interesting thing is, however, as that sort of situation becomes increasingly common in our society, most people are going to eventually learn that they shouldn't be making judgmental decisions about somebody based only on what they find online any more than they should be making such decisions based on other superficial factors.... like race, age, et al. It will never be perfect, of course... but to be honest, you can still find racist jerks too, even in places which are very culturally diverse.

Re:It's the sign of our times

[kilfarsnar]

Great quotes, Johann. Thanks!

Re:It's the sign of our times

[Anonymous Coward]

but the mere fact that they know it does not, and privacy only covers what people simply know about, not necessarily what they do with the information.

In other words, you're cool with some guy watching your 10 year old daughter change through the part in the curtains, as long as they're not jacking off?

Re:It's the sign of our times

[cayenne8]

Everyone google everyone. When someone is asking for employment, seek a job, seek a position, ask for marriage, new neighbors etc...you'll get googled. This isn't good, in fact - it's very bad, for everyone, including yourself. Because at some point, you'll have no privacy anymore.

Well, there's good reason to not put information about yourself on the internet. I've been on since about '92, and thankfully googling myself comes up very little pointing to me. I don't do FB or twitter, etc.

You don't have to be highly searchable, so many people are doing this to themselves by publishing every picture ever taken of themselves, and constantly publishing their daily routine and other more personal information. People are doing it to themselves sadly.

But while so much privacy is lost today, sadly...you CAN do things to help keep your digital footprint to the lowest possible level, and still have a thriving and fun life. Just because you're not on FB doesn't mean you have to be a hermit either, I prefer to get out and interact with real people in meatspace.

Re:It's the sign of our times

[alex67500]

False analogy... rape is an act of violence against a person, and causes harm against that person, while the mere act of knowing something about someone else which they may not have wanted anyone else to know is not, and does not really infringe on their rights in any way. What a person *does* with that information might hurt somebody, but the mere fact that they know it does not, and privacy only covers what people simply know about, not necessarily what they do with the information.

The fact that there IS freely-available information about me is annoying. It dates back to my teenage years and I'd like them gone. Luckily I've been cited and Google-crawled enough that these have slowly disappeared (death of Geocities for instance) or moved to page 2 of Google results (best place to hide a body by the way, nobody ever goes there).

Re:It's the sign of our times

[boristdog]

Yeah, but those of us with fairly unique names are boned if we have anything bad online, real or manufactured.

This is why I have to have a facebook account, a linked-in account, etc. that I do NOTHING with except maintain a vanilla profile. I don't want someone setting up an account in my name. 15 years ago someone sent a stupid, highly ungrammatical "letter to the editor" of a local paper (which maintains an online presence) using my name as a joke. They printed it in the online edition and the damn thing STILL comes up on the first page of a google search.

So until I'm in the paper for rescuing a batch of orphans from certain death and the story gets picked up by lots of outlets, I have a former co-workers joke returned to anyone who googles my name.

Re:It's the sign of our times

[Johann Lau]

does not really infringe on their rights in any way

Privacy in itself is a right, so how does that work?

Re:It's the sign of our times

[hduff]

Google is like a knife: neither inherently good nor inherently evil.

This is slashdot. I need a car anlogy.

Re:It's the sign of our times

[Johann Lau]

Don't mention it :) I'm happy when I can stick them somewhere and they get read. You can find more here, but I got a bit lazy with tagging them, so it's currently a bit of a mess.

Re:It's the sign of our times

[firewrought]

Seriously? Abandon individual privacy but try to simulate its effects with legislation? Privacy affords one real dignity, autonomy, and economic advantage. It corrects for the excesses of law, limits the will of the ruthless, and satisfies an innate psychological need. When someone learns something private about you, your game-theoretic outcome IS harmed irrevocably. And when they act on that knowledge (as the majority of humans and human institutions will inevitably find a way to do--legal or not since it's very easy and very deniable), the crow comes home to roost. NEVER trade real up-front protection for some sort of bureaucratic after-the-fact promise.

Re:It's the sign of our times

[mark-t]

You are confllating what people know vs what people do.

Re:It's the sign of our times

[sjames]

So prohibit sharing that private information with others. That is the a thing you might do with that information that can harm someone.

Tying it back together, a person who has been raped might as part of their recovery like to just interact normally with others rather than as the rape victim everyone tip toes around. That can't happen without a degree of privacy.

The best way to make sure someone doesn't discriminate against you for something they know about you is to have them not know. That's why job applications often avoid questions that are irrelevant to qualification that might lead to illegal discrimination. It protects the applicant and the employer.

Re: It's the sign of our times

[techprophet]

Google is like a car: neither inherently good nor inherently evil.

Re:It's the sign of our times

[Belial6]

You are ignoring what the AC said. In both situations the one collecting data must 1) DO the act of collecting the information. They then 2) KNOW the information. Finally, they can 3) DO an action based on that information. The AC made the point that DOing the action to collect the information is a violation. He tried to drive the point home by asking if you were cool with someone DOing the act of collecting data when it is your ten year old daughter changing her clothes. You tried to pretend that action 1 is really action 3 and argued against that strawman.

Re:It's the sign of our times

[ultranova]

Sure - the one who GETS the information will be empowered by what he or she THINKS is facts, because it's out there - in plain text for everyone to see. But what you DON'T see, is the context, context as in "the other information", we're talking the "real" story here...

No, you miss the point. The problem is precisely the party that already holds more power in the interaction is even further empowered. The problem is that a potential employer can check what I do in my free time ("this guy drinks beer?"), not that I don't get to excuse my actions ("I only took half a pint"). That means I no longer have free time. The entire world will/has become a panopticon, which is a prison.

Re:It's the sign of our times

[ultranova]

False analogy... rape is an act of violence against a person, and causes harm against that person, while the mere act of knowing something about someone else which they may not have wanted anyone else to know is not, and does not really infringe on their rights in any way. What a person *does* with that information might hurt somebody, but the mere fact that they know it does not, and privacy only covers what people simply know about, not necessarily what they do with the information.

Aiming a gun at me doesn't hurt me either, but do you really expect me to just sit there and wait to see if you'll pull the trigger? Knowledge is power, and knowledge about me is power over me. If you set out to gather it, you force me to react for the same reason why pulling a gun at me forces me to react: I might not be bleeding yet, but if I don't act, chances are I'll be soon enough.

So in a post-privacy world, it may be obvious that some legislation will need to be made in what a person is legally allowed to practice based on information that they discovered without the knowledge or consent of the person that they discovered it about.

Or we could simply acknowledge that googling me is a form of stalking, and should be treated as such.

Re:It's the sign of our times

[mark-t]

Individual privacy anywhere that a person has no personal and direct control over who can see or hear them (ie, inside of their own privately owned property) is destined to be unsustainable in any environment where there is sufficient interest in finding out about that person.

Privacy is not a right, per se... It is only a courtesy that gets afforded to people out of either politeness or respect.

Re:It's the sign of our times

[mark-t]

When you can ever begin to enforce a restraining order prohibiting anyone from googling you, you may have a point.

Re:It's the sign of our times

[mark-t]

:So prohibit sharing that private information with others. That is the a thing you might do with that information that can harm someone.

Absolutely... and indeed, someplaces already have laws in place which expressly govern that exact issue. Currently, however, what you can find out about someone via google is not legally recognized as "private information".

