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

[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

[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

[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

[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.

Patients Lie

[jamesl]

And it could kill them.

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

[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

[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.

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....

[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.

"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: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

[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.

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?

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 ...

[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:"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: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: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.