The Internet as Collateral Informant

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.

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.