The best way to make sure someone doesn't discriminate against you for something they know about you is to have them not know.

Possibly... but you can't legislate the flow of knowledge, you can only legislate what people actually do about it.

Re:It's the sign of our times

[sjames]

The knowledge doesn't flow by itself, it is communicated. That communication can be legislated.

People do need to keep in mind though that what they post publicly could end up nearly anywhere (and since they communicated it themselves, it's hard to prohibit that legally). They can hope laws are in place to prohibit discrimination and they can hope that those laws are actually obeyed, but I do agree that that can on;y go so far.

As a society, we need to fully recognize that everyone has various personas (at least at work vs. at home) and that people change over time. We're pretty good at understanding that cookie thievery at age 4 doesn't say much about an adult and we have some limited legal awareness that teenaged indiscretions shouldn't follow us into adulthood, but we have a way to go.

Patients Lie

[jamesl]

And it could kill them.

Re:Patients Lie

[rmdingler]

And it can harm doctors. With the spread of viral diseases like hepatitis, patient deception can lead to infection of medical personnel.

Re:Patients Lie

[KingOfBLASH]

Patients don't lie. They just don't have a medical professional's understanding of what is and isn't important.

Re:Patients Lie

[DigiShaman]

She told the doctor she had no idea why there was coke in her system. If she's telling the truth (doubt it), ok, fine. But if she lied or is in denial, that's totally on her.

Re:Patients Lie

[gweihir]

Only if the doctors and nurses are incompetent. Unless they are sure, they have to assume HIV and the like anyways and be careful.

Re:Patients Lie

[Anonymous Coward]

If she tells her doctor, the topic may end in his records, and be mentioned on the phone. State authorities steal medical records and break into confident communication. She'll likely not survive getting "busted".

Why the fuck should she put the rest of her life on the line to make her doctor happy? It's probably bad enough as it is with the tests being on medical record.

Re:Patients Lie

[CaptSlaq]

Patients don't lie. They just don't have a medical professional's understanding of what is and isn't important.

I have a bridge I'd like to sell you...

Everyone lies, even when it's to their detriment. Shame (among others) is a very powerful emotion.

Re:Patients Lie

[KingOfBLASH]

Bollocks. I don't do coke. I don't do drugs. I don't do anything I'm ashamed of.

If my doctor asks me something, I tell him truthfully. Sometimes though what I tell him is not what he wanted to ask. That's not due to my lying. It's due to my not understanding the question asked, or at least, not understanding what is important in regards to the question.

Re:Patients Lie

[demonlapin]

MD here. They lie. They lie all the time. Usually not all that important, sometimes it is. We almost always know anyway.

Re:Patients Lie

[ArsenneLupin]

And it can harm doctors. With the spread of viral diseases like hepatitis, patient deception can lead to infection of medical personnel.

Doctors should always wear gloves. The patient himself might not even know yet that he has an infection.

Or the patient may actually have told it to the secretary, who marked it on the form, but the doctor didn't take time to read the form.

Re:Patients Lie

[ArsenneLupin]

Patients don't lie. They just don't have a medical professional's understanding of what is and isn't important.

A little bit like computer users then, hehe... How possible can a noob know that having rebooted the computer is somehow important to the analysis to the problem?

Re:Patients Lie

[gstoddart]

She told the doctor she had no idea why there was coke in her system. If she's telling the truth (doubt it), ok, fine. But if she lied or is in denial, that's totally on her.

Or, you know, maybe she has been clean for 30 years, doesn't touch the stuff any more, and literally has NO IDEA of why it's in her system.

Reading that I almost got the impression the doctor realized there could be residual cocaine, and that it was likely a false hit.

Re:Patients Lie

[gstoddart]

30 years of residual in new blood samples??!

I don't know enough about it to know how long it stays in your system ... but I gather from TFS that the doctor decided that the information he had wasn't what he needed and moved on from it, and didn't pursue it.

So, for all I know cocaine is fat soluble and persists for a very long time.

Totally not qualified to speak to the medical stuff.

Re:Patients Lie

[Anonymous Coward]

It's not about importance. Humans lie, but interestingly they mostly lie when they believe (even wrongly) that their deceit will be effective.

So that's why it pays to have indisputable data. Voice recordings, data logs, CCTV, radar etc. give you an edge on getting the _people_ to tell you the truth. And in turn it makes you take people seriously when their story is incredible but matches the external evidence. People at Clapham Junction saw the lights go from green to red unexpectedly, a thing that should never happen. But they weren't believed. If there had been forward cab CCTV footage of the lights changing, they'd have been believed and a fatal accident might have been prevented (faulty wiring was causing some signals to show clear instead of danger, intermittently, such a signal resulted in a multi-train collision later on).

Re:Patients Lie

[gstoddart]

cocaine typically can't be detected past 3 days.

And yet, the doctor seems to have determined that it had nothing to do with the current stuff and moved on:

There, on MugShots.com, was a younger version of my patient's face, with details about how she had been detained for cocaine possession more than three decades earlier. I looked away from the screen, feeling like I had violated my patient's privacy. I resumed our medical exam, without bringing up the finding on the Internet, and her subsequent hospital course was uneventful.

So, depending on the kinds of tests he was doing, he apparently concluded it was a red herring.

Re:Patients Lie

[Qzukk]

and literally has NO IDEA of why it's in her system

All she did was bake some cookies using the baggie of sugar she found in the sugar jar.

Re:Patients Lie

[Stickerboy]

cocaine typically can't be detected past 3 days.

And yet, the doctor seems to have determined that it had nothing to do with the current stuff and moved on:

There, on MugShots.com, was a younger version of my patient's face, with details about how she had been detained for cocaine possession more than three decades earlier. I looked away from the screen, feeling like I had violated my patient's privacy. I resumed our medical exam, without bringing up the finding on the Internet, and her subsequent hospital course was uneventful.

So, depending on the kinds of tests he was doing, he apparently concluded it was a red herring.

Let me give you some insight as a doctor.

Patient comes in, lies, is actually abusing cocaine. Cocaine is a stimulant, and can cause overexertion of the heart through either chronic use or acute overdose, leading to shortness of breath and weakness, which the patient came in with. Additionally, smoking cocaine and all its impurities can damage the lungs.

It had everything to do with the "current stuff", as the patient lying and abusing cocaine as an elderly person ties everything together logically. Medical mystery solved, the doctor goes about his day. Seeing gramps come into the hospital after shooting up or smoking some dope is uncommon, but not unheard of.

Now, elderly person comes in, unknown care situation at home or what passes for home. Tests positive for drugs in their system. This explains why they came in with their symptoms, but not how it got there. That possibility requires further investigation, and may be cause for a call to adult protective services.

TL,DR: Not a red herring. The doctor reacting as they did was because they got the answers they needed, not because it wasn't relevant.

Re:Patients Lie

[demonlapin]

The doctor almost certainly looked at the form. But the form relates facts; it doesn't tell a story. Part of the process of making a diagnosis is getting people to talk about their problem as a story - it lets us know what the patient thinks is important and why they came, which may or may not have much to do with what is really wrong with them.

Re:Patients Lie

[Rich0]

MD here. They lie. They lie all the time. Usually not all that important, sometimes it is. We almost always know anyway.

The patients pretend not to lie, and the doctors pretend that they don't know.

