Searching for a reputation: Your online presence is worth monitoring

The unanticipated magic of the Internet search engine is that it surreptitiously allows you to find out what's being said about you behind your back.

With so much information accessible just by entering your name, the name of someone you know, the name of a business associate or even the name of a patient into a search engine, any pretense of manners or decorum has long been chucked out the window when it comes to digging for dirt, or lack thereof. In fact, far from being seen as rude, self-searching in particular is considered a wise business strategy, a way to make sure you know what face you are portraying to your patients -- and your potential patients.

"From a reputation standpoint, the search engines are becoming a reference point," said Nolan Bayliss, co-founder of Chicago-based Naymz, which sets up online profiles for individuals and businesses, including physician clients.

Using search engines for this purpose has become so widespread that two leading dictionaries last year added "googling," for the eponymous Google company.

But whether it is googling, or Yahooing, or Alta Vistaing, the ability to find so much information so easily is raising questions for physicians about how much searching is too much -- particularly in digging up background on patients.

Googling yourself

Typing your own name into a search engine used to be considered a form of ego tripping. That is, until it became apparent how much people relied on googling to learn about other people.

"I think that if you're going to talk about Google, we first need to say Google is for the public and for everybody. And I think everybody should periodically google themselves," said family physician Joseph Scherger, MD, a clinical professor in the Dept. of Family & Preventative Medicine at the University of California, San Diego, School of Medicine. Dr. Scherger said he goes so far as to set up Google Alerts for himself and his family, so the search engine sends him an e-mail whenever a site pops up with one of his watch-names on it.

Online reputation management, a business concept that didn't exist a few years ago, has emerged to help physicians and others manage their Web profiles and put their best Google face forward. Online reputation management aims to raise or improve a person's standing on search engines, whether by solving problems from negative opinion showing up high on Web searches or by creating devices to make client John Smith stand out among the multitude of other John Smiths.

Though there are sites devoted to doctor ratings, and bloggers and message boards on which people will complain about their physicians, experts say most doctors' biggest problem is that they have no online presence. But this also can be an advantage, giving those physicians a chance to manage their profile before it gets managed for them, said Andy Beal, founder of Marketing Pilgrim, an online reputation manager in Raleigh, N.C.

"Any professional should lay the groundwork ahead of time so they've got their profile on Flickr [a photo-sharing site], got a personal blog, a business profile, a membership profile, so they're laying the foundation so Google has positive or neutral stuff," he said. "That way, if something negative happens, it's hard to get in the top 10."

Some companies, such as Bayliss' Naymz, offer a platform to aggregate your appearances on the Web so that everything you want to be known about you appears on one site. Professional online manager services can range from as little to $50 a year to hundreds or thousands of dollars, depending on the level of service.

Of course, if you actually did something wrong, online reputation management can go only so far.

But experts say if you find information that is not true, or if you see a trusted patient expressing frustration, it's worth initiating a conversation. The key is to be cordial and professional, and to remember that "if you retaliate, that would end up on Google, also," Dr. Scherger said.

So if it appears that the person denigrating you could be troublesome, or if the comments are on a site that seems troublesome, it's best to just let it go.

Googling other people

For employers in Finland, it is illegal to use search engines to look for background information on job candidates. Everyone else can pretty much google to their heart's content, checking out prospective, current and past employees, business partners or physician partners.

The Connecticut-based executive search firm ExecuNet last year said 77 of 100 recruiters use search engines to dig up information on job-seekers, and many other surveys point to the increasing use of Google and social networking sites to get information on potential employees.

Neurosurgeon Joe Walker, MD, founding partner of the eight-physician Sierra Neurosurgery Group in Reno, Nev., is glad he used Google to find information about a potential business employee. The night before the job interview, Dr. Walker said the search engine led him to newspaper accounts of possible financial chicanery at the candidate's past job. The next day, Dr. Walker said he and the other doctors asked the unpleasantly surprised candidate about what happened.

Since then, the practice has used Google as "one more arrow in the quiver" for checking out job candidates, Dr. Walker said. "You can pick up some information you wouldn't normally find."

But searchers have to be careful they are not branding the wrong person through a faulty search.

His common name has made Dr. Walker familiar with the need to reshape searches by adding specific terms, such as "neurosurgeon" or "Reno," for himself. He does similar refinements to increase his chances of getting more accurate results from searches on potential business partners.

Googling your patients

Legally and ethically, so far, anyone (except those Finnish employers) can search for, and act on, information about themselves and anyone else with impunity. But debate is just beginning on if, or when, it's OK for physicians to google their patients.

An October 2006 letter to the Journal of American Psychiatry described a hypothetical situation in which a crack-addicted man being seen at a crisis center repeatedly denied any ideas of suicide. But then a resident performed an Internet search and found a recent newspaper article about this same man being admitted to a psychiatric hospital after jumping off a bridge.

"I'm still a believer in the old-time medical interview and getting the information from your patient," said Ardmore, Pa., psychiatrist Gregory Neimark, MD, the letter's lead writer. "But, especially in cases where it's unclear, where you have doubts, it's useful."

Even if physicians accept that patients are googling them, not every physician agrees it's a good idea to google back.

"Let's say you google a patient and you find information out about the patient. Should that be put in the medical record?" Dr. Scherger asked. "What is slowly happening is the medical record is increasingly being owned by the patients themselves. The rule of nothing about me without me -- you don't put anything in the medical record that I [the patient] don't approve of."

Also, if physicians do google, should they tell the patient?

"I don't know the answer to that," Dr. Neimark said. "It has an effect of parentifying the situation. I think in some ways the article I wrote specifically avoided that issue because it's an emergency situation.

"The nature of the relationship is we have a fiduciary obligation to [patients], and we are bound by ethics, and the onus is on us to be ethical in our approaches to new media."