Web Searching for Information About Physicians

The Internet will increasingly change patients' expectations of clinicians, so that physicians will routinely need to offer services like e-messaging, instant messaging, video conferencing and other online services. —Pew Internet & American Life Project¹

Physicians have become accustomed to the curiosity and dependency of patients in the practice of medicine. Yet they need autonomy and privacy to move freely in their personal lives. They wince under the glare of publicity and often feel grateful to medical dramas on television and in film for helping to slake that curiosity.

But some patients want more. Physicians intuit that those pressing for nonmedical relationships with their caregivers and those seeking information about them are potentially clinging, possibly personality disordered, or perhaps even threatening.² Not uncommonly, casual conversations in physicians' dining rooms turn to one or another colleague who is being stalked by a patient and must take the necessary steps to protect home and family. Many physicians are wary of gifts that are too personal and social invitations that seem too seductive. The delicate balance between therapeutic self-disclosure and boundary violations is precarious³ and is an increasingly important part of medical education.

This concern has moved into the digital world, but awareness of this issue among physicians seems bifurcated. Many physicians over a certain age never envision their patients Web searching, but many physicians of a later generation expect such digital curiosity from patients. The Internet is widening the gap between net-savvy physicians and older physicians formed in a culture that was net-naive. Web-based search engines, such as Google, Yahoo!, Microsoft Live, and others, make finding personal information about physicians as simple as typing the physician's name. This process, of course, is anonymous on the part of the searcher, so it is almost impossible for a physician to know when a particular patient is searching for personal information.

Professional information about physicians is easily available on the Web. States now routinely publish information about a physician's education, training, board certification, and publications. These Web sites may also include information about disciplinary actions against a physician by a state's licensing and registration authorities. Information about lawsuits and malpractice claims are often available with a dozen keystrokes. Increasingly, data about physician performance are being made available in the public domain.⁴ Within the quality assurance movement, programs such as the Insurance Commission's Clinical Performance Improvement Initiative⁵ are making available to physician groups, insurance companies, and indirectly to patients information about an individual physician's performance.

Beyond the professional realm, however, personal information is readily available on the Web. Many cities and counties have made mortgage deed registries available online. In New York City, for example, with just a last name, a patient can obtain a physician's home address, home price, and mortgage information.⁶ It also may be possible to infer if a physician is married or in a domestic partnership by determining whether the physician is a co-owner of a home. More comprehensive information can be found from several Web sites that will complete discreet “digital background checks” for a small fee. Date of birth, criminal records, marriage records, bankruptcy records, small claims court filings, and judgments are often available.

Social network sites are another way patients can find information about physicians. Web sites such as facebook.com and myspace.com are commonly used by college and graduate students. This is particularly relevant for medical students as they enter residency or practice. These young physicians often maintain relationships with classmates and peers through their online identity on these social networking sites. Information about a person's hobbies, favorite movies, and relationship status are commonly available. Pictures of the user in social settings are commonly posted or “tagged.” Extensive information about one's social network is also available. A user's profile is often linked to an individual's friends' profiles, thus allowing a patient to find out personal information about a physician's community of friends. Depending on what information a physician has posted in his or her social profile account, a patient can determine what groups a physician belongs to—revealing information about favorite sports team, social causes, musical tastes, sexual orientation, and political leanings.

In some cases, there may be slanderous information about a physician on the Web, published in a blog or on a Web page by a vengeful patient, colleague, or ex-lover. Equally vexing, there may be slanderous information published about someone with the same name as an unlucky physician. There may be few clues available to the Web-searching patient that would allow that patient to know that this is not his or her physician.

To date, the strategy for dealing with this issue has been for physicians to avoid having a Web presence or to remove whatever Web presence that already exists. The older generation of physicians might believe that being absent from the Web is the surest way of avoiding disclosure of personal information on the Web. Some training directors may ask new residents to close social networking accounts, Web pages, and blogs. But younger generations of physicians do not see absence from the Web as a palatable option. They believe that a digital identity is not just a recreational activity but, rather, an integral part of how they live and connect with colleagues, family, and friends. As the current cohort of trainees move through residency, they are bringing with them an expectation of digital connectedness. They recognize that ignorance of an individual's Web presence does not mean it does not exist. They are aware that much information about them will be available to patients with or without their consent.

Although it is difficult to control what is published about a physician on the Internet, there are some steps that physicians can take to control the information that is readily available. A basic strategy for building a digital identity is based on the knowledge that the average user views 1.9 pages of results per search term.^{7 - 8} By being proactive, a physician can put forward information that is more likely to be listed in those first few pages of results and pushing back unwanted material, thereby having some control over information that is posted.

Although it may seem counterintuitive, creating a Web page is a simple strategy for controlling information. Each practice should have a Web page that includes contact information, hours of operation, and a list of basic services provided. Posting academic information, such as specialty training completed, may be helpful in preventing confusion with persons who have the same name. Even for solo practitioners, setting up a free Web page through online services is simple. This allows patients to find information they are commonly searching for and provides them with specific information. Such information may satisfy a patient's desire to find some digital connectedness to his or her physician, thereby discouraging deeper online probing.

Using Privacy Settings on Social Network Sites. Physicians who decide to maintain a social network page should use privacy controls to limit access to their most personal information to specific friends. Such privacy controls allow physicians to post less intimate information in his or her public profile (name, work affiliation, city of residence, a picture) and keep more personal information (sexual orientation, relationship status, birth date, photo galleries) available only to friends through a private profile.

Being Aggressive About Slanderous Material. If slanderous information is posted about a physician (or someone with the same name that could be mistaken for the physician), consider using one of several Web-based services that can help remove such information. Several commercial online services will help negotiate the removal of potentially slanderous information from Web sites and make a referral to legal counsel that specialize in this area of the law.⁹

Talking to Patients About How They Are Using the Internet. If a physician suspects that an Internet-savvy patient is engaged in seeking personal information about him or her, we recommend that the physician talk with the patient about the garnered information. This is particularly relevant when treating young adults or adolescents who commonly use the Internet. Physicians should clearly inform patients that the Internet is not a substitute for face-to-face conversation.

Physicians Should Be Mindful of Their Web Presence. Every physician should regularly conduct a Web search of himself or herself. The most effective strategy is the query “John Q. Smith” or “John Smith, MD” with quotation marks. Search engines are continuously indexing data on the Web and search results change daily.

Physicians should be mindful that patients want to know about them and have increasingly better tools to unearth such information. Taking the initiative of creating one's own Web identity through the development of a practice Web page and limiting access to personal information on social Web pages can allow for effective communication with patients while balancing personal information.