Honestly, I think half of that problem would go away if we didn't treat doctors like gatekeepers. If somebody wants a prescription for anything other than an antibiotic they should be able to just go to the store and buy it. I could see not forcing insurers to cover it, but I think that if we treated doctors less like gatekeepers we'd see fewer adversarial relationships.

If people went to the doctor solely because they wanted the doctor's advice they'd be far less likely to lie to them, because they would have no reason to do so. Nobody hires an engineer to come in and look at their foundation and then refuse to let them in the house.

The reason patients lie to doctors is that they ultimately disagree with them about something, but don't perceive (rightly or wrongly) that they have any choice about seeing the doctor in the first place. Usually that is because they need access to some medication or other treatment to manage their medical condition and they can't have that access without the permission of a doctor. So, they manage the doctor to get what they need, and the doctor is getting paid for their time so as long as he has plausible deniability he won't get sued about what the patient refuses to tell him. I think that fundamentally taints the relationship.

Re:Patients Lie

[demonlapin]

Can't be detected past about three days. It was fresh. I don't know why this gentleman was given the great pulpit of the NYTimes to say he felt bad about when a nurse Googled a patient, but he wasn't looking at an ex-user of cocaine.

Re:Patients Lie

[mjwx]

MD here. They lie. They lie all the time. Usually not all that important, sometimes it is. We almost always know anyway.

This.

I'm not a doctor, but the last time I went to one I got the weirdest look after a brief examination. I asked him what the problem was and all he said was he doesn't get many patients who tell him the truth. I've worked in tech support, so I know when a user lies to me it just makes the whole thing longer and more painful for everyone. So I dont lie to people who I'd like to help me (especially when I'm in pain).

Re:Patients Lie

[hawguy]

cocaine typically can't be detected past 3 days.

And yet, the doctor seems to have determined that it had nothing to do with the current stuff and moved on:

There, on MugShots.com, was a younger version of my patient's face, with details about how she had been detained for cocaine possession more than three decades earlier. I looked away from the screen, feeling like I had violated my patient's privacy. I resumed our medical exam, without bringing up the finding on the Internet, and her subsequent hospital course was uneventful.

So, depending on the kinds of tests he was doing, he apparently concluded it was a red herring.

Let me give you some insight as a doctor.

Patient comes in, lies, is actually abusing cocaine. Cocaine is a stimulant, and can cause overexertion of the heart through either chronic use or acute overdose, leading to shortness of breath and weakness, which the patient came in with. Additionally, smoking cocaine and all its impurities can damage the lungs.

It had everything to do with the "current stuff", as the patient lying and abusing cocaine as an elderly person ties everything together logically. Medical mystery solved, the doctor goes about his day. Seeing gramps come into the hospital after shooting up or smoking some dope is uncommon, but not unheard of.

Now, elderly person comes in, unknown care situation at home or what passes for home. Tests positive for drugs in their system. This explains why they came in with their symptoms, but not how it got there. That possibility requires further investigation, and may be cause for a call to adult protective services.

TL,DR: Not a red herring. The doctor reacting as they did was because they got the answers they needed, not because it wasn't relevant.

The problem is that they didn't get any answers at all -- just because she used Cocaine 30 years ago doesn't mean she still does. I used a number of drugs 20 years ago that I literally haven't touched in decades.

If he suspects abuse, then he shouldn't dismiss that suspicion just because she once used the drugs. If she associated with people 30 years ago that had access to cocaine, there's a good chance that she still comes into contact with people today that have access to cocaine, so if anything, the fact that she once used the drug makes it more likely that someone may be giving it to her now.

Re:Patients Lie

[CODiNE]

And sometimes doctors assume the patient is lying when their moral judgement of the person conflicts with what they're being told by them.

Such as the non-sexual transition of chlamydia. But no let's take kids away for their parents and throw the pervs in jail, it's statistically not likely they're telling the truth so they must be lying.

Re:Patients Lie

[Stickerboy]

cocaine typically can't be detected past 3 days.

And yet, the doctor seems to have determined that it had nothing to do with the current stuff and moved on:

There, on MugShots.com, was a younger version of my patient's face, with details about how she had been detained for cocaine possession more than three decades earlier. I looked away from the screen, feeling like I had violated my patient's privacy. I resumed our medical exam, without bringing up the finding on the Internet, and her subsequent hospital course was uneventful.

So, depending on the kinds of tests he was doing, he apparently concluded it was a red herring.

Let me give you some insight as a doctor.

Patient comes in, lies, is actually abusing cocaine. Cocaine is a stimulant, and can cause overexertion of the heart through either chronic use or acute overdose, leading to shortness of breath and weakness, which the patient came in with. Additionally, smoking cocaine and all its impurities can damage the lungs.

It had everything to do with the "current stuff", as the patient lying and abusing cocaine as an elderly person ties everything together logically. Medical mystery solved, the doctor goes about his day. Seeing gramps come into the hospital after shooting up or smoking some dope is uncommon, but not unheard of.

Now, elderly person comes in, unknown care situation at home or what passes for home. Tests positive for drugs in their system. This explains why they came in with their symptoms, but not how it got there. That possibility requires further investigation, and may be cause for a call to adult protective services.

TL,DR: Not a red herring. The doctor reacting as they did was because they got the answers they needed, not because it wasn't relevant.

The problem is that they didn't get any answers at all -- just because she used Cocaine 30 years ago doesn't mean she still does. I used a number of drugs 20 years ago that I literally haven't touched in decades.

If he suspects abuse, then he shouldn't dismiss that suspicion just because she once used the drugs. If she associated with people 30 years ago that had access to cocaine, there's a good chance that she still comes into contact with people today that have access to cocaine, so if anything, the fact that she once used the drug makes it more likely that someone may be giving it to her now.

Which is a valid point, too. But the response to that is complicated. It may have been an incomplete story given to us - when I ask a social history on substance use, I usually ask a variation of, "Are you using any illegal or street drugs? Have you done so in the past?"

Most people who are steadfastly lying about current use will say no to both. People who have fallen off the wagon may lie about the first question in the beginning and tell the truth on the second, but if you come around again the patient will usually admit to it when directly asked and they know it's pertinent to treatment. If this patient had lied to the doctor about using before, I wouldn't blame them for thinking they're lying about both the past and now.

So, what then? Usually it comes down to conversations with the patient and his/her family or caretakers, and talking with adult protective services. If you aren't satisfied with the patient's safety at home, you tell them you're locking them in the hospital as a matter of patient safety until you're done investigating. The drug abusers will usually confess after this, because they want to get out of the hospital, after they're feeling better, to go back to using.

Re:Patients Lie

[demonlapin]

They lie because it suits them. I'm not a clinic doctor; I'm an anesthesiologist. People lie to me. Why? I don't know. If there's anyone who really, absolutely, positively needs to know the truth, it's the guy who is about to pour a cocktail of drugs into your veins and put you into a medically induced coma while someone else carves you open. But they lie.

Re:Patients Lie

[Rich0]

Yeah, that one I don't get, unless they're afraid you're going to document something that is going to cause them problems elsewhere.

