當醫生上網搜索病人信息大綱

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.

我仍然清晰地記得我第一次谷歌搜索患者的經歷。那是我在骨髓移植科實習的最後一天，我與一個患者閒聊，她告訴我她是個畫家，並建議我去上網看看她的作品。我搜了搜，覺得她的畫着實精彩。因此，雖然我與她只有短暫的接觸，但她成爲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.

除了藝術作品，谷歌也曾帶給我一些其他的信息，一些常規的醫患交流（如詢問病史、服藥史等）無法帶來的東西。舉個例子，幾周前，我搜索發現我的一位患者在20世紀60年代曾是奧運會冠軍和世界紀錄保持者。這些信息幫助我更深入地瞭解患者，使我更容易與他們建立感情。

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.

醫生們確實會“谷歌”他們的患者，至少我認識的大部分醫生都這麼做。在我們這個年代，使用谷歌這類搜索引擎和在Facebook這類社交網站上分享子女或旅行照片一樣，都是順理成章的事兒。但是，讓我感到吃驚的是，許多醫生在“谷歌”他們的患者之前，從不停下來想想這種搜索將會給醫患關係帶來些什麼。

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.

萬一醫生們搜到一些不那麼溫馨或失真的信息呢?我最近讀到一個病例，說一個26歲的女士要求醫生給她做預防性雙側乳腺切除手術，因爲她的祖輩中很多人有患乳腺癌的病史。但是，這名女士拒絕接受任何檢查，而且她的醫療團隊注意到她關於家族史的敘述中也有幾處自相矛盾的地方。當醫生們在網上搜索這名患者時，他們發現她註冊好幾個Facebook賬號，謊稱自己有惡性腫瘤來募集捐款。在其中的一個頁面上，她甚至貼出自己剃光頭髮的照片，裝成進行過化療的樣子。此後，醫生們立即停止了對這名女士的“治療”。

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.

曾經有位虛弱的老年患者來我這裏看病，她感覺自己呼吸特別困難。我們沒能立刻探明原因，可她呼吸窘迫的問題卻一天重過一天。爲了查查她是否不小心攝入了什麼毒物，我安排她進行了一次毒品篩查。讓我大感意外的是，她的可卡因指標竟然呈陽性！對於一個像她這樣年齡和身體狀況的人來說，吸毒是無法想象的事兒，於是我擔心她是否經受了某種虐待，但她告訴我她完全不知道這些可卡因是如何進入到身體內的。

When I walked out of the room, a nurse called me over to her computer. There, on , 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.

當我走出診室時，一個護士把我叫到了電腦前。在上，我看到了我的患者年輕時的照片和她三十多年前因爲持有可卡因被拘留的細節。我將眼睛從屏幕上移開，頓時有一種侵犯了患者隱私的罪惡感。後來，我幫那位患者做完了剩餘的檢查，沒提起在互聯網上發現的她的那段歷史。她接下來的留院治療並沒有出任何意外。

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.

由於我們醫生對科技的依賴越來越深，在我看來，“醫生谷歌患者”的現象只會越來越普遍。但是，我仍然想強調：醫生們絕不應該去網絡上搜索關於患者的信息。更重要的是，作爲醫務工作者，我們應該反思：爲什麼我們總想去“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.

在我看來，去網上搜尋患者“足跡”的唯一正當理由是出於安全考慮。舉個例子，如果一個患者表現得瘋瘋癲癲，疑似有精神問題的話，去網上調查他可能會有助於確認他提供信息的真實性。或者說，如果醫生懷疑一個兒科患者曾遭到虐待，在網上搜尋證據會是一個理性的做法。醫生們也可以在他們擔心患者有自殺傾向或需要聯繫某位無正常反應的患者家屬時，上網搜尋一些信息。在我所居住的馬薩諸塞州，當患者被懷疑有濫用藥物的行爲時，醫生們可以查詢一個專業的數據庫來追查患者取得管制類藥物的各家藥房。不過，如果一個醫生上網搜索他的患者僅僅是爲了查看一些患者們不願分享的個人信息的話，這就是完全錯誤的。

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.

前幾天，我的一個家庭保健病人又來到診室，帶來了一些令人擔憂的消息。儘管用藥劑量增加了，他的恐慌症卻越來越嚴重。他告訴我，隨着他的生意越做越成功，他的壓力越來越大，恐慌症發作的頻率也越來越高。

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.

我走出診室，找到我的頭兒，跟他說起這個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.

“什麼樣的生意？”上級問。當我說我忘記了問患者時，他立馬在電腦上打開“谷歌”的頁面並輸進了患者的名字。

But before he pressed return, he paused.

但在按下“確認”鍵之前，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.

這很不尋常——我認識的大部分醫生從不猶豫。然後，隨着光標在屏幕上閃動，他按下了“刪除”鍵，直到患者名字裏的每一個字母在搜索欄被清除得乾乾淨淨。接着，他做了一件外科醫生們已做了幾個世紀的事兒：在患者身旁坐下來，問起他的故事。