Mandatory monitoring of your digital phenotype?

I do not google my patients. I would get annoyed if my patients google me. (I’m aware that people have: I clearly recall a termagent from Human Resources who informed me — when meeting about a relative — that she would not have hired me because of something I said about the then PM on USENET).[1]

I am quite aware that any inforation on the work servers — at the clinical job — is accessible by official information act: the exceptions are when it breaks the privacy code. We are held to that: this means that those without (such has human resoruces, and worse, politicians) can say things we cannot reply to.

Because we will protect privacy.

It seems that some in the USA are breaking what should be a personal boundary.

And there are those who think that clinicians should monitor such. For our own good, of course.

Past APA President Paul Appelbaum, M.D., explored the ethical and legal implications of using a patient’s “digital phenotype”—which refers to the entirety of an individual’s online presence—as well as emerging technologies that may be used to track patients online in real time. He outlined five areas of concern that individual psychiatrists, and the profession generally, must think about with regard to use of a patient’s digital phenotype: accuracy of online information, clinical effectiveness and impact on patient care, efficiency in terms of the time and effort required to collect and assimilate online information, privacy concerns, and boundary considerations. A digital phenotype can include Facebook and other social media postings, emails, and comments on blogs and other websites. Appelbaum said the potential effect of all this new information on patient care is far reaching. “We are creating a new kind of medical record with all this information,” he said. “It creates a permanent record that once would not have been accessible, but now can be accessed by insurers or in legal procedures.” Some patients may actually ask their psychiatrist to monitor their Facebook posts. “It is not at all inconceivable that a patient could tell his or her psychiatrist, ‘I get into these online arguments, and I get very, very angry. I want you to see what happens,’ ” Appelbaum said. But doing so could open a door that psychiatrists had never anticipated, he suggested. “People are wondering if we might see a legal duty to monitor patients’ online presence,” Appelbaum said. “Legal duty depends on a standard of care. The standard of care is in the hands of our profession. To the extent that we begin routinely Googling or otherwise collecting collateral online information, we may be establishing a standard of care that will be enforced against us.”

I am always amused by those who think we can deal with such. I’m busy enough clinically: there is just enough time to see people and review what I have [2].

You do not want to be reading or monitoring everything. Even if you have permission there are two questions.

  1. Is this effective? There is, to my knowledge, one paper on machine learning for adverse events. I am aware of some research projects, but I have not seen their results. What I do know is that the current RANZCP guidelines (and the APA guidelines on self harm. do not recommend such because the base rate is low and Bayes’ theorem applies.
  2. Is it a good use of my time? I have about 20 hours of face to face, clinical time a week. (The rest of the time is teaching, administration, procedures and research). If I am to do such review, or even consider a report of such, does it add sufficient value to patient care that it should cut into clinclal time or liaison with families to ensure continuity of care?

The idea that this should occur is risky. We already have referrals via interpol from facebook. We do no want to be held to a standard of care that is impossible.

And I have no interest in any agency monitoring me. For my own good or not. That is the work of the holy spirit, for my salvation, or the narrative of this age, for the converse.

And lead me not to being a mandatory monitor, a big brother, to satisfy the hunger of the lawfare trolls and their legal minions.


  1. Twitter is for trolling and my Facebook profile is fairly locked down
  2. Not helped when notes are not available, or lost: or worse, digitized and placed on a server farm which destroys them. All happen.

One thought on “Mandatory monitoring of your digital phenotype?

  1. If this was to be become common practice and it was known that psychiatrists did this type of research on their patients, would that not reduce the likelihood of a patient to get help even if its needed?

    Probably

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