Managing the E-Patient: Caring for Web-Savvy Patients

December 16, 2009

In nearly 20 years, the Internet has revolutionized the way information is consumed. Consumers now take it for granted that they can find relevant information quickly and at little or no cost. (1)

This phenomenon also undeniably applies to patients. Recent research from the Pew Institute found that "75% to 80% of Internet users have looked online for health information," though Pew also reports that this number leveled off in 2008. (2) A Harris Interactive poll found that "health information seekers are 81% of Internet users; 66% of all adults." (2)

Patients now have access to information that was once only available in medical school libraries. "Gone are the days that physicians are the only source of health care information," says Houston pediatric gastroenterologist and physician blogger Bryan Vartabedian, MD.

Physicians must now work with patients who bring in reams of paper about their conditions and diagnose their own illnesses on the Internet. How do physicians treat these new "e-patients"? Should they discourage such patients from surfing for answers to their health care questions? Or should physicians work with them and preemptively point them to the right kind of online health information? This article will examine what it means to treat e-patients and how the Internet has changed the physician-patient relationship.

ONLINE RESOURCES

Patients feel empowered by the information they find online and are taking more responsibility in their own health care. A study published in the Indian Journal of Medical Societies found that most adults from the U.S., Japan, France, and Germany who participated in a recent survey thought online health care information to be trustworthy, of good quality, easy to understand and easy to find. Further, the patients who were surveyed also reported that information found online "has influenced their treatment decisions." (3)

Patients also use the Internet to connect with other patients with rare diseases and experts who study those diseases. (4) Patients also like the Internet because they may receive positive feedback from their online interactions. (5)

The high cost of health care may also drive patients to look online. "Consumers increasingly have to pay out of their own pockets for medication and other health products and services, forcing them to think more about the cost and quality trade-offs of their choices. Patients may also increasingly become concerned that they receive cost-effective but suboptimal medical care and try to explore alternate sources of expert medical opinion." (5)

RELIABILITY OF INFORMATION

When it comes to finding accurate and objective health information online, the big question is whether the health information comes from a reliable source and whether that information is kept up to date. "The main drawback of the Internet lies in the fact that the Web is unregulated and the quality of the medical information is variable." (3)

"In several instances, pharmaceutical companies intentionally tried to delete or modify Wikipedia entries that mentioned adverse effects associated with their drugs." (6)

E-patients are particularly vulnerable to inaccurate online information because they lack the experience and knowledge to tell good information from bad. Also, high-quality information is less useful if patients are overwhelmed with its volume. (4) This means physicians spend a lot of extra time explaining to patients why the information is inaccurate. A recent article from the Journal of General Internal Medicine reported that 69% of patients surveyed said they discussed web searches with their health care professionals. (7)

TIME CONSTRAINTS
Even when patients have access to good information, finding the time to discuss it with their physicians can be a challenge. "Physicians would like to answer patient's questions, but they often feel the pressure of time," says Jane Holeman, vice president of risk management at TMLT. "Physicians want to make sure that their patients are getting information that is accurate, and that the patients understand that information. But this can be a huge time investment."

According to a survey published in the Journal of Medical Internet Research, physicians "recognized the value of the Internet in providing information, which could lead to more productive consultations. However, these (consultations) also tended to be longer. Problems were often not with the information per se, but for the patient (and the clinician) to be able to sift through and evaluate the information." (4)

Certainly, not all the information that e-patients bring to physicians is inaccurate, but research indicates that physicians have mixed reactions to the quality of online health information. Only 39% of all physicians see the Internet as a valuable health information source for patients. A recent survey by Forrester Research found that only 25% of respondents thought the Internet was useful in providing patient education. Data from a random sample of 1084 physicians conducted by the American Medical Association indicated even more dissatisfaction with the Internet among physicians. Only 11% of respondents felt the Internet was useful in providing patient education. (5)

THE PATIENT-PHYSICIAN-INTERNET RELATIONSHIP
It is difficult to deny that the Internet has already changed the patient-physician relationship. (8) "Information technology is beginning to change the exclusive focus of health care from curing disease to preventing disease and enhancing health status."

