How and in what ways does patients’ Internet health information-seeking behaviour influence the patient-physician relationship?
The rapid proliferation of health information on the Internet has resulted in more patients turning to the Internet as their first source of health information and acquiring knowledge on their health conditions before seeking a professional diagnosis.
This is changing the ways that patients interact with healthcare providers. Gone are the days when individuals passively received health information and interventions, assuming that a doctor held all the answers. Nowadays, it’s increasingly common for patients to find resources and/or seek out additional information online.
With online health information becoming increasingly popular among patients, this may change the way in which patients interact with and participate in consultations with their physicians and how they feel about their relationship with their physicians.
When researchers Sharon Swee-Lin Tan and Nadee Goonawarden systematically reviewed existing research on patients’ Internet health information seeking and its influence on the patient-physician relationship, they found that it can improve the patient-physician relationship depending on whether the patient discusses the information with the physician and on their prior relationship.
The impact of patients seeking online-heath information on the clinical encounter
In their review, Swee-Lin Tan and Goonawarden point to two over-arching concerns.
(1) Misinformation on the web
With the quality of medical information on the web ranging from peer-reviewed to personal blogs and anecdotes of other patients, patients may not possess the necessary skills to evaluate medical information and relate it to their own health circumstances. Therefore encouraging patients to discuss their Internet information searches is increasingly important, given that acquiring information on the Internet has the potential to misguide patients with inaccurate information.
(2) Satisfaction and trust in physician
When patients’ online findings do not align with physicians’ diagnosis or treatments, concerns have been raised as to how a patient’s appointment satisfaction and trust in the physician would be affected, and how conflicts could occur between the physician and patient – physicians could feel threatened by the information and respond defensively by asserting their “expert opinion.” This may then result in dissatisfied patients who may seek a second opinion, change the physician, change their treatment plan, or self-medicate using recommendations found on the Internet.
Facilitators of discussion of online findings during consultations
The review highlighted 3 facilitating factors that encouraged patients to discuss online health information with their physicians:
(1) Having a family member present at doctor visits
Having a family member present would help patients remember what to ask and made the context more comfortable to share online findings.
(2) Doctor-initiated inquiries
Some patients reported incidences of doctors’ positively encouraging patients to search the Internet for information.
(3) Encountering a treatment-related advertisement that suggested talking with a doctor.
Online advertisements or recommendations about certain medications and treatment prompted some patients to initiate a conversation with their physicians.
Barriers to discussion
(1) Concerns over how physicians would react
The most common barrier to patients’ willingness to discuss their online findings was that patients were skeptical of how physicians would react: “patients were afraid doctors would perceive them as “challenging” and “confrontational” if they discussed their health condition from a more informed point of view during consultations.”
(2) Physician resistance to discussion of Internet information
The second most common barrier for patients was “the resistance or discouragement from physicians encountered when patients tried to discuss their Internet information research during consultations.”
Conflicts arising from physicians and patients having different interpretations of the online information (when patients valued this information more) had adverse implications for the patient-physician relationship, resulting in higher levels of patient anxiety, confusion, and frustration.
Patients also felt that some physicians reacted in a way that “implicitly or explicitly discredited the patients’ ability to become informed via the Internet, presenting serious barriers to shared decision making during consultations, with the physicians asserting their authority by dismissing patient-acquired knowledge.” As a result, “patients carefully observed their physicians before deciding whether to reveal their Internet research, and patients would only bring up their Internet health searches if they felt the situation was right.”
(3) Fear of embarrassment
A third major barrier was the fear of embarrassment. Patients who identified this to be a barrier felt “they did not possess the required skill set to evaluate online medical information. They had a lower level of confidence in the trustworthiness and the credibility of online information. They manifested a sense of being unsure of how to explain the information they found and how to relate it to their own condition, and hence did not want to mention it to their physicians.”
Other than these 3 main barriers, some patients did not discuss their findings during consultations because “they did not think the information was important enough and they searched the Internet just to be informed.” Other reasons cited were “a reluctance to interfere with physicians’ diagnostic process and lack of time during doctor visits.”
Implications for the patient-physician relationship
In the studies reviewed by the authors, most patients felt that “Internet health information seeking prior to consultations had improved their communication with doctors and the effectiveness of their consultations.”
Patients felt more in control and confident during the consultation as a result of bringing information to their physicians. Patients also felt more confident in their physicians’ diagnosis once they had discussed their online findings.
Patients used the information to help them prepare for their visit, ask better questions, and understand what the physicians told them (they believed the patient-physician communication had improved because they could understand their doctors and the jargon they used better).
By discussing information they had accessed on the Internet or setting questions in advance, “patients were able to better understand and participate in consultation sessions with their doctors.” Thus patients “felt better equipped to communicate with their physicians during the consultations” resulting in “greater clarity, orientation, and certainty.”
A majority of patients had felt more comfortable with information from health care providers because of their Internet searches and felt more confident with the doctor’s advice. Interestingly, patients who shared online information felt that they received more attention from their physician, compared with non-sharers.
The patients’ sense of empowerment was dependent on how receptive providers and specialists were to the patients’ desire to take part in the decision-making process. The review showed that “the effect of online information on the patient-physician relationship depended on several factors.”
(1) The positive influence of online information was stronger when patients had an opportunity to discuss their online findings.
Patients who perceived their information search to have improved their relationship with physicians saw the Internet as an additional resource that supported doctors’ advice and enhanced the relationship with doctors. On the other hand, when patients valued the information they found on the Internet above their physicians’, this information led patients to ignore physicians’ expertise.
Not disclosing their Internet information searches could erode patients’ trust in their physicians if the diagnosis or the recommendations are different from their Internet research findings.
(2) Physicians’ reaction to patients when they shared their online findings could determine the positive or negative effect on the relationship’s quality.
When patients perceived physicians to be threatened by their bringing online information, 49% of the patients were seriously dissatisfied with the consultation and 4% believed their relationship was worsened. Conversely, patients felt that the relationship was strengthened “when physicians displayed adequate communication skills in discussing patients’ queries.”
(3) The quality of the existing relationship with physicians
Patients judged their physicians’ reactions as “mostly positive when they had a good prior relationship, even when the doctors’ replies were evasive or openly critical of the patients’ Internet search.”
It’s important to note that patients don’t see their information searches as a substitute for clinical advice. Patients typically see the Internet as an additional resource that can help them to better understand doctors’ recommendations and advice. They still value traditional doctor-patient consultations as important to their understanding of online health information, and their trust in physicians remained very high. Under this model of care, the physician acts as a teacher or a friend by engaging patients in a dialogue through the decision-making process.
When physicians embrace openness to online information and encourage patients to discuss the online information they have, patients’ perception of physician resistance and fear of embarrassment could be reduced and patients are more likely to discuss online information with their physicians.
In contrast to the belief that patients’ Internet research can erode the patient-physician relationship, our findings show that patients’ Internet health information seeking has the potential to improve the relationship.
The authors conclude that as patients have better access to health information through the Internet and expect to be more engaged in health decision making, traditional models of the patient-physician relationship need to be adapted to patients’ changing needs by incorporating their perspective into a relationship-centered medical paradigm.
Tan SSL, Goonawardene N. Internet Health Information Seeking and the Patient-Physician Relationship: A Systematic Review. J Med Internet Res 2017;19(1):e9
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