Re:Patients Lie

[nebular]

Ask for a 2nd opinion. Although the Gyno is a speciallist and must be referred to by her GP, the Gyno is required to honour your request for another opinion and make a referral for you to another gyno. Canada won't stop you from seeing the doctor of your choice, but if you want the gov't to pay for it you need to have a good reason for seeing someone other than a GP, hense the referral. Also you can always contact a specialist to get an appt. without a referral and pay cash, however that is a the discresion of the specialist (they often won't make any appt without a referral in order to avoid wasting their time)

Re:Patients Lie

[CODiNE]

True in the child abuse example I gave, they have to report. But what about when the same false positive or alternate infection scenario is ignored and "Sorry but he cheated on you, that's the facts" breaks up a marriage?

It's too easy for a health care provider to make snap judgements like that which can ruin lives. Nothing you can say will convince them otherwise since "patients lie". That's true.. 99% of the time.

I admit I'm sensitive to it. Our health experts told my wife I cheated on her and refused to discuss it with me. Fortunately my wife knows me better than that. (And I know she didn't cheat either) Good luck convincing anyone though. That's a 1% thing that is so much easier to believe is a lie even though their diagnostic methods have known weaknesses to them.

But I agree most people lie a lot.

Re:Patients Lie

[demonlapin]

I try to point out to people that it's not that the medical establishment is always right, it's that 99+% of the time, the person who says "you've got it all wrong!" is the crazy one. Hard odds to overcome.

Re:Patients Lie

[ultranova]

It had everything to do with the "current stuff", as the patient lying and abusing cocaine as an elderly person ties everything together logically. Medical mystery solved, the doctor goes about his day. Seeing gramps come into the hospital after shooting up or smoking some dope is uncommon, but not unheard of.

Except, of course, the medical mystery has not been solved. Using cocaine in no way rules out other possible reasons, such as greasy arteries. In fact it, if merely admitting that they use cocaine makes the doctor declare "mystery solved", then it would be in the patient's best interests to lie about it to get a proper examination.

Re:Patients Lie

[demonlapin]

Well, actually, the HIV thing is a little different. Certain diseases are mandatory reports - you have to inform the state Health Department about the diagnosis, and in the case of STD's they will want to investigate all your sexual contacts and treat them.

Re:Patients Lie

[gweihir]

Yes, it is a risk. But it is prevalent, patient lying does not really play a significant role. The only situation where patient honesty would play a role is if they indeed have HIV or something drastic medical personnel cannot be vaccinated against and the patient is able to inform the medical staff and lab results are not available yet. That is a rather small part of the risk-landscape for accidental self-sticks and hence "sharps" procedures are rigorously adhered to by any true professional. But as in any profession, there are people that are not good at what they do. Whether it is in the medical field for this risk, electricians blowing themselves up or professional drivers using unsafe habits. Ignore the risk and have it main or kill you. Nothing new, nothing special about the medical field.

Re:Patients Lie

[Anonymous Coward]

MD here. They lie. They lie all the time. Usually not all that important, sometimes it is. We almost always know anyway.

Yeah yeah yeah. Just like when you "knew" that my liver dysfunction was due to chronic alcoholism instead of acetaminophen burn. Asshole.

Acetaminophen and Paracetamol (http://en.wikipedia.org/wiki/Paracetamol) are the exact same fucking thing but they are not labelled that way. Thanks for making such a dangerous substance so difficult to identify.

So yeah, thanks for asking if I had taken any Paracetamol when trying to treat my fever and then deliver Paracetamol to me intravenously after I had taken large doses of Acetaminophen. And then having the nerve to assume I am an alcoholic because my liver is shutting down. Fuck you. That damage is irreparable. Yeah. You know. You always know. And the patient always lies and is always hooked on some chemical. Fuck off.

Re:Patients Lie

[Rich0]

I would argue that even many antibiotics and whatnot should not require a prescription.

I think the only antibiotics that it would make sense to not require a prescription for are those which are fed to animals, since they're already nearly-useless anyway.

Now, as far as which antibiotics I think should be routinely fed to animals, I'd say that should be none of them.

I think that all antibiotic use of any kind anywhere should require a prescription, because it isn't about your health, but about everybody else's. If the use of antibiotics is not regulated, then society has to pay a boatload of money to discover new ones when the existing ones would otherwise work just fine. Notice that private companies aren't discovering new antibiotics? That's because there is no financial sense in doing so. It makes just as much sense to have the government paying to develop new antibiotics while doing nothing to control the waste of the ones we have.

Re:Patients Lie

[Rich0]

Yeah, that one I don't get, unless they're afraid you're going to document something that is going to cause them problems elsewhere.

Except... doctor-patient privilege. Medical records are private, and unless you give permission, even family is not allowed to know.

And how many people really understand the extent of doctor-patient privilege? I know I don't, and I know a heck of a lot more about it than the average person. I don't know what a doctor can be subpoenaed for. I don't know what they have to disclose to my insurer, or who they can talk to, or who gets told about things even though they shouldn't.

I do know that my doctor can't pass on something they don't know about.

I agree that there are other factors as well as you point out.

And there are a ton of mandatory-reporting laws out there. If your patient confessed that they like to abuse kids chances are you wouldn't keep it quiet, assuming that were even allowed. If your patient confessed that they are missing half of their field of view you probably have a legal obligation to report that to the local DMV. And so on...

Re:Patients Lie

[CaptSlaq]

"Everyone lies, even when it's to their detriment. Shame (among others) is a very powerful emotion."

It has nothing to do with shame (which is usually an emotion associated with children and/or people going through puberty).

It has to do with the risk of the doctor saying "well its your own fault then, find another doctor."

I'm in my 50's, retired, and I use drugs - I have ever since I retired. I'm going to enjoy my retirement. I've been honest with my doc - once I knew he would just accept my drug use and still treat me.

Sooooo.. Fear (of losing your doc) would be included in that "among others" clause, yes?

Also, to say that shame is relegated exclusively to children and adolescents is IMO absurd.

So....

[MitchDev]

... adoctor will fondle and touch and examine your most intimate body parts, yet they shouldn't look at publicly available information? STUPID.

Yes, they shouldn't jump to conclusions based on what they find, but otherwise, fair game.

Re:So....

[Vitriol Angst]

I feel more confident in a Doctor having more information than a for-profit insurance company -- which already KNOWS MORE than the doctor in many cases.

Re:So....

[gstoddart]

... adoctor will fondle and touch and examine your most intimate body parts, yet they shouldn't look at publicly available information? STUPID.

Except when doctors look at this publicly available information, the fact that they looked at it also becomes information which, while not publicly available, is still available to Google and, by extension, the government. Because the search engine knows who did the search (possibly exactly who if you're logged in) and where it came from.

The simple act of the search allows someone to say "this doctor's office looked for this person, and they also looked at this information". You don't think big data can't then determine that "this person has that condition and is being treated by that doctor"?

And then you've violated HIPAA laws and your obligation to patient confidentiality.

Unless you can prove no 3rd party could glean information from you doing that search (and I assure you, the doctors can't), you pretty much have to assume that someone actually could.

Which means the default position here has to be "no, you can't do that". Because it has more potential to cause harm than people realize.

Re:So....

[SacredNaCl]

I'm more concerned with doctors being able to find medical records from other doctors. You see one quack and get a misdiagnosis, and it can haunt you for years to come. With electronic records, almost all of the hospitals are linked here, and a simple search turns up everything. Its impossible to correct things in your medical files as well. All you can do is add a statement to them.

Re:So....

