当医生上网搜索病人信息

I remember when I first looked up a patient on Google. It was my last day on the bone marrow transplant unit, back when I was an intern. As I stood before the patient, taking her history, she told me she had been a painter and suggested I look up her work on the Internet. I did, and I found her paintings fascinating. Even though our paths crossed fleetingly, she is one of the few patients I vividly remember from that time.

我仍然清晰地记得我第一次谷歌搜索患者的经历。那是我在骨髓移植科实习的最后一天，我与一个患者闲聊，她告诉我她是个画家，并建议我去上网看看她的作品。我搜了搜，觉得她的画着实精彩。因此，虽然我与她只有短暂的接触，但她成为了令我印象最深的患者之一。

Google has taught me other things, too, things that don't come up during the routine history-taking or medication checks of my usual doctor-patient interactions. I learned recently, for example, that one of my patients had been an Olympic gold medalist and world-record holder in the 1960s. Knowing more about my patients as people helps build empathy.

除了艺术作品，谷歌也曾带给我一些其他的信息，一些常规的医患交流（如询问病史、服药史等）无法带来的东西。举个例子，几周前，我搜索发现我的一位患者在20世纪60年代曾是奥运会冠军和世界纪录保持者。这些信息帮助我更深入地了解患者，使我更容易与他们建立感情。

Doctors do "Google" their patients. In fact, the vast majority of physicians I know have done so. To my generation, using a search engine like Google comes as naturally as sharing pictures of our children or a recent vacation on a social networking site like Facebook. But it surprises me that more physicians don't pause and think about what it means for the patient-doctor relationship.

医生们确实会“谷歌”他们的患者，至少我认识的大部分医生都这么做。在我们这个年代，使用谷歌这类搜索引擎和在Facebook这类社交网站上分享子女或旅行照片一样，都是顺理成章的事儿。但是，让我感到吃惊的是，许多医生在“谷歌”他们的患者之前，从不停下来想想这种搜索将会给医患关系带来些什么。

What if one finds something that is not warm and fuzzy? I recently read about a case in which a 26-year-old woman went to a surgeon wanting to have a prophylactic double mastectomy, citing an extensive history of cancer in her family. However, she was not willing to undergo any work-up, and her medical team noted several inconsistencies in her story. When they searched online, it turned out she had set up multiple Facebook accounts soliciting donations for malignancies she never had. One page showed her with her head shaved, as if she had already undergone chemotherapy. The surgeons immediately decided to halt her care.

万一医生们搜到一些不那么温馨或失真的信息呢?我最近读到一个病例，说一个26岁的女士要求医生给她做预防性双侧乳腺切除手术，因为她的祖辈中很多人有患乳腺癌的病史。但是，这名女士拒绝接受任何检查，而且她的医疗团队注意到她关于家族史的叙述中也有几处自相矛盾的地方。当医生们在网上搜索这名患者时，他们发现她注册好几个Facebook账号，谎称自己有恶性肿瘤来募集捐款。在其中的一个页面上，她甚至贴出自己剃光头发的照片，装成进行过化疗的样子。此后，医生们立即停止了对这名女士的“治疗”。

I was once taking care of a frail, older patient who came to the hospital feeling very short of breath. It wasn't immediately clear why, but her breathing was getting worse. To look for accidental ingestions, I sent for a drug screen and, to my great surprise, it came back positive for cocaine. It didn't make sense to me, given her age and the person lying before me, and I was concerned she had been the victim of some sort of abuse. She told me she had no idea why there was cocaine in her system.

曾经有位虚弱的老年患者来我这里看病，她感觉自己呼吸特别困难。我们没能立刻探明原因，可她呼吸窘迫的问题却一天重过一天。为了查查她是否不小心摄入了什么毒物，我安排她进行了一次毒品筛查。让我大感意外的是，她的可卡因指标竟然呈阳性！对于一个像她这样年龄和身体状况的人来说，吸毒是无法想象的事儿，于是我担心她是否经受了某种虐待，但她告诉我她完全不知道这些可卡因是如何进入到身体内的。

When I walked out of the room, a nurse called me over to her computer. There, on MugShots.com, was a younger version of my patient's face, with details about how she had been detained for cocaine possession more than three decades earlier. I looked away from the screen, feeling like I had violated my patient's privacy. I resumed our medical exam, without bringing up the finding on the Internet, and her subsequent hospital course was uneventful.

