
Getting Googled by Your Doctor - dnetesn
http://cancer.nautil.us/article/225/getting-googled-by-your-doctor-is-the-new-normal
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kakarot
So what I got from this is that police feel like they can search your home
without consent over a facebook profile photo.

Nice.

He should have requested help from the ACLU, sued the person who made the call
that he needed to be forcibly taken in, and sued the police department for
illegal search, while making the case VERY public.

I was wrongfully committed once by a vengeful relative (not even blood) who
deceitfully pretended to be my guardian, making up shit about my state of
mind.

The government is still hounding my mother about the medical bills, which she
refuses to pay because she did not even find out what was going on until I was
committed and could not be released. I was kidnapped from her house and was
led to believe we were going somewhere else. Next thing I know, a police
officer is at the car window telling me we can do this the easy way, or the
hard way.

I take this kind of intrusion on personal liberty to be especially heinous.

~~~
alsetmusic
> He should have requested help from the ACLU, sued the person who made the
> call that he needed to be forcibly taken in, and sued the police department
> for illegal search, while making the case VERY public.

While I agree with you in principle, it should also be noted that some people
may not want their mental health treatment to become a matter of public
record. It may affect their future in unpredictable ways (employment,
relationships, legal disputes, etc). It could be used against them down the
road.

~~~
kakarot
That's the unfortunate truth... so he should have gone after a large
settlement, citing that very reason.

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jauer
I wish there was a way to give a psychologist all my online tracks (down to
Slashdot posts when I was 12), context of what I was thinking around the
posts, and along with the usual story of my life. Then diff it against
"normal" and provide advice--"because of X you seem to react Y so maybe try
Z".

~~~
quanticle
Dear god, I hope there isn't. While my online persona is pretty much the same
as my real-life persona, I know quite a few people who have more than one
online identity. I would hate to have someone characterized with a mental
illness because their psychologist came across their old tumblr or
livejournal.

~~~
busituykdu1222
The disagreement between the two of you is kind of paralleling an emerging
debate over trends in mental health assessment research.

Right now, there are large grants (from the federal government) being
dispersed to develop systems to basically scrape patients' social media info
and smartphone data (including things like GPS, accelerometer data, etc.) to
predict outcomes. There's other related research going on too.

Traditionally, assessment methods work more like an instrument: you introduce
a stimulus and record a response. I don't think that's going to change,
because of various advantages of that sort of data, but the utility of other
types of data is being actively discussed. You have privacy issues like are
being discussed here, but there are also practical issues like: what if your
severely mentally ill patient doesn't have a Facebook account they use
regularly? What if they don't even own a phone, or use it, which common?

Looking for patients on the web isn't uncommon. It's not really so much your
depressed office manager, it's your patient who is being court-ordered for
some service because they pulled a gun on their girlfriend and used the butt
of it to knock their 2-year-old over. Imagine that they come in, and you're
supposed to be monitoring their danger to self or others, and aren't willing
to say much to you, and won't consent to have you contact a third party, or
don't even have a third party to contact. If a situation arose where you could
find something on Google, would you refrain from searching it? What about an
online public government-run database? What about reddit? What about Facebook?
Where do you draw the line? Should the courts be ordering that psychologists
and psychiatrists be able to scrape your phone? Install an invasive monitoring
app? What if you haven't been convicted yet? What if you aren't charged with
anything, but have been deemed incompetent to make your own medical decisions?

~~~
quanticle
_If a situation arose where you could find something on Google, would you
refrain from searching it? What about an online public government-run
database? What about reddit? What about Facebook? Where do you draw the line?_

The courts have already answered this question for a different audience: the
police. There is already a rich legal body of knowledge and practice that
governs where and when searches are appropriate. That should be the _minimum
baseline_ for mental health professionals. If a police officer, a person
trained and vetted by the legal system to detect threats and use (up to
lethal) force to end them cannot access this data, there is no way that some
damn _civilian_ should have access. If you want access, get a court order,
just like a police officer, just like a state attorney. No court order? Fuck
right off.

In your case, I can easily see a judge saying that the person in question is
legally mandated to turn over social media accounts for some period of time as
a condition of their sentence or parole.

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notadoc
I find it hard to believe most doctors have the time to casually google
patients.