[gstoddart]

Next bit of news: Doctors offices use VPN's and Tor to access Google.

Bullcrap. Even if doctors all had the technical sophistication to do this, which I assure you, they don't -- if you can identify the IP address of the VPN (or some of the TOR exit nodes) then you can still determine that 'a' doctor, and possibly 'this group of doctors' is doing searches about people.

When I see this:

When I walked out of the room, a nurse called me over to her computer. There, on MugShots.com, was a younger version of my patient's face, with details about how she had been detained for cocaine possession more than three decades earlier.

I immediately think, "yup, the, the nurses are just googling and finding everything about you, and they're probably doing it with zero anonymity". My impression of the standards of IT and security in the average medical context is that it's barely there (if at all), managed by people who don't know or care, likely woefully out of date and missing security updates, and probably on a network which has been compromised by malware.

Sorry, but the interwebs pretty much guarantee that unless you took some pretty extraordinary measures, determining that a specific doctors office had the mugshots.com up for a patient isn't all that tough, which tells you that patient is associated with that doctor.

I do not believe the average doctor's office has the technical skills, resources, or inclination to be able to do this in a way which would be safe, stay within HIPAA laws, and guarantee you aren't leaking out patient information in the process.

Which means they have no business doing it in the first place, but being doctors, think they know everything and have no idea of the ramifications of this.

Re:So....

[sharkette66]

Uh, no. This is a feeble understanding of HIPAA. HIPAA would only be involved with the information in the medical record, and violations occur when information in the medical record is shared in a way that HIPAA does not allow. There are many exemptions.

Googles records of a person's search, even a doctor's search, would not constitute sharing a patient's personal medical information(PMO) in a way prohibited by HIPAA.

The idea that google knows something has been searched, then by extension 'the government knows it', therefore an inference can be made about the subject matter of the search, therefore something was illegally shared in violation of HIPAA? No way....

The google searches occur because the PMI in the record doesn't match the physical evidence in front of the health care professional. If a doctor learns something about a patient's medical condition on the internet, the privacy afforded by HIPAA should apply, of course.

Re:So....

[MitchDev]

That's idiotic. First, Google doesn't know who the doctor is, second, he's only looking you up, not putting your medical records out there.

This HIPPA shit goes too far if there's any way a HIPPA-cryte case could be made from a Doctor Googling info ANYONE could Google...

Really, you people need to change your tinfoil hats, I think your brains rotted clean through...

Re:So....

[doesnothingwell]

With electronic records, almost all of the hospitals are linked here, and a simple search turns up everything.

After being in the same local hospital system for twenty years I can say, not really. A doctor might keep everything but the hospitals do not. They remember your insurance data and where to bill/reach you, and even a ten year old defunct phone number. But some tests from 5 or 6 six ago not so much, its about tracking the money.

Re:So....

[mdielmann]

You could call it DuckDuckGo.

Re:So....

[Belial6]

First, if you think Google doesn't know who you are, you are naive. Second, a search on "MitchDev sores on genitals" is most certainly putting medical records out there if you are sitting in the doctors office waiting for him to look at your sores. It is silly to say that typing in medical information and submitting it to a third part isn't putting medical records out there just because the primary purpose of the database isn't the collection of medical records.

Anyone couldn't Google that information. For example, I couldn't Google your real name for genital sores because I don't know your real name. Of course, even if I did know your real name, it wouldn't be illegal for me to publicly disclose any ailment you might have because I am not your doctor. HIPAA does not apply to me. It does apply to your doctor and your nurse.

Re:So....

[MitchDev]

The story doesn't say what the search line was. It may have just been the user's name. Why are you such an ass defending the idea that this is somehow a HIPAA violation if a doctor searches the same records available to EVERY OTHER HUMAN BEING ON THE PLANET?

Re:So....

[Belial6]

Since the story is about the medical personnel looking for a reason that this person had cocaine in her system AND they found a link about the patient having used cocaine, the likelihood that the search included the patients name as well as the word cocaine is extremely high, while the likelihood that it did not contain both terms is extremely low.

The fact that the search results are available to every other person on the planet does not mean that the information that the patient was currently in the hospital being treated for cocaine overdose is available to everyone on the planet. I'm sure you are aware that asking a question can be supplying information in and of itself. For example, if one to hear their wife's male co-worker( with whom she had been working multiple all nighters for the last few months), ask their wife's sister if the wife had gotten the herpes test, one could infer that their wife has been cheating on them. Anyone on the planet could ask the question, but that doesn't mean something is being stated when that specific individual asks it.

I find it interesting that you think the guy wanting patent confidentiality to be the ass. That also says a lot.

Re:So....

[MitchDev]

I think an idiot thinking a doctor who wants more information about a patient he's trying to treat is in the wrong to be much more telling about you.
Let me guess, you're an ambulance chasing lawyer who loves raping doctors who've done nothing wrong just to line your own pockets...

Re:So....

[Belial6]

So, we are clearly in disagreement. You believe that a doctor is doing nothing wrong if they tell people about their patient's medical conditions if it is a "patient he's trying to treat". I think that it is wrong for doctors to tell people about their patient's medical conditions without their consent. Yes. Both of our positions say a lot about us.

One of us may be right and the other wrong, but the point of HIPAA is specifically to prevent doctors from telling people about their patients medical conditions.

Re:So....

[MitchDev]

Where the FUCK does it say he told anybody SHIT beyond typing a name into a FUCKING SEARCH ENGINE????

Are you THAT FUCKING STUPID?

Re:So....

[Belial6]

It says it in the summary. Your ignorance on how search engines work does not make me stupid.

"feeling like I had violated my patient's privacy"

[east coast]

Why would he feel that way?

To me, if a doctor can find something about a patient without going to crazy lengths to do it then he shouldn't feel bad about it. It would be like me telling my doctor I've given up smoking and he sees me smoking in front of my local Starbucks a month later. On my next visit should he really ignore that I'm smoking again or should he ask about it or come outright and say "I caught you in the act."

Granted, I'm an adult and I can decide but for medical guidance to be accurate and worthwhile you have to be honest with your doctor and his pointing out the embarrassing truth might be what it takes to get a patient to straighten up and fly right.

It's only fair

[Anonymous Coward]

After all patients google the doctors too.

Re:It's only fair

[gweihir]

It would be fair if doctors paid the paid the patients tons of money as well. As they do not, this is not a symmetric relationship.

Re:It's only fair

[neo-mkrey]

Or go here: www.healthgrades.com

Re:It's only fair

[demonlapin]

Do you pay your doctors tons of money? I seriously doubt it. I suspect you pay a government or an insurance company tons of money, depending on where you live.

Re:It's only fair

[Luke has no name]

Does that mean you get to examine them too?

Re:A snap misdiagnosis

[Vitriol Angst]

So, essentially, Dr. Haider Javed Warraichis is suggesting patients to lie, because doctors are more prone to misdiagnose if they have more information?

See what I read is that the Doctor was sharing a mistake they made with a snap judgement, based on getting MORE INFORMATION -- but out of context. I think our take-away could be; "If you are going to use this internet-based information, take it with a grain of salt and find some context." There's nothing about lying, that I'm reading.

It's a good thing he didn't ask her if her parents were embarrassed about her drunken sexy behavior on spring break.