As patients become more informed, the physician-patient relationship has become "triangulated" to include the Internet. (9) According to Dr. Vartabedian, "patients want information but still desire the role of a physician as someone to guide them. This varies with the needs and personalities of different patients. Some patients still want a paternal relationship with their physician, while others want their physicians to take a more hands-off approach."

This does not necessarily mean that physicians are no longer the nucleus of the health care plan. As Dr. Vartabedian states, "The physician is more important than ever to help patients make good health care judgments."

The Internet is reworking the physician-patient relationship, giving patients the ability to use Internet health information to make better decisions. (10) "Physicians can play an active role by directing patients to good web sites and engaging in preemptive online literacy," says Dr. Vartabedian.

"Apart from prescribing drugs, medical professionals probably should also start prescribing the right sites to be seen for further information about the patient's condition. This would not only provide authentic material to the patient but also save the time of the patient." (3)

Physicians can prepare a list of web sites that they trust and share these lists with their patients. "In the past decade, the web has served as a platform for resources presenting 'edited data', compilations of medical summaries based on the literature, and other information sources. In investigative studies of seeking online information, many physicians have selected these types of resources. Web sites sponsored by the government, academic medical centers, or professional medical societies all have authoritative information that can be relied upon." (6)

CONCLUSION

Despite a fast-changing world, the role of the diagnostician will stay with the physician. "Only physicians know the difference between health care information and good medical judgment," says Dr. Vartabedian. "Over the next 50 years, physicians will offer patients the wisdom that they cannot find online. Physicians will spend less time as holders of information and more time in their essence: caring healers who are interpreters of information and are trusted advisers."

SOURCES

  1. Sastry S, Carroll S. Doctors, patients, and the Internet: time to grasp the nettle. Clinical Medicine. March/April 2002. 131-133.
  2. Fox S. The engaged e-patient population. Pew Internet & American Life Project. August 26, 2008. Available at http://www.pewinternet.org/Reports/2008/The-Engaged-Epatient-Population.aspx.
  3. Shashank M, Akerkar LS, Seth GS. Health information on the internet: patient empowerment or patient deceit? Indian J Med Sci. 2004; 58. (8): 321-326.
  4. Potts H, Wyatt J. Survey of doctors' experience of patients using the Internet. J Med Internet Res. 2002; 14 (1). Available at http://www.jmir.org/2002/1/e5
  5. Anderson JG, Rainey MR, Eysenbach G. The Impact of CyberHealthcare on the physician—patient relationship. J Med Syst. 2003; 27 (1): 67-84.
  6. Pho K. Wikipedia isn't really the patient's friend. USA Today. July 2009. Available at http://blogs.usatoday.com/oped/2009/07/wikipedia-isnt-really-the-patients-friend.html
  7. Diaz JA, Griffith RA, Ng JJ, Reinert SE, Friedmann PD, Moulton AW. Patients' use of the Internet for medical information. J Gen Intern Med. 2002; 17(3): 180—185.
  8. Kidd M. General Practice on the Internet. Aust Fam Physician. 2001: 30 (4). 359-61.
  9. Wald HS, Dube CE, Anthony DC. Untangling the web: the impact of Internet use on health care and the physician—patient relationship. Patient Educ Couns. 2007; (68): 218—224.
  10. Sciamannaa CN, Clark MA, Diazc JA, Newton S. Filling the gaps in physician communication: the role of the Internet among primary care patients. Int J Med Inform. (2003) 72, 1-8.
  11. Ritterband LM, Borowitz S, Cox DJ, Kovatchev B, Walker LS, Lucas V, et al. Using the Internet to provide information prescriptions. Pediatrics. 2005 116 (5): 643-647. Available at http://pediatrics.aappublications.org/cgi/content/full/116/5/e643
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