~~~
true_religion
Psychologists usually have self-imposed limits on the number of patients that
they see in total.

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Kenji
Never ever publicly tell stuff like that you're suicidal. It's a recipe for
disaster. People think they have to send police after you, lock you up and put
you under watch - mostly causing more harm and problems than good. They
actually think that it is morally okay to violate your freedoms in this
situation. Get help - the best way would be to talk to someone face to face.
Don't post morbid stuff on the net, you worry everybody crazy.

~~~
Houshalter
Are you saying it's not morally ok to stop suicidal people? You really
wouldn't even if it was your friend or loved one? Would you want them reading
comments like this, telling them to keep it secret?

~~~
Kenji
Yes, that is what I am saying. My respect for self-ownership and individual
choice runs so deep that if someone truly wants to die (not as in voicing
suicidal thoughts as a cry for help, but actually wanting to die), I'd respect
that. If someone has the right to live, they should have the right to die.

As for telling them to keep it a secret (at least to the public) - that is not
because I would mind. It's just an advice to protect themselves because
society tends to react to this stuff in extremely retarded ways.

~~~
Houshalter
Most people who attempt suicide and survive say they regret it. Usually almost
immediately. Suicidal moods are often temporary and they would be fine if they
waited it out. I might agree in principle that people have a right to end
their lives. But in practice it seems like suicidal people are not making a
perfectly informed decision and are better off being saved from suicide. And
suicide doesn't just affect that person, it affects everyone around them too
you know.

And therefore I honestly think comments like yours are dangerous. Telling
suicidal people to stay quiet and not get help they need, or even encouraging
them to do it.

This is something that personally affects me a great deal. I have a close
friend who often has thoughts of suicide. I dread that the day will come I
will find out they are dead, and I will be devastated. I'd do anything to
prevent that. Their moods are always temporary and they go back and forth from
being depressed to on top of the world in just a few days.

~~~
Kenji
>Most people who attempt suicide and survive say they regret it.

And later on they may regret failing their attempts.

>But in practice it seems like suicidal people are not making a perfectly
informed decision

Many people don't make perfectly informed decisions about a variety of things,
yet we allow them to exercise their freedom to do so.

>And suicide doesn't just affect that person, it affects everyone around them
too you know.

That's a stupidly selfish and ignorant argument of everyone around the person.
"You gotta keep on living because otherwise I feel sad." Not even considering
that the mourning of a death of a friend is nothing compared to the suffering
of a full-blown suicidal depression. If someone had terminal cancer and was
suffering horrible pain every day, you wouldn't tell them to go on because
them dying "affects everyone around them too you know".

>Telling suicidal people to stay quiet and not get help they need, or even
encouraging them to do it.

I did neither of those. I clearly stated "Get help". I clearly stated to seek
out dialogue, but not publicly over the internet. I never encouraged anyone to
kill themselves, I just want to protect the liberty of anyone to do it.

All in all, you completely misunderstood me.

------
zAy0LfpBZLC8mAC
How is that not illegal due to the simple fact that you are disclosing to a
third party who your patients are?

~~~
jlarocco
How?

~~~
zAy0LfpBZLC8mAC
By typing it into their search form and sending it to their server, and
especially on "social networks" by the further (non-)interaction with the
person?

~~~
true_religion
HIPAA rules specifically permit incidental disclosures that accompany a
permitted purpose such as relating to safety, patient communication, or health
treatment, including payment.

If your doctor has a reasonable reason to Google a patient beyond mere
curiosity, HIPPA would allow the search to take place because the revelation
of a name is considered a 'minor' disclosure, and was incidental and as
minimal as possible.

If HIPPA didn't have such exclusions, merely calling a patient by name in a
crowded waiting room would be a violation.

~~~
zAy0LfpBZLC8mAC
> HIPAA rules specifically permit incidental disclosures that accompany a
> permitted purpose such as relating to safety, patient communication, or
> health treatment, including payment.

I think those really are very different cases. For example, telecommunication
is protected by other laws. So, yes, a doctor may call you and even speak into
their telephone about your medical information, thus effectively transmitting
that information to their telco, but then, telecommunication providers are not
allowed to listen to calls or use the contents for marketing purposes, or
whatever.