FTA;

To me, the only legitimate reason to search for a patient’s online footprint is if there is a safety issue. If, for example, a patient appears to be manic or psychotic, it might be useful to investigate whether certain claims the patient makes are true. Or, if a doctor suspects a pediatric patient is being abused, it might make sense to look for evidence online.

That to me means; "limit your searches to investigate psychosis or abuse, and double-check conclusions."

Re:"feeling like I had violated my patient's priva

[schlachter]

It's public info, and it could help the doc make a decision, so let them use it.

BUT, make them spell out the patient what data they used to make their diagnosis if it was not provided directly by the patient.

Re:"feeling like I had violated my patient's priva

[rmdingler]

Granted, I'm an adult and I can decide but for medical guidance to be accurate and worthwhile you have to be honest with your doctor and his pointing out the embarrassing truth might be what it takes to get a patient to straighten up and fly right.

This is probably accurate in many cases.

The geriatric coke addict in the summary not withstanding.

What surprises me is that...

[Nutria]

tests can detect cocaine many, many years later. How is this so?

Re:What surprises me is that...

[sandytaru]

I thought the implication was that she lied about having no idea how coke was in her system because she was still an addict and still taking it?

Re:What surprises me is that...

[Cornwallis]

tests can detect cocaine many, many years later. How is this so?

Old story but true:

http://en.wikipedia.org/wiki/Contaminated_currency

Re:What surprises me is that...

[Luckyo]

We're talking human body here. Unlike pieces of paper or plastic, human bodies have metabolism that removes various toxins from the body with time.

Re:What surprises me is that...

[Nutria]

I thought of that too. The summary implies, though, that the doctor dismissed that possibility (patient too old).

Re:What surprises me is that...

[MozeeToby]

And that is a major failing on the doctor's part. Old people can be addicts too.

Re:What surprises me is that...

[Stickerboy]

And that is a major failing on the doctor's part. Old people can be addicts too.

I replied about this above this thread, too.

The doctor responded the way that they did, because the rest of the medical picture falls into place once it becomes known that the patient is still abusing cocaine. The doctor didn't dismiss the possibility, treating cocaine addicts for their health issues is commonplace.

The question that was nagging the doctor was, how did the drugs get into the patient's system in the first place? Elder abuse takes many different forms.

Re:What surprises me is that...

[mjwx]

We're talking human body here. Unlike pieces of paper or plastic, human bodies have metabolism that removes various toxins from the body with time.

Not all the trace chemicals are metabolized. In the case of THC it can be detected years later when it's released from body fat. Also drugs can be detected from other trace chemicals that aren't toxins and can stay in the body much longer.

Re:What surprises me is that...

[Valdrax]

The doctor dismissed that at first, suspecting that it was involuntarily in her blood, before finding out evidence that she had previously been an addict. I'm not really sure how anyone would read the summary any other way.

Re:What surprises me is that...

[hendrikboom]

My wife, a doctor, tells me the tests cannot detect 30-year-old cocaine use, but can detect recent cocaine use. So the implication is that the patient was using recently and was lying.

Re:What surprises me is that...

[Luckyo]

Read the thread ahead to find out why you are wrong. Another poster sourced papers on the subject which cite metabolism period of days rather than years.

Re:"feeling like I had violated my patient's priva

[Lemmeoutada Collecti]

Just remember as you say things like that, the doctor doesn't work for you. He works for the insurance company, the one who is paying him and with whose policies he either complies or goes unpaid. It's been a long time since the doctor was really in charge of his practice.

Hmmmm ...

[gstoddart]

Wouldn't doctors googling their patients essentially violate HIPAA rules?

Because you've now let the fact that you are a doctor treating a specific patient bleed out around the corners, and since Google is keeping track of who you are and what you searched for, they know it too.

Unless you are doing this in such a way that you can guarantee you're not causing patient confidentiality to be breached (which Google sure as hell isn't), I'm of the opinion you've demonstrated a lapse in ethics, and a breech of the law.

And, even if you search in a manner you know was anonymous, if those searches come from something which is identifiable as being the anonymous search of doctors, the content of those searches can still leak information out.

Because when Google see that Dr. Joe Quack has searched for Bob Skippy Smith followed by a quick refresher on the symptoms of herpes .... Google knows (or can infer) that Bob Smith has Herpes.

Doctors are not information theorists, and quite possibly not well educated enough about this technology to be using it in conjunction with their medical practice. Because clearly, if they understood this a little better, they'd realize they've more or less violated their ethics (and possibly the law) by doing this.

Doctors Googling their patients is a terrible idea, and has every possibility of violating the privacy of the patient, as well as the laws meant to protect it.

Re:Hmmmm ...

[drinkypoo]

Wouldn't doctors googling their patients essentially violate HIPAA rules?

They have a legal expectation of privacy that the search metadata won't be used for illegal purposes. The illegal acts of others are not their responsibility unless they had reason to believe that they would be committed. If they were googling the information of a political refugee, there would perhaps be more grey area.

Re:Hmmmm ...

[Stickerboy]

I am a doctor.

Wouldn't doctors googling their patients essentially violate HIPAA rules?

No.

Because you've now let the fact that you are a doctor treating a specific patient bleed out around the corners, and since Google is keeping track of who you are and what you searched for, they know it too.

Unless you are doing this in such a way that you can guarantee you're not causing patient confidentiality to be breached (which Google sure as hell isn't), I'm of the opinion you've demonstrated a lapse in ethics, and a breech of the law.

Violating HIPAA takes intent. And you're taking the doctor's responsibility to protect patient information way too far.

For example, Doctor X discusses Patient Y's case with Friend Z, with specific identifying information. HIPAA violation.

Doctor X discusses Patient Y's case with consulting Doctor A in a suitably private conversation over the telephone. Unknown to the parties, the NSA / and/or the phone company is wiretapping the line, and just learned all about Patient Y. Not a HIPAA violation on either Doctor's part. Doctors have to take reasonable precautions to protect their patient's privacy. Guarding against every possible outlet that snooping intelligence agencies and snooping internet companies could use is too much, and we'd never get anything productive done.

And, even if you search in a manner you know was anonymous, if those searches come from something which is identifiable as being the anonymous search of doctors, the content of those searches can still leak information out.

Because when Google see that Dr. Joe Quack has searched for Bob Skippy Smith followed by a quick refresher on the symptoms of herpes .... Google knows (or can infer) that Bob Smith has Herpes.

Doctors are not information theorists, and quite possibly not well educated enough about this technology to be using it in conjunction with their medical practice. Because clearly, if they understood this a little better, they'd realize they've more or less violated their ethics (and possibly the law) by doing this.

Doctors Googling their patients is a terrible idea, and has every possibility of violating the privacy of the patient, as well as the laws meant to protect it.

This would be an incredibly bad idea on Google's part to try to gather accurate information this way on patients. Because I assure you, doctors are neither linear nor subject related in their internet searching. Just because I google "gstoddart" and then a few minutes later "UpToDate: complications of inserting foreign objects in anus" does not mean the two are anywhere related, despite what you're thinking. I may have 20 different patients on my service at any given time, and I frequently have to be thinking about multiple cases at any given time during a workday. Hell, just to make things more confusing for google, maybe I googled "best place to order roses nearby" in between those two google searches, because I'm taking my girlfriend out to dinner after work.

Sorry, while I hate it, no one, not me, not you, has privacy anymore online or electronically. While we can fight against it, get used to it.