当我走出诊室时，一个护士把我叫到了电脑前。在MugShots.com上，我看到了我的患者年轻时的照片和她三十多年前因为持有可卡因被拘留的细节。我将眼睛从屏幕上移开，顿时有一种侵犯了患者隐私的罪恶感。后来，我帮那位患者做完了剩余的检查，没提起在互联网上发现的她的那段历史。她接下来的留院治疗并没有出任何意外。

I am tempted to prescribe that physicians should never look online for information about their patients, though I think the practice will become only more common, given doctors' — and all of our — growing dependence on technology. The more important question health care providers need to ask themselves is why we would like to.

由于我们医生对科技的依赖越来越深，在我看来，“医生谷歌患者”的现象只会越来越普遍。但是，我仍然想强调：医生们绝不应该去网络上搜索关于患者的信息。更重要的是，作为医务工作者，我们应该反思：为什么我们总想去“谷歌”那些患者。

To me, the only legitimate reason to search for a patient's online footprint is if there is a safety issue. If, for example, a patient appears to be manic or psychotic, it might be useful to investigate whether certain claims the patient makes are true. Or, if a doctor suspects a pediatric patient is being abused, it might make sense to look for evidence online. Physicians have also investigated patients on the web if they were concerned about suicide risk, or needed to contact the family of an unresponsive patient. In my state, Massachusetts, doctors can also use a specialized database to track every pharmacy a patient took controlled drugs from — an especially useful tool when drug abuse is suspected. But if the only reason a doctor searches online is to gather personal information that patients don't want to share with their physicians, then it is absolutely the wrong thing to do.

在我看来，去网上搜寻患者“足迹”的唯一正当理由是出于安全考虑。举个例子，如果一个患者表现得疯疯癫癫，疑似有精神问题的话，去网上调查他可能会有助于确认他提供信息的真实性。或者说，如果医生怀疑一个儿科患者曾遭到虐待，在网上搜寻证据会是一个理性的做法。医生们也可以在他们担心患者有自杀倾向或需要联系某位无正常反应的患者家属时，上网搜寻一些信息。在我所居住的马萨诸塞州，当患者被怀疑有滥用药物的行为时，医生们可以查询一个专业的数据库来追查患者取得管制类药物的各家药房。不过，如果一个医生上网搜索他的患者仅仅是为了查看一些患者们不愿分享的个人信息的话，这就是完全错误的。

Recently, one of my primary care patients was back in clinic, with some worrisome news. In spite of increasing the dose of his medication, his panic attacks were getting worse. He had told me that as he saw his business success grow, so did his stress, and the frequency of his panic attacks.

前几天，我的一个家庭保健病人又来到诊室，带来了一些令人担忧的消息。尽管用药剂量增加了，他的恐慌症却越来越严重。他告诉我，随着他的生意越做越成功，他的压力越来越大，恐慌症发作的频率也越来越高。

I stepped out of the clinic to speak with my supervising physician. I related the patient's history, telling him about the growing success of the patient's business.

我走出诊室，找到我的头儿，跟他说起这个患者的商界故事和生意上的成功。

"What sort of business?" he asked. When I told him that I had forgotten to ask, he quickly flipped the window on the computer before us from an electronic medical record to Google and typed in the patient's name.

“什么样的生意？”上级问。当我说我忘记了问患者时，他立马在电脑上打开“谷歌”的页面并输进了患者的名字。

But before he pressed return, he paused.

但在按下“确认”键之前，他停住了。

This was unusual — most doctors I know don't pause. Then, with the cursor blinking before us, he pressed the backspace key, keeping it pinned until there were no more letters for the cursor to gobble up. And he proceeded to do what has worked for physicians for eons. He sat down next to the patient and asked.

这很不寻常——我认识的大部分医生从不犹豫。然后，随着光标在屏幕上闪动，他按下了“删除”键，直到患者名字里的每一个字母在搜索栏被清除得干干净净。接着，他做了一件外科医生们已做了几个世纪的事儿：在患者身旁坐下来，问起他的故事。