Today, on Twitter, I got pulled into an exchange about whether or not client reviews on websites can be assumed to be waiving their confidentiality rights. Thank you to @dr_wayne and @TherapyOnline, my two co-discussants in online ethical dilemmas.
The conversation started in response to this posting describing how clinicians are more free to respond to anonymous reviews and explaining how requiring people to post with real names is not great for health-related businesses (or the clients who wish to review them), as it would violate our pledge of confidentiality.
This is an area in which we need to exercise restraint and caution. Clients reviewing us on a website, no matter whether their real name is used, is not the same thing as their signing a release of information authorizing us to discuss their care. Even when we do get such releases of information, we can discuss only the minimum amount of necessary information, and only to people who are involved in their treatment.
While it can be tempting to defend our professional reputations on online review sites, I’d argue that this is not a necessary sharing of information relevant to an individual’s treatment. It is an unjustified breach of our primary obligation of confidentiality, disclosing a treatment relationship to a wide public audience, let alone one that is clearly not involved in their care. Yes, negative online reviews are problematic, but we need to consider other ways of managing this. And let us remember, that clients do not owe us confidentiality. This is a one way street.
This is also a good time to look back at what our agreements are with clients at the outset of treatment. If we outline the limits of confidentiality and we do not state that online reviews constitute an exception to this on our part, it is a huge breach to disclose this information whether or not we like the review a client has left of our practice.
There have been cases in which physicians have attempted to limit the freedom of speech of clients by requiring treatment agreements that care can be terminated if the client posts an online review. Others have tried to assert copyright ownership over online reviews left by their clients. Perhaps physicians and clinicians would be better off outlining how they intend to respond to reviews instead and making this part of treatment agreements.
It is my belief that clients have a right to disclose their relationship to us with anyone they choose, without a threat of our disclosing their health data.
Similarly, if an individual tells a friend or their spouse that they see us in psychotherapy, this does not mean we have a free pass to discuss them with these people. If a client tells a room of people that they met with us and loved us (or hated us) we are not permitted to talk to those people about their care.
Should a public forum on the Internet be any different? Why or why not?
Do you think a client leaving a review should mean their clinician can comment about their treatment?
Note: comments are now enabled on this blog. I’d love to know people’s thoughts and responses to this.