Re:Hmmmm ...

[Stickerboy]

Further examples of HIPAA violations and nonviolations and why.

Doctor X discusses Patient Y's case with Doctor Z, also involved in the case, at the supermarket. This is a HIPAA violation, as long as there are bystanders and he used specific identifying information. The Doctor intended to have the conversation in a place where he could have reasonably assumed there were unrelated people overhearing.

Now, Doctor X discussing Patient Y as a generic stroke case in public that could be one of a million just like it, with no identifying information, and debating the best ways to treat it? Not a HIPAA violation. Happens all the time during teaching rounds and medical conferences.

Doctor X leaving Patient Y's information up on a public console in a hospital? HIPAA violation. Doctor X could reasonably know that other people are going to walk by and either incidentally or purposefully look at the information he left up.

Doctor X looking up Patient Y's information on a public console in the hospital, and then taking it down before leaving. If an investigator or spy comes by with a USB drive of cracking tools and reconstructs Patient Y's information? Not a HIPAA violation. Doctor X took reasonable precautions with intent to protect Patient Y's privacy.

Doctor X opening Patient Y's chart to write a note and orders, and unrelated person sneaking behind him and sneaking a quick peek over the shoulder at Patient Y's information without anyone seeing? Not a HIPAA violation on the Doctor's part. No intent to share. Reasonable protection. Doctors shouldn't have to hire armed security guards to watch their back while they're focusing on treating patients.

Re:Hmmmm ...

[Belial6]

The doctor releasing medical data to Google is already using the data in illegal ways.

Re:Hmmmm ...

[Belial6]

The example above was not a generic search on cocaine and then a generic search on the patients name. It was a search that included cocaine and the specific patients name in the same search. Doing a Google search is not like having telephone call with another doctor and asking about the patient's genital sores. It is like submitting your issue with genital sores to a company that specializes in collecting and selling data.

Re:Hmmmm ...

[Belial6]

Doctor X discusses Patient Y's case with Doctor Z, also involved in the case, at the supermarket. This is a HIPAA violation, as long as there are bystanders and he used specific identifying information. The Doctor intended to have the conversation in a place where he could have reasonably assumed there were unrelated people overhearing.

This would be the violation described in the summary.

They better get the right person or bad stuff may

[Joe_Dragon]

They better get the right person or bad stuff may happen like (up to death with big law suits)

Just have to have the right name.

[willy_me]

This will only work on a few people. When I google myself, William Douglas, I get a pile of hits and none of them are for me. Additionally, people can still change their name if they want to distance themselves from their past. Will not hide you from government agencies but will be good enough for everyone else.

On a side note, a question to the grammar Nazis. When using the word "Google" as a verb, should the first character be capitalized? And as a website that supposedly stays neutral, should it even be used as a verb within headlines?

Now if you would please forgive me, I must go monitor Bing to see if their is a sudden spike in searches for "William Douglas".

Re:Just have to have the right name.

[telchine]

On a side note, a question to the grammar Nazis. When using the word "Google" as a verb, should the first character be capitalized?

Not usually. However in the title it's correct to capitalize each word.

Re:Just have to have the right name.

[minstrelmike]

On a side note, a question to the grammar Nazis. When using the word "Google" as a verb, should the first character be capitalized?

Seems to me capitalization in current English is used for proper nouns.
I don't know that we've ever Had proper verbs.

To google or not to Google, that is the question.
Whether 'tis nobler to suffer the slings and arrows of outrageous liars or search for info about them on the web (because we know everything on the web is absolutely true.)

Re:Just have to have the right name.

[mrchaotica]

Additionally, people can still change their name if they want to distance themselves from their past.

...including their education and work history, making it much harder to find a job.

Re:Just have to have the right name.

[unitron]

This will only work on a few people. When I google myself, William Douglas, I get a pile of hits and none of them are for me.

Well I really am "Mr Anonymous Coward", so it's much worse for me.

I told Noel he should give his kid a normal first name, but no, he had to be cute about it.

I figured it was going the other way

[Nyder]

I figured the Doctors were googling patients info to see how much they could overcharge for their service.

Re:"feeling like I had violated my patient's priva

[MozeeToby]

Wait, so this doctor now knows that his patient has a decades old history of drug abuse, at least one near overdose, and the rest of her stay was uneventful and he never brought it up... Am I the only one who says "WTF" to that? That seems like a much, much larger failure on the part of the doctor than googling a patient.

Re:"feeling like I had violated my patient's priva

[Nikker]

I don't think the result of your doctor finding out health concerns should result in a "gotchya" moment and why should it? Your doctor knows you very well in most circumstances in a medical and a social way, cornering his/her patient is always the least fruitful way of resolving an issue or helping someone.

Re:"feeling like I had violated my patient's priva

[Andrewkov]

So you take your car in to the dealership for a warranty repair. The mechanic googles you and sees you're a fan of The Fast and The Furious .. therefor you're probably abusing your car and are denied the free repair. It's a slippery slope..

The Poor Man's Background Check

[stevegee58]

Everyone realizes that googling names can frequently come up with false hits from the wrong person with the same name. Employers do this, boyfriends and girlfriends do it. Even though everyone knows how unreliable it is, they still keep googling names and using the results.
In a world constantly screaming for "moar" information it's a shame there's not enough reflection on how valuable or correct it is.

Re:The Poor Man's Background Check

[Cro Magnon]

Yup! When I self-googled, I got a whole page of MyRealName, none of which was me. The first real "me" I found was some dumb question I asked on a mailing list 15 years ago, and I have plausible deniability for that one.

Personal history, meh

[egnx]

I'm less concerened about the quack looking for my personal history than I was by one using google for diagnosis and drug interactions. He made no attempt to conceal it either, he pointed out the results on screen to me. That was rather surprising but hey, sometimes I use google to help me diagnose a fault...

Re:Personal history, meh

[demonlapin]

Why on earth would you want a doctor to try to memorize every drug interaction possible (which is both incredibly hard and really a pharmacist's job) when it can be easily searched for with databases that don't ever forget? Do you have any idea how many drugs there are?

Decision to Treat at All

[Petersko]

i think doctors should be permitted to use the search to decide whether they want to treat a patient at all, based on certain criteria. For instance, if you find the patient ranting about three other doctors and claiming to be in litigation with hospitals over various perceived slights... maybe they want to steer clear. Maybe the person really has a terrible track record of bad doctors and hospitals, but I fear the loss of physicians because of false accusations and public airings of disagreements.

However, I think using it for additional diagnostic data seems dodgy. There are too many ways that can go south. What's physically present, medically recorded, and obtained directly from interview should constitute much of the initial sphere of information.

Re:Decision to Treat at All

[Belial6]

Or, they could belong to the wrong church. Or, they could have worked on the wrong political party's campaign...

Hmmm.... No, doctors performing investigations on people to decide whether they want to treat them or not is bad.

Re:"feeling like I had violated my patient's priva

[Andrewkov]

Oops, bad analogy, but you get the point..

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Re: A snap misdiagnosis

[Anonymous Coward]

Yeah, everyone knows you need to close your eyes AND cover your ears to make the world disappear.

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[account_deleted]

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[account_deleted]

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Re:"feeling like I had violated my patient's priva

[demonlapin]

It's bad storytelling. I strongly suspect that he expected to find out she was positive for benzodiazepines or opioids, if anything, which is why cocaine was irrelevant to her treatment.