> If your doctor has a reasonable reason to Google a patient beyond mere
> curiosity, HIPPA would allow the search to take place because the revelation
> of a name is considered a 'minor' disclosure, and was incidental and as
> minimal as possible.

First of all, it's not just the name being disclosed, it's the link to the
doctor that's being disclosed. And the question is: Well, was it minimal? How
do you determine that? And was it incidental? What are the criteria?

Imagine a doctor called everyone in their city, asking them if they knew
anything about their patient. Not out of curiosity, but because they are
trying to get a better understanding of the medical situation of their
patient. They are only disclosing the name, so it's a minor disclosure, right?
And also, it was just incidental, right? They didn't call to tell everyone who
their patient is, they called in order to collect information they thought
could help them!

Now, how exactly is that actually different from asking google? The number of
humans involved? What if you hired a detective to collect information on your
patient? At least, you then could put confidentiality clauses into the
contract, instead of giving the information to a company where your use of the
service implies accepting some TOS that allow that company to essentially use
the information to make money in any way the like!

> If HIPPA didn't have such exclusions, merely calling a patient by name in a
> crowded waiting room would be a violation.

Well, that doesn't seem like a particularly convincing argument to me. They
are physically present and essentially identifiable to the other people in the
room anyway, and essentially due to their own decision to go there. So, yeah,
there probably is a need for exclusions that allow this, but that example
doesn't really help with figuring out where the limits are or should be.

~~~
true_religion
I would say its' a gray area.

HIPAA exceptions in recent years have focused on both identifying information
and medical condition together.

For example, the NCIS exception allowing mental health staff to disclose to
NCIS if an individual should not be permitted to own a firearm due to their
mental state. That's a revelation of both the name and their medical
information.

Or the finance exception, that allows payment processors to know the names of
patients without requiring them to have a business agreement with the medical
agency and subject themselves to HIPAA rules. They have no access to medical
records and aren't sufficiently entangled with the medical practices so it's
been ruled that they are except.

Or the media exception, in which you can disclose that a patient is in
'stable' or otherwise condition in the ER if a member of the media calls for
them by name. In this case, the media already knew the name, and the
disclosure is deemed for the public good.

Now.... sharing a name with Google to receive completely public information
about a patient? That's not something that's specifically prohibited or
denied. It could be argued that Google had a 'need to know' just to deliver
the search result, and as others have argued, Google cannot connect an
arbitrary name search to a patient's medical history.

If it were to come up, the deciding factor would be was the search for the
patient's benefit? Name disclosures have historically been deemed to be
minimal if there's no other information attached, and HIPAA provides wide
latitude to doctors to use a patient's name in the ordinary course of business
or to further treatment goals by contacting people or organizations not
directly related to the patient.

> Well, that doesn't seem like a particularly convincing argument to me.

Keep in mind all of my examples are simply that... examples. They're not
arguments into themselves.

------
dontreact
I wish there was a way to explicitly consent for all my health data to be free
and public for any purpose.

~~~
intopieces
Be careful what you wish for. Making such information free and public could
open you up to all kinds of tracking and discrimination, not to mention higher
costs for insurance or credit.

Anonymize it and I'm there, though this certainly would not help in this
situation described by this article.

~~~
lettergram
Don't forget, they just ruined any opportunity for their children to also have
a anonymous genome.

Literally, if there is some hereditary disease, they may have just made it so
their kids can never get affordable insurance -_-

~~~
Houshalter
It's been illegal for awhile for health insurance companies to use genetic
information. And now they can't even discriminate against any preexisting
conditions.

~~~
intopieces
But how would you know if they had? My insurance bill doesn't give me a
breakdown of how they decided my premium. And how do you know that they won't
be able to in the future? Healthcare regulations are subject to the whims of
the current government.

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rdiddly
As a social media self-exile I have to laugh at the (emphasis mine)
"increasing openness of _our_ lives, which _we_ increasingly spend online..."
Who's this 'we'?

If someday I'm unfortunate enough to have to see a doctor, and they Google me,
they'll find nothing. What happens then? Will they have to do their job using
only the information I specifically provide them? Horrors.

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TazeTSchnitzel
I wonder what privacy law, particularly outside the US, says about this.

