Of course as professionals we do discuss our patients if we require supervision or consultation. But this implies that we have a formal relationship with our consultant or supervisor and that they assume the same responsibility we have to safeguard a patient's privacy. In short it is on a need to know basis. Those we bring in can be held just as responsible as ourselves, the actual therapist, if our client’s privacy is compromised.
Unfortunately few if any of these conditions are met on Internet discussions boards. We cannot assure “need to know” since we cannot know who will be getting copies of our correspondence. We might as well let drop copies of our patient’s records out of windows.
On the Internet, in most cases, we do not have any formal agreement with other discussion group or list members including the list owners. We often have no way of knowing if they are professionals or not. Therefore we cannot ethically and possibly legally give them confidential information on our patients. They are neither formal supervisors nor formal consultants contracted to protect the information. [2]
For years now, I have been warning my colleagues about the dangers of such online discussions. Recently it was reported to me that perhaps some progress is being made. But is it enough?
Some of my colleagues who once were critical of me for my warnings are now calling for caution. Where once they called for case discussions on non-secure discussion groups or listservs, now they are advising some minimal caution at least.
It seems that one member of a prominent therapist discussion group recently posted actual case notes of one of their patients. A least that is what the list owners thought. A notice went out pleading with the entire list not to post case material but send it first to the list owners for reworking or disguising the identity of the client mentioned.
I have to recognize this as a sort of progress even if it's minimal but it is still fraught with problems and dangers. It is a beginning I suppose. Unfortunately there still is a long way to go.
The problem is my colleagues still are missing one critical point. Even if a therapist on such a list sent the material to the list owners first, does the therapist have the right to send confidential information to other colleagues where there is no formal consultation or supervisor relationship? In my opinion a review of professional standards and most state laws require informed consent unless there is a formal supervisory/ consultation agreement. Even then one can argue that the patient should be so informed as to who besides the therapist will have access to case information and or records
Among the many dangers of therapist discussing patient online even if they first send the actual information to the list owners is there is no way of being sure that the list owner has the competence to protect confidentiality. What if the list owners error and violate the patient’s confidentiality? Once a therapist emails a record to someone they have lost control of the material. The therapist and the patient are at the mercy the receiver. Who is to be held accountable in such situations?
I have no doubt the list owners meant well. But good intentions without competence or knowledge of standards can be just as harmful as malice.
From what I have been told the list owners actually went to the trouble of deleting the particular post from the list. They thought they solved the problem or at least conducted some from of damage control. The case notes still went to several hundred people but at least they are no longer in the list archives.
The owners also sent out a plea that other members should not send their case records to the list. Here is where lack of competence comes in. In their warning to the entire list they hit reply to a post, which contained the records/notes. Thus another copy of the records when out to the several hundred list members. An error no doubt, but if these were an actual record/notes there would have been a double breach of confidentiality. And there is no telling how many more times these notes can be posted again on this list or else where. [3]
It takes time for therapists to get up to speed on online confidentiality. I am optimistic that it will evolve. I only hope that too many patients will not be harmed until them.
If you are in therapy and value your confidentiality you should make it very clear to any therapist that you do not want your therapist discussing ANYTHING about you in unsecured online discussion groups. You may need to get your therapist to give you such assurances in writing and hold them accountable
1] I have been on tour of Australia and Southeast Asia for the past six months
[2] Too often practitioners do not wish to pay for supervision or consultation and use Internet discussions as a cheap way of getting help. But it is often at the risk of the client’s privacy.
[3] The good news is that the therapist who posted the original email claims that he or she radically disguised the notes, which all patient Identifying info was disguised. The individual was merely giving an example of how to write a progress note. This of course would be acceptable since no actual patient was involved. But the list owner did not know that when they sent out copies to several hundred strangers
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