Re:A snap misdiagnosis

[mjwx]

So, essentially, Dr. Haider Javed Warraichis is suggesting patients to lie, because doctors are more prone to misdiagnose if they have more information?

Erm... because doctors would never make a misdiagnosis based on wrong information.

Has Dr. Javed Warraichis been self prescribing a wee bit too much?

One of the big reasons doctors (or anyone) turns to other sources of information beyond the horses mouth is because the horse fucking lies.

Those of us who've survived their time in tech support know that what the user tells you is never to be trusted. The same is true for patents. The big difference is that doctors dont have the luxury of finding out what is actually wrong from another source. So they have to rely on their intuition, external observation and the ability to tell what someone isn't saying.

I'm willing to bet that in the case of 95%+ of all misdiagnosis the cause was the patient either didn't tell the doctor what was actually wrong or worse, lied about it.

Re:"feeling like I had violated my patient's priva

[drinkypoo]

Well, look at the current case. The medical test was used to make the diagnosis, the social networking data was only used to determine whether the person had likely been drugged without their knowledge. In this case, it suggested that she probably hadn't been (since she had a history of cocaine use) in spite of her protestations to the contrary.

Here's two. I trust the NIH is acceptable.

[caveat]

Haven't done any reviewed work in years, I kinda miss it! I'm not going to bother doing full citations, just title and link, if that's OK with you.

"With a 50 ng/mL cutoff concentration and following low doses of 10 to 45 mg cocaine by multiple routes, detection times extended up to 98 h." - Urinary Excretion of Ecgonine and Five Other Cocaine Metabolites Following Controlled Oral, Intravenous, Intranasal, and Smoked Administration of Cocaine, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3159558/

"In serum, in chronic users, benzoylecgonine (primary metabolite of cocaine, the standard screening chemical) (BE; LOD 25 ng/mL) was detectable for 5.1 days on average (maximum 8.6 days)." - Detection Times of Drugs of Abuse in Blood, Urine, and Oral Fluid, http://www.researchgate.net/publication/8480649_Detection_times_of_drugs_of_abuse_in_blood_urine_and_oral_fluid/file/60b7d52a213aab0fb

Re:A snap misdiagnosis

[Austerity Empowers]

My opinion is that doctors are busy, and they're combating declining profits by pipelining more patients. If a doctor googled me I'd be shocked that he found the time or interest. I'm not sure I could consider it a breach of privacy...if it's on google it's hardly private, no matter what I may personally prefer.

In the small window of time they do give me, I think think my doctor at least attempts to give my family the best care he can. He just has to restrict himself to about 15 minutes of care. Honestly given the cost of doctor visits I'd try cutting out the blow before I ever showed up, but I suppose if you could afford the drugs then the visit may not be so bad.

Re:"feeling like I had violated my patient's priva

[SleazyRidr]

We give doctors a lot more trust than car mechanics, and we expect them to act professionally. If a doctor thinks that I'd be better off taking a drug, I'll probably take her advice and medicate myself. If she feels like she needs more information that I've given and googles it, then I think that's still a good thing.

Going back to your analogy: if the mechanic googles me and sees that I am a fan of F&F, so he replaces my oil with a higher performance blend, that would also be a good thing.

Re:"feeling like I had violated my patient's priva

[thoromyr]

+1

My doctor is now refusing to continue issuing a prescription (innocuous [not a substance restricted by anything other than requiring a prescription], but moderately expensive) because the insurance company has instructed otherwise. The problem (for me) is that the alternatives either don't work or have bad side effects. This is all documented as the insurance company has kept changing the prescription to anything else under the sun. The doctor now refuses to write the script at all and was plainly afraid of the consequences should he do so.

I went to a specialist and at first they refused as well for the same reason. I pressed, and eventually they decided they "could try". I've been notified by the insurance company that they will allow the script (modified for reduced dosage) for a while, but will not pay any part of it.

So: not only will the insurance company not pay for any part of the medication, but they will only allow me to have access to it for a limited time.

Just one example. Once you get old enough to have chronic health issues the system becomes clear. You pay the doctor, the pharmaceuticals pay the doctor, the insurance company pays the doctor, but only the pharmaceuticals and insurance companies have any say in your treatment (and the insurance companies have the most control). Supposedly this (bureaucracy controlling health treatment) is the problem with socialized healthcare, but it is the reality of our capitalist healthcare system.

Re:This is kind of like ...

[MindPrison]

Yes, I was bringing up the racist's excuse as a parallel. Nicely missed, chump...

I was momentarily autistic when I wrote that

He wasn't autistic. He doesn't know what it's like to be autistic. He was comparing being autistic with his "stream of consciousness" writing.

some of my best friends are autistic, and very intelligent btw

He uses his friends to gather comedy material. He believes autism makes people look unintelligent or he wouldn't feel the need to point out his friends're intelligent.

Would you like me to continue or should you shut up before I analyse you into a hole as well?

How do you know my friends? You're making up assumptions. "he believes", as if you knew what I believe. You do not know me, but you ASSUME you know me from my text, you sir, are an idiot.

Re:This is kind of like ...

[Meyaht]

OH OH DO ME NEXT!

Re:A snap misdiagnosis

[NJRoadfan]

"Everybody Lies" -- Dr. Greg House

Re:"feeling like I had violated my patient's priva

[Belial6]

Too bad, the search your doctor did returned the results for the SleazyRidr down in Florida. The one suffering from low blood pressure, and the medication she just prescribed you will make our high blood pressure worse and give you a stroke.

Re:A snap misdiagnosis

[Anonymous Coward]

I'd go along with that, but the tech support analogy is flawed. Users (generally) aren't lying to the help desk for the same reasons that patients lie to their doctors.

Help desk lies are often efforts to avoid blame or ridicule. Doctors get some of that too, but IME it is more often that patients are lying because they believe that if they are honest, they will be blown off or misdiagnosed. Whether or not that's a justified belief is probably differs by physician.

Re:"feeling like I had violated my patient's priva

[schlachter]

that's a stupid analogy.

no one is discussing using this to deny care, I'm not even sure how one could do so.

the better analogy is that after seeing your youtube vid of you burning out in the parking lot of your local mall, they figure out why you always have an alignment problem...and recommend a burn out friendly suspension setup.

Simple Solution

[Anti-Social Network]

Use a search anonymizer. Replace your Google search provider in the browser with a less intrusive data-mining version of the service. Use it for patient searches instead of direct Google. Done.

Re:A snap misdiagnosis

[mjwx]

I'd go along with that, but the tech support analogy is flawed. Users (generally) aren't lying to the help desk for the same reasons that patients lie to their doctors.

Help desk lies are often efforts to avoid blame or ridicule. Doctors get some of that too, but IME it is more often that patients are lying because they believe that if they are honest, they will be blown off or misdiagnosed. Whether or not that's a justified belief is probably differs by physician.

Actually you'll find the reason is the same. Patients lie to doctors to avoid judgment, the same as they lie to helpdesk. The fear isn't from misdiagnosis, it's from the fear that the ways they've deviated from the social norm will be discovered and exposed.

People who lie to helpdesk believe their lies just as much as the ones they tell to their doctor. Cognitive dissonance is very strong especially combined the desire to avoid judgement.