Sunday 17 December 2017

'When benefits outweigh risks, social media snooping is ok'

A woman stands holding her smartphone whilst framed against a wall bearing Facebook Inc.s 'Thumbs Up' symbol in this arranged photograph in London, U.K., on Wednesday, Dec. 23, 2015. Facebook Inc.s WhatsApp messaging service, with more than 100 million local users, is the most-used app in Brazil, according to an Ibope poll published on Dec. 15. Photographer: Chris Ratcliffe/Bloomberg via Getty Images
A woman stands holding her smartphone whilst framed against a wall bearing Facebook Inc.s 'Thumbs Up' symbol in this arranged photograph in London, U.K., on Wednesday, Dec. 23, 2015. Facebook Inc.s WhatsApp messaging service, with more than 100 million local users, is the most-used app in Brazil, according to an Ibope poll published on Dec. 15. Photographer: Chris Ratcliffe/Bloomberg via Getty Images
Psychiatrists can now gather collateral information on patients from social media. Stock photo: Getty

Patricia Casey

I attended the Royal College of Psychiatrists International Congress in London last week and one of the topics being discussed was the issue of psychiatrists obtaining information about their patients from social media and the internet.

Worldwide, one-in-four people have a presence on social media and it is therefore likely that a large proportion of our patients will also be visible on social media. Likewise, our patients frequently check us out on our hospital web pages.

For us psychiatrists, face-to-face contact is at the core of how we work. We take detailed histories from the patient so that we can understand the person's background, their past and current stressors and their points of vulnerability and resilience.

Much as the physician does blood tests and X-rays to assist in making a diagnosis, the equivalent in psychiatry is to obtain information about the person and their life from other sources that have a good knowledge of this person's life.

A question that is now being asked is to what extent we are justified in obtaining collateral information about our patients, from the most up-to-date sources of communication and information such as Facebook, Twitter, blogs and websites. It could be said that having access to a patient's current writings and activities is likely to be a valuable source of potentially relevant material.

To some, actively searching for this information might seem like snooping. The question is whether this is as sneaky as the word implies, or is it justifiable to seek additional material about patients from their online activity to assist us in understanding our patients? After all, if there were newspaper reports about some aspect of a patient's lives we would almost certainly read them and then file them in their medical records. Like newspaper articles, social media and websites are public documents, apart from Facebook 'friends', which are more restricted.

Arguments are also advanced that accessing our patients' social media involvement constitutes a boundary violation. Psychiatrists are very aware of such intrusions because of the very special relationship that we have with our patients who entrust us with information about their most tormented thoughts and disturbing impulses.

Yet, if information on websites, blogs and in media is public, how can reading this constitute an infringement? Some writers on this topic have suggested that permission from the patient should be obtained before such activity begins.

To date, studies dealing with this question have focused on psychotherapists/psychologists. For example a study in January 2016 of over 207 psychotherapists found that almost 40pc had checked their clients' information online when the therapists considered that they may have been lying.

Because this is a new area, definitive answers are lacking but the conversation has begun. There is a recognition that the imperative is to do the best by the patient. The information gleaned from sources such as blogs and social media might enrich the treating doctor's knowledge about the patient, especially if these have not been disclosed during treatment.

For example a young woman tells her doctor that her relationship with her mother is good, while at the same time aggressively castigating her on social media. This might suggest that either she, the patient, is not being fully truthful with her therapist, or that she is displaying bravado to her friends. Even without disclosing your knowledge about this contradiction to the patient, the discussions in therapy could now refocus so that the therapist will establish the true situation between the young woman and her mother.

Another example that demonstrates the grey area around this question arises when a person jumps into the river. Upon being rescued, he tells you, the doctor, that this was accidental while a blog prepared some two hours before the jump indicates that he had planned this so as to end his life.

If there is a downside to gathering information in this way, it is that the doctor-patient relationship might unravel because the patient has discovered that the doctor entered their psychological territory without permission. In instances such as these, we need to consider whether it should be disclosed or not.

Social media is here to stay and it has blurred the boundaries in the doctor-patient relationship. Until there are clear ethical guidelines to assist the doctor, caution is the best solution.

In an individual case when we have social media information, if the benefits of raising this with the patient outweigh the risks, as in the examples given above, than that may be one worth taking.

This is a judgement call and there are no definitive guidelines for psychiatrists just yet. So until then the motto should be 'patients first'.

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