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Beyond Googling: The Ethics of Using Patients' Electronic Footprints in Psychiatric Practice

Fisher, Carl E. MD; Appelbaum, Paul S. MD

doi: 10.1097/HRP.0000000000000145

Electronic communications are an increasingly important part of people’s lives, and much information is accessible through such means. Anecdotal clinical reports indicate that mental health professionals are beginning to use information from their patients’ electronic activities in treatment and that their data-gathering practices have gone far beyond simply searching for patients online. Both academic and private sector researchers are developing mental health applications to collect patient information for clinical purposes. Professional societies and commentators have provided minimal guidance, however, about best practices for obtaining or using information from electronic communications or other online activities. This article reviews the clinical and ethical issues regarding use of patients’ electronic activities, primarily focusing on situations in which patients share information with clinicians voluntarily. We discuss the potential uses of mental health patients’ electronic footprints for therapeutic purposes, and consider both the potential benefits and the drawbacks and risks. Whether clinicians decide to use such information in treating any particular patient—and if so, the nature and scope of its use—requires case-by-case analysis. But it is reasonable to assume that clinicians, depending on their circumstances and goals, will encounter circumstances in which patients’ electronic activities will be relevant to, and useful in, treatment.

From the Department of Psychiatry, Columbia University College of Physicians and Surgeons.

Original manuscript received 28 June 2016, accepted for publication subject to revision 16 September 2016; revised manuscript received 26 October 2016.

Correspondence: Paul S. Appelbaum, MD, Division of Law, Ethics, and Psychiatry, Department of Psychiatry, Columbia University College of Physicians and Surgeons, 1051 Riverside Dr., Unit 122, New York, NY 10032. Email:

© 2017 President and Fellows of Harvard College
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