The Patient Will See You Now

We live in an age in which patients have powerful tools for finding out more about their physicians. In the same way that friends now share online opinions about their favorite restaurants, the usual word-of-mouth recommendations about physicians has extended to online forums. Many physicians find this perturbing and go to great lengths in a futile effort to suppress these online opinions. Some even resort to litigation to remove negative opinions posted on websites and blogs, claiming that they’re libelous. I know many physicians who are struggling with the need to promote their practice while hiding online details about their private lives. Some physician friends of mine are even concerned about their physical safety, as they’ve attracted the attention of patients who have gone beyond being merely fans. These patients have devolved into stalkers that comb the Internet in the hopes of finding a nugget of information that can assist them in their obsession to connect with the object of their desire.

For every reader who is experiencing a similar nightmare or who is worried that they too might become the object

of an obsessive patient’s attentions,

I’d like to pass along some secrets that these physician friends of mine shared with me. I’ll explain how their “suitors” found out about them, how they fought further inadvertent disclosure, and

how they have successfully continued an online private life with their loved ones. (To be clear, in this article, I am not referring to my own experience, to the experience of any of my professional partners, or to my place of employment, past or current.)

Your information is everywhere

One barrier to online privacy is that the practice of medicine is by necessity a public endeavor, since you have to let patients know when they can come to see you and list hours of operation on your practice website. Like many urgent care physicians, I don’t keep regular hours, so it’s harder to track me down, but most physicians have a regular schedule that establishes a pattern that’s easy to follow. Because of that, if they are leaving after dark at night, many of my friends ask for a security escort to their vehicle. It’s sad, but physicians are public servants and prime targets for stalkers. I’ve even heard of extreme cases in which the stalker hid inside the office, waiting for an opportunity when the physician was alone. Thank goodness none of my friends have been injured, and I hope it never gets to that. One measure of prevention is to not tempt stalkers by feeding their appetite with online details about your family and friends.

There is no privacy on the Internet. You need to be aware that anything you write online is public information. Even if you believe that you’re writing on a private website, there are many people who manage that site that have access to your writing. Lapses in online security have disclosed plenty of information to the public that was never intended to be on the open Internet. Even medical records, intended to be secured in private research databases, have been inadvertently exposed. You may feel safer by writing under a pseudonym, but the computer from which you write has a unique address, an “IP address,” that records the location and specific computer from where you’re writing. Even if you write from an Internet cafe, details of what you write can be used to triangulate your identity.

There are many unexpected ways in which folks can find out about you. Do three different Google searches: one on your name with “Dr” or “MD,” one on your home address, and one on your personal phone number, and you’ll be shocked at where these details can be found online. For references that list my home address and personal phone numbers, I e-mail the administrators of those Web pages and ask them to delete my personal information. You often find the e-mail address of the administrator at the bottom of the webpage. When Googling, don’t stop at the first page of search results, keep going through all of the pages just to make sure. Although you can’t help having your state license registration on a public page, hopefully the only other details on that page are your practice address and contact information. The same goes if you’ve registered your business with your local Chamber of Commerce; make sure their website only provides information about your practice, not your personal details.

When searching, you may also find references and information dating back to medical school and residency. Using these dates, stalkers can approximate your age, so some of my friends have argued in favor of removing dates of med school graduation from public webpages. More recent search results may link to your house sale or purchase, or renovations listed by the local paper, uncomfortably disclosing your home address. If you have given any PowerPoint CME presentations at grand rounds or to trainees, you often put your contact information and e-mail address on the last slide, which will appear online if uploaded for medical residents to review later. You may have published articles in journals whose abstracts appear online and often include your e-mail address—make sure it’s your professional e-mail address. If you have registered your practice’s website URL, the Who.is website (

http://who.is

) shows the address and phone number of the person who registered that URL, which in small practices is often handled by the doctor. Some physicians put their contact information and e-mail in the comments sections of blogs and forums in order to hear back from their favorite physician bloggers, musical artists, or performing arts groups. Guess what? Those details are searchable online. Even if the comment is made in a supposedly private website like Sermo (

www.sermo.com

), it’s easy to find the necessary information to register (medical school and year of graduation) and read your comments.

How can putting more public information online help protect your private information?

One unfortunate place that your home address has to be listed is your local City Hall. If your stalker is determined enough, they can go digging for the record of the purchase of your home since it is a matter of public record. Some physician friends of mine have been concerned enough to purchase their homes through trusts or use the name of their spouse to limit the chance that their home address could be ascertained. But even that might not be enough; I’ve known physicians who had to get restraining orders against particularly persistent stalkers.

The best way to combat inadvertent expo-

sure is to flood the Web with information you want your patients to know about you: your professional practice information listed on your clinic’s website, your philanthropic interests, and your community affiliations. There are two ways to increase the visibility of this information and make it come up higher in online searches. One is to submit the links to whatever sites you use

to promote your practice, such as the local newspaper, online directories by Google and Yahoo, your IPA, county medical society, or even Yelp. You’ll find these by doing a search on your name, and they should already come up early in searches. Increase the page rank (popularity) of your own site by encouraging more sites to link to it. Whenever you do a local talk, use your practice website as the contact information, and they may thank you online by posting a link to your website. You should always link to your practice website when you leave comments on blogs and other websites. If you write in support of particular philanthropies or community organizations, link to your practice website within the article or endorsement. Consider giving health education talks, and in the ad promoting your talk, link to your practice website. Consider answering health education questions in your local paper; they’ll usually post it online, where you can ask them to link to your practice website. You can do the same at sites like MedHelp.org (

www.medhelp.org

), where I answer questions as well. Post many answers, and that will quickly flood search results with the contact information you want people to know, as well as provide more links back to your site to increase page rank and thus searchability.

Facebook privacy issues

One uniform response I’ve had from physician friends who have been stalked is anger and an unwillingness to give up their social life online. They still want to share their lives digitally with family and friends. There are a few ways to make things a little more private, other than flooding the public Internet with what you want the public to know about you. For starters, stop writing about your private life on public webpages; consider just e-mailing friends directly. Many people find e-mailing less useful than updating Facebook when trying to keep family and friends up-to-date, but are worried about inadvertent exposure. Go here

www.facebook.com/settings/?tab=privacy

to learn more about Facebook privacy settings. I’ve set all of the privacy settings to make my information available to only those I friend request. I can also block specific users, a feature that’s been helpful for friends who have been stalked. Some of them have had to ask Facebook multiple times to intervene to block the many different user IDs that a persistent stalker may set up to try to “friend” them, but it stops after they remove their profile from “Public Search Results”. You may also want to remove your name from any “tags” of photos posted online by friends and family to limit more widespread exposure of your facial image. For my practice, I have a public Facebook page that is viewable to those who are not even signed into Facebook and that serves to redirect search results on my name to this public page. If you twitter about your private life, consider making your tweets “protected”

http://twitter.com/settings/account

so that only friends you’ve granted access to can read your tweets.

Efforts at maintaining online connections are worthwhile given the power these tools have to deepen our friendships with those we care about. It’s important though that you realize just who you’re keeping up to date with and prevent prying eyes from seeing your private life. With a little care when sharing information online, and a lot of effort at increasing the popularity of your public practice site, you can do it!

Dr. Choi is an

editorial board member and full-time family physician practicing urgent care as a partner at Palo Alto Medical Foundation, where he sees patients in clinic, as well as online via PHR.

MDNG