If a Patient Googles Me, What Do They Find?

Technology is changing the way we practice psychiatry in many regards. There are electronic records, communication methods (email, blackberries), decision-support tools, databases and more. Furthermore, there is more information available publically, about professionals, than ever before. What does this mean for psychiatrists and psychiatric residents?

Today, the Group for the Advancement of Psychiatry conducted a workshop on the above topic to help attendees reflect on how they use email and how to manage information in the public sector that relates to clinical care. The first fictitious case presentation involved doctors and patients using email. There are several issues and some “rules-of-thumb about this:

• We have to make sure the email is “secure” with encryption for privacy and confidentiality
• According to the American Medical Informatics Association, emails are literally part of the official record, which means we (and patients) need to be mindful of the content
• We and patients need to choose a mode of communication that best fits our goal: email for minor communication (e.g., scheduling appointments, offering a web site resource, to check in across time zones); telephone for brief discussions that need to go back and forth a bit (preferably not cell phones which are usually not private)
• Timing is an important part of choosing the mode, as emergencies or immediate upcoming events are not best handled by email
• Psychiatrists need to learn the pros and cons and then teach the residents, who are often more savvy with technology and who must adapt use of technology from personal to professional use—a big transition

Another key transition for us has to do with use of Facebook and this was the second fictitious case presentation at the workshop. A resident came to supervision bewildered that a patient had visited his Facebook page to join as a “friend”. Several issues arise and here are some “rules-of-thumb about this:

• There are some headings to make some comments and pictures private on Facebook, though absolute privacy is not likely
• Saying “no” to the request should be discussed with care to current and past patient experiences
• As students and residents develop their professional careers, how should their Facebook be changed? For those in practice, should we have one?
• Information out there about us (and patients) on Google, when discovered, should be openly discussed in the doctor-patient relationship

Overall, a few themes apply to both cases. There are generational differences that affect how we use technologies, as well as how we perceive their impact. Technology stretches the “frame” or context of the doctor-patient relationship, which used to be just in the office (other than incidental contacts). Technology accentuates the quantity and perhaps the complexity of doctor-patient relations. It is important for psychiatrists and residents to reflect on these issues in order to see what “works” depending on the context of clinical care and apply some of these “rules-of-thumb”.

Don Hilty, M.D.

Co-Chair, APA Scientific Program Committee

University of California, Davis