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How the Internet Can Hinder the Doctor-Patient Relationship March 2015

Dr. Douglas Drossman Blog, News, Uncategorized Comments Off on How the Internet Can Hinder the Doctor-Patient Relationship March 2015 , , , ,

IDoctor And Patient Teamt is no surprise that many patients take to the internet to search for health information, find support from other people who share similar health conditions or experiences and research doctors and other healthcare providers via online review sites often basing their decision on who to seek care from on the number of stars or the content contained in the review.

But while the internet has an important role to play in healthcare, empowering patients to take a more active role in their health, the internet can also do more harm than good especially when there is an endless amount of information available to patients online, making it difficult for them to ascertain among other things, which sources are credible, whether the information is based on scientific evidence and whether or not the information is relevant and accurate for their (or their loved one’s)particular health condition.

bigstockphoto_Hand_Type_Computer_369004Let’s consider some of the scenarios where a patient’s online hunt for information can impact both the patient and the provider in challenging ways:

  1. Googling for Answers: People who search using very common symptoms (i.e., diarrhea, constipation, nausea, abdominal pain) without much other qualification. This gives a very large number of possibilities that really take medical knowledge to sort out.
  2. Self-diagnosis: To make things worse patients are vulnerable to “med student syndrome”. When a medical student has a symptom and they look it up – what do they focus on? The worst possibility. When I was a 4th year med student I took an elective in Denver Colorado for a month. I was on hematology (specialty of blood diseases). Two weeks in I took my own blood smear and looked under the microscope. Based on all my new knowledge, I found these unusually large cells. I checked the photographs in the books and sure enough they looked like the cells seen in acute leukemia. As it turned out these were reactive lymphocytes, which became larger in response to the high altitude. But how would I know that with my limited knowledge?
  3. Information overload: Some patients may run the risk of going to the doctor armed with their new information from the internet and then put the physician in a defensive position. “How do you know this isn’t pain from pancreatic cancer? I just read about it and have those symptoms!” The physician may practice defensive medicine and order tests just to satisfy the patient when it’s not really indicated, or conversely may stand ground and appear confrontational to the patient. It’s also possible that the doctor might not even have thought of the possibility. A good doctor would say “let me look into that and get back to you”. But beware of the doctor who strongly argues the case; egos may be hurt.

On the positive side, with a good patient-provider relationship (as we seek to promote in our practice) the relationship is a partnership not a confrontation. The patient can bring ideas from the internet and the provider can put it in perspective. Here are some examples of how a doctor might respond in a positive manner: “Yes you have pain that seems like pancreatic cancer, but a year ago the CT was negative; if you had pain from cancer it would have been seen then. Let’s move on now to managing your functional GI pain” or if the physician is not sure, “let’s consider this and other possibilities further.”

Watch this video demonstration, “Doctor, I want a CT scan,” where I respectfully approach a delicate and common situation when a patient is pressing, despite medical advice, for additional testing to uncover the cause of certain symptoms.

From the physician side there are problems as well. Consider the following:

  1. Doctors are forced to spend more and more time online with the electronic medical record (EMR) which I believe is more for billing purposes than to help the patient. Too much attention to the computer during the office visit can take away from good communication.  See my blog post on the EMR
  2. Many doctors in practice need to maintain their practices through referrals. With specialties at major medical centers it may come from other specialists or primary care. But for community doctors they also need to rely on their patients’ recommendations: “Dr. Jones….he’s the best! He really takes the time to listen.” Now there are patient evaluation sites like Health Grades, Vitals, etc. where patient evaluations of their doctors can be compiled. The good news is that if a provider consistently gets glowing reviews you can expect a good clinical interaction with your appointment. And, for the most part people like to give good reviews. However, you don’t need more than one angry patient to make a doctor look like an ogre. So one or two bad reviews doesn’t necessarily mean there is a problem. Be aware that there really is no good way to judge the quality of the doctor’s technical skills in diagnosis or treatment from the patient perspective; for the most part what the patient is judging is their interpersonal skills. For technical competence and good knowledge, check their training credentials and the hospitals where they work. Ideally you want both features.
  3. Some doctors may try to encourage good comments. There are examples of doctors who might prescribe medications e.g., opioids to satisfy some patients with pain when it might not be medically indicated.

Yes, the Internet is rapidly changing the doctor-patient relationship by giving patients the opportunity to assume much more responsibility for their own health care—and there is no doubt this increased empowerment of patients is challenging the traditional role of the physician in providing care. I urge patients to also recognize the ways in which the Internet can hinder their relationship with their physicians and potentially impact the delivery of care. Additionally, I encourage healthcare providers to be mindful of the ways patients are using the Internet in relation to their health—and learn how the vital role of effective communications can help foster a collaborative physician-patient relationship that achieves quality delivery of care.

 

Douglas A. Drossman, MD