To the Editor: In this letter, we describe a novel and potentially important way in which the Internet has influenced our practice of clinical psychiatry—the use of the Internet as a collateral informant in the psychiatric encounter.
“Mr. J” is a 38-year-old man who came to our crisis response center with suicidal ideation without a plan. Recently, the patient had been kicked out of his girlfriend’s house because of his ongoing abuse of crack cocaine. The resident on-call performed a medical history and physical examination, including a suicide risk assessment, but the patient’s denial of prior suicide attempts led the resident to believe that the patient was at low risk for suicide overall. While writing the patient’s medical history and physical examination results, the resident decided to perform an Internet “Google” search on the patient and discovered a newspaper article from 3 months earlier detailing how Mr. J was pulled by police from a nearby river and admitted to a local psychiatric hospital after he jumped off a major bridge in what was described as a suicide attempt.
Internet search engines such as Google process billions of websites in a matter of milliseconds to produce a hierarchical arrangement of “hits” that match the search criteria. Thus, entering an individual’s name into a search engine can reveal interesting results, ranging from newspaper articles to personal Web pages to court cases that are a matter of public record. In the case presented, a single Internet search, performed in a matter of milliseconds, revealed information that would be vital to determining the patient’s ultimate disposition.
While Internet-based mental health screening (1) and treatment (2, 3) applications have been examined, there has been, to our knowledge, no investigation into the role of Internet-accessible personal information in the clinical evaluation of psychiatric patients. Our case illustrates some of the ways in which the Internet can be used to aid decision making in clinical situations. Although the information gleaned from the Internet frequently has, at best, an adjunctive role, this data can be, at times, invaluable in the decision-making process.
What are the implications of having these new and powerful, fast, and free data sources at our disposal? Should all of our new patients be “Googled”? Should they be informed that we are indeed “Googling” them? How should we assess the quality and accuracy of Internet data? What about other potentially useful, although perhaps more controversial, sources of information on the Internet? Many states now have websites that list parole absconders and wanted fugitives and offer online registries of sex offenders. In addition, elements of patients’ financial, criminal, and civil histories can be obtained on the Internet. What, if any, role could and should this sort of information have in clinical evaluations, and what are the ethics of this? We hope that this letter is only the beginning of further exploration and discussion of these complicated and exciting new issues involving the role of the Internet in clinical psychiatry.
1.Houston TK, Cooper LA, Vu HT, Kahn J, Toser J, Ford DE: Screening the public for depression through the Internet. Psychiatr Serv 2001; 52:362–3672.Winzelberg AJ, Classen C, Alpers GW, Roberts H, Koopman C, Adams RE, Ernst H, Dev P, Taylor CB: Evaluation of an internet support group for women with primary breast cancer. Cancer 2003; 97:1164–11733.Farrell SP, Mahone IH, Guilbaud P: Web technology for persons with serious mental illness. Arch Psychiatr Nurs 2004; 18:121–125
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