doctor-patient interactions

The internet is a storehouse of information and, in recent years, patients have taken to searching the internet to decipher symptoms, diseases and possible treatments for illnesses; a phenomenon commonly referred to as “Dr. Google”. Flemish researchers investigated the link between Dr. Google and doctor-patient interactions and found that internet searches did not negatively affect patients’ symptoms, anxieties or confidence in their physicians, and that physicians considered information-seeking behaviours may be beneficial to their relationships with patients.

 

In an age when information is quite literally at our fingertips, and a simple Google search can yield an abundance of information (though not all of it reliable), a question that arises is how our consumption of this knowledge affects our interactions with the outside world. In particular, it is crucial to know the effect health-related information obtained via “Dr. Google” has on our health-seeking behaviours and interactions with health-care providers.

Published in the British Journal of General Practice, a study conducted by Van Riel and colleagues sought to examine patient online information-seeking behaviours and doctor-patient interactions by proposing two research questions aimed two populations: patients who use the internet to seek health information and a cohort of Flemish general practitioners (GPs). For the first part of their study, researchers recruited the patient study population in public and non-public places (i.e. private GP practices) in Flanders, Belgium and on social media. They only included Flemish citizens between the ages of 18 and 75 who used the internet to look up health information. A survey was created to collect participant responses and distributed online via social media (i.e. Facebook) and email during the months of March and April 2016. The survey collected descriptive data on personal characteristics, frequency of internet use, searches for health information online, and frequency of doctor visits, as well as participant opinions on 12 statements aimed at determining the impact of online search behaviour on the actions, behaviours and feelings of the participating patients. Additionally, the researchers performed two days of survey administration in the streets on April 4th and 8th, 2016. In total, 718 participants completed the survey; most were female and the average age of responders was 40 years old.

Over a quarter of respondents reported that they did not start medication without consulting a physician, regardless of their search results. One thing to note is the possibility that patients may fail to report using well-known/over-the-counter medications, not realizing that these are, in fact, medications. Regarding feelings of reassurance and anxieties arising from internet searches, the more frequently participants searched the internet for specific complaints, the more likely they were to reporting reassurance; however, there was an increase in anxiety or worry, particularly among the younger participants. A large number of respondents reported decreased severity of symptoms after consulting Dr. Google. Respondents who visit their GP frequently went to consultations more often after internet searches and presented with increased anxiety and additional complaints. Responders who frequently consulted the internet regarding health issues exhibited less confidence in their GP after the online search; however, 56% of respondents reported having more confidence in their GP and over half of respondents reported going to their GP after their internet search. Older participants had a higher frequency of doctor visits after consulting the internet, as did those who made frequent visits to the doctor.

For the second part of the study researchers contacted Flanders GPs with least two years of experience by phone and email and requested their participation in the study. They selected nine GP participants in total, who were intended to be a representative sample in terms of age, sex, practice type and geographical features. From the data obtained from the patient surveys, researchers generated five statements to discuss with GPs and added an additional two geared at measuring the effect of online search behaviour on GP consultations.

All 9 GPs unanimously agreed that most patients did not self-medicate after their online searches and the majority of GPs indicated that they did not feel the internet search affected patients’ confidence in the GP.  Eight of nine GPs thought that patients rarely experienced additional symptoms after performing internet searches and over half anticipated that patients with a hypochondriac profile experienced additional symptoms after searching the internet. All GPs agreed that internet searches generally do not affect the severity of the symptoms, except possibly in the younger crowd (20-30 years old). When discussing patient anxiety, over half of the GPs believed searching on the internet made their patients more anxious, while the rest considered that anxiety related more to the patient and the context of the health situation. All nine agreed that an increase in concerns would occur in naturally anxious patients. Eight of nine GPs indicated that online search behaviour had positive effects on the consultation. These behaviours allowed for the GPs to understand the ideas, concerns and expectations of their patients, which could contribute to the diagnosis or provide new information to the GP. All but one GP considered it very important to explain and put into perspective the information the patient had obtained. The GPs also spoke about the importance of providing patients with reliable websites from which to source information.

The authors consider the large number of participants as a strength of their study. The similarities between trends observed in the patient surveys and GP surveys are also a positive. Selection bias, due to unequal distribution of sex and education level is a limitation of the study. Additionally, information bias may be present; during survey administration, responders indicated that they had difficulty interpreting some statements. The limited number of GP responses is another limitation; the results of the survey may not necessarily be representative of all Flemish GPs.

The study results indicate that patients generally look to the internet for medical information to help guide their decisions, and in most cases, this behaviour does not lead to heightened anxiety. Information-seeking behaviours might even promote better patient-doctor relationships, as consultations become more of an exchange of information, which may help to inform the GPs diagnosis and treatment plan and encourages patient involvement in health outcomes. This exchange can also provide a good starting point for physicians to provide their patients with reliable references for health information, so that patients are not creating undue anxiety for themselves by consulting unreliable sources. The researchers hope that these findings will spur on further research to examine the interactions of vulnerable groups with online health information and the risks involved. Additionally, they consider that medical schools should teach future doctors how to deal with information-seeking patients and how to benefit from this new trend, as well as emphasize the importance of providing their patients with reliable internet sources, a responsibility that should be shared by all medical authorities.

 

Written By: Sara Alvarado BSc, MPH

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