Physician Boundaries and the Internet
The physician and patient relationship is, by definition, an intimate one. They see us naked, and we ask them questions about everything from sexuality to social issues, from the seriousness of disability to the not so serious halitosis. They tell us when we are dying, and when we are going to become parents, and when we are getting sicker, no matter what we do. We share our concerns about obesity, aging, and smoking, too. The boundaries can become blurred.
The psychiatrist (or psychologist) to patient relationship can have even fuzzier boundaries as we talk about our relationships, our addictions, our fantasies, and our fears.
In You, your doctor and the Internet (LA Times, August 26, 2010), Judy Foreman tackles this question. Foreman talks about two aspects of how the Internet is reshaping the physician to patient relationship and is rubbing away at boundaries.
Friending Your Doctor
One way is in the realm of friending. Are you friends with your doctor? Should you be? And what about your psychiatrist? As Foreman points out, this could be more trouble for the patient than it’s worth. Imagine being a patient in addiction recovery. Oops, better not post those party pics. But what if your buddy tags you anyway? Will you move quickly enough to intercept the incriminating evidence? And yes, evidence, for the stakes are undoubtedly higher if therapy is court-ordered.
On the doctor’s end of things, intimate details could be accidentally revealed. We are all, ultimately, responsible for our online privacy, but Facebook in particular seems to be continually tweaking its settings. How fast can the doctor chase after his or her privacy settings, and clamp down on those old embarrassing fraternity pictures?
Googling Your Doctor/Your Doctor Googling You
Foreman also mentions the push-pull of Googling. Should the patient Google the doctor? Foreman is all for that. After all, medical care is a service, comparable in some ways to a garage. You’d check to see if your mechanic was certified, and if they were complaints against him or her. Why not check out your doctor? Or, as Foremen herself writes:
There’s no question that Internet searches can be an important tool for healthcare consumers. “Patients should Google their doctors, to check on credentials, training, scholarly articles and the like,” says Dr. Daniel Sands, the senior medical director of clinical informatics for the Internet Business Solutions Group at networking giant Cisco Systems.
That sort of curiosity seems healthy, to give patients and potential patients some control. For psychiatry and psychology in particular, it’s helpful if there’s chemistry between the doctor and the patient. A traumatized female rape victim might only want a female doctor treating her. A man with impotence might prefer a male therapist. A check on Google can at least get the basics out of the way.
But the other half of this, to Foreman, is a different story. For Foreman, doctors Googling patients seems more of an invasion. However, Foreman allows for some instances where Googling might be necessary, e. g. a possibly suicidal patient who stops coming to therapy sessions – it makes sense for a therapist to check up on the patient using the latest and fastest technology. This seems analogous to calling a patient on the telephone if they are in crisis. A physician shouldn’t feel that anything other than sending a messenger is too invasive. There is the matter of urgency, and time delays can be critical.
Not so Fast
But what if it’s not so urgent? What’s the protocol for when a prediabetic patient claims to be going for a brisk walk when in reality they’re visiting Burger King (and checking in from Foursquare)? If the doctor ran into the patient in person and noticed this contradictory and ultimately destructive behavior, no one would say that the doctor was invading the patient’s privacy (this is assuming that the connection is a real one and not a result of the doctor following the patient around). It seems that the apter analogy is to active Googling versus stumbling upon (N. B. not the use of StumbleUpon) to find a patient’s activities. A by chance meeting or locating online is one thing; actively stalking, in person or over the ‘net, is something else entirely.
Behavior and Ethics
And what of the patient’s own behaviors, in the context of the doctor going too far? In PBS’s Behavioral Ethics video, Dan Ariely says about ethics, “… it’s all about being able, at the moment, to rationalize something and make yourself think that this is actually okay.” Is the fast food okay? Is the snooping? These are patients, generally, who are of the age of majority and are considered competent and sane. Is the fast food in their best interests? Of course not. But when physician concern turns into self-righteous attempts to control patients’ behaviors, then boundaries are so blurred, and were crossed so long ago, that they aren’t even recognizable anymore.