Interesting Question …

There was an interesting question asked of Randy Cohen, who writes The Ethicist in the New York Times Sunday Magazine:

I interview high-school seniors who apply to my alma mater. I routinely Google these students and discovered that one posted information on his blog that reflects poorly on him. May I ask him about the blog? May I mention it to the university? Should it affect the score I give him?

Cohen had an interesting answer:

Put down the mouse and step away from the computer. You should not Google these students in the first place, let alone make your dubious discoveries a factor in college acceptance.

You would not read someone’s old-fashioned pen-and-paper diary without consent; you should regard a blog similarly. Your reading this student’s blog is legal — he posted it voluntarily, and in that sense it is public information — but not every young person grasps this. Many unwisely regard their blogs as at least semiprivate. You should not exploit their youthful folly. Indeed, so befogged are students about online postings — especially to FaceBook, MySpace and the like — that universities commonly devote a portion of freshman orientation to wising them up.

Phillip Burns, who works in the office of student conduct at the University of Nevada, Las Vegas, says, “Many of us in the field have put great time and energy into educating our students on the potential risks involved with online communities and want them to realize how — once posted — that information is out there for pretty much anyone to see and use.” U.N.L.V. itself does not seek out online information in evaluating applicants.

Because such material will not be considered for most students, it is unfair to subject your interviews to this additional scrutiny. What’s more, such online info is unreliable, even when posted by the person himself, as many an Internet dater has learned to her peril. Not every six-foot guy with a head of rich luxuriant hair would be recognized as such. Not in person. Not by his wife. (He’s married? That liar! That tiny, bald liar!)

As to this blog affecting your view of the student, how can it not? You can’t unread it. It’s bound to influence you, and that is part of the problem.

UPDATE: Lublin checked with the university and was told not to ask the student about the blog but to include its URL with his report.

I’m not quite sure that I agree with him. His answer is based, to some extent, on the premise that what people post to their blogs is “… at least semiprivate …” – whatever that means. I’ve come to understand that whatever is posted on the internet is most definitely public. And as such, it is not privileged or protected. The real question is whether or not applicants to a university should have their backgrounds looked into, and if so, how far. Certainly universities look into students backgrounds to a limited extent: they require letters of recommendation, transcripts and test scores. But those items provide only a limited picture. An applicant may choose to solicit recommendations from thre 3 teachers who he has good relationships with, but not the 8 who feel otherwise. If the school or teachers don’t know that the student was arrested for DUI or like to make YouTube videos showing small animals being tortured, then the university may not know the full extent of the applicant they are accepting.

If posting one’s not-so-bright exploits on a blog, or in a video, or as a series of publically available photos reflects poor judgement, shouldn’t universities be allowed to evaluate applicants and taken into account that that applicant may have poor judgement that could cause problems in the future? What does one make of the ability of college applicants to comb through student-written reviews of university faculty available on-line at sites like RateMyProfessors.com – reviews that are in no way, shape, or form objective, while colleges shouldn’t Google the names of applicants to look for any serious “red flags”.

The reason I bring this up in this forum is because of an interesting discussion that was held over on Sermo. For those of you not familiar with Sermo, it is an online community of physicians where questions can be asked of the community and, similarly, answered by the community (or a subset thereof). It’s not unlike AskMetaFilter – just medical.

In any case, someone recently posed the following question to Sermo:

Is it ethical to “Google” your patients?

We all experience difficult patients that are not always completly honest with us? I read in some comments on another post that some physicians will preform an informal background check on their patient by “Googling”. I’m not sure if this is productive or ethical. Is it OK to use any resource at our fingertips to dig up information on our patients even without their knowledge? Are there HIPPA implications here?

Needless-to-say, this elicited a number of comments. Also, a “poll” of 135 physician respondants showed that 88% said, “Yes, any information in the public domain is fair game” while 11% said, “No, it is not ethical or legal to search for further information about your patients outside of what is disclosed when taking a history”. Some of the comments were very thought-provoking. I can’t link to the page because Sermo is a member-only community, and I won’t repost the page because I don’t want to violate the privacy of the people who answered. However, I can tell you that a fair number of people answered along the lines of, “I’ve never thought of doing that!”. Here’s an anonymized sample of some of the more interesting responses:

  • “If the patient makes your radar go off and you’re suspicious of something, anything out there is fair. I don’t think there is any HIPAA violation because most of what you would find on Google would have nothing to do with their health.”
  • “Doctors are such funny creatures, we run so afraid of everything. Is is unethical to look at public information about people who are coming to your office? You do not even have to “accept” patients for treatment if you do not choose to. Of course it is OK to look up this information, and there is absolutely nothing about this that violates HIPPA … If you need some information about a patient, then look it up. If you are nosey and gossiping and just plain snooping, then I guess you know the answer. You must look at what is your true motive for researching this information on your patient and determine is it right”
  • “I work part time in an urgent care in [a place with a lot of entertainment personalities], i google people i “kind of recognize” all the time.”
  • “I would consider the Googling of patients highly irregular, unethical and probably a violation of HIPPA. Could you take your patients name and walk to the courthouse and ask a clerk to do a search for you – I think not. Don’t think for a minute that because yuo’re in the internet that no one knows what you’re doing and there is not an electronic fingerprint of the queries you make. Patient – physician confidentiality is the cornerstone of what we do — breaks this and god help us. By the way HIPPA was meant to expedite transfer of medical information — it was not meant as carte blanche to take your patients information and google it.”
  • “If a local newspaper publishes an article about one of our patients, are we prohibited from reading it? If there is a public record of an event that involves one of our patients, are we forbidden from reading or having knowledge of that information? Yes, there is bogus information posted on the web — but there are also numerous valid news sources and community information sources that have just as much validity as our newspapers or our local television newscasts. Is there a difference between seeing information on a computer screen instead of on the page of a newspaper?”
  • “I google patients often, and you would be amazed what I have found. Here are a few examples.A well dressed father brought in his XX year-old son, who had fallen out of a second story window and was in excruciating pain. Father said his son was allergic to everything except oxycontin. I searched the father’s name on the county website and found half a dozen arrests for drug related offenses. I called the narcotics squad of the police department and eventually learned the father had gotten prescriptions for his son from several physicians and emergency departments in the past month … A mother brought in her XX year-old son for treatment of ADHD and unsocialized aggression. The boy’s father had been in prison. There was something that worried me about the way the family acted, so I googled the father. He had escaped from prison and was on “America’s Most Wanted!” I did not say a word. Later that night father was arrested. At 3 AM I heard a knocking on my front door. I figured mother assumed I had turned in the father, so I did not open the door. I later learned mother had left her purse in my office, but I am still glad I didn’t open the door.”
  • “Who said patients have the right to tell us “only what they want us to know”? The whole concept of confidentiality is that they feel safe to tell us EVERYTHING and we will not tell anyone else. Whenever I get the feeling that the patient is not being honest with me I explain “we do not seem to have the rapport that is necessary for a good physician-patient relationship, and therefore…” without being specific. I don’t do tests unless different outcomes will lead to different next steps, and I don’t ask questions unless dfferent answers will lead to different next steps. But since a dishonest or evasive answer can lead to a WRONG next step (just like an erroneous test result) I have to insist on the truth if I am to treat the patient correctly.”
  • “Patients “google” us all the time. But then again, who amongst us has time to “google” patients”