The Doctor-Patient Relationship in the Internet Age

The advent of the “information technology age” has led to a rapid change in the doctor‐patient dynamic. Before the Internet became host to a plethora of medical information and advice, the doctor‐patient relationship was confined primarily to office consultations. In that setting, doctors advised patients on the best course of medical action, and the patients weighed their options before proceeding. Now, the modern patient has the ability to access extensive information on nearly every medical condition. Today, the patient arrives armed with information about potential diagnoses and courses of treatment. This inversion of roles presents a number of ramifications for the routine practice of medicine. Patients are in a position to lobby their doctors about treatment, and treat medical advice with skepticism and concern [1]. However, despite the fact that access to a wealth of online resources has the potential to alter the doctor‐patient dynamic, it has not necessarily replaced healthcare providers as the essential medium of care [2]. The full scope of this new doctor‐patient relationship involves access to information, the quality of the information accessed, and how that information is interpreted by patients.

In a study published by the Journal of Medical Internet Research in 2003, 85% of American physicians surveyed indicated that a patient had researched medical information online and brought that information to a visit [3]. This high percentage is mitigated by the fact that the same physicians reported that less than one‐fifth of their patients had come to an appointment with Internet research [4]. This suggests that only a small number of patients were presenting research found online to their physicians. In that same year, however, a poll published in the Journal of Patient Education and Counseling reported that 80% of American adults who used the Internet had researched health information, and the share of adult Internet users searching for medical information had been rapidly increasing since the proliferation of the Internet [5]. At the beginning of the decade, a study published in the Journal of General Internal Medicine in 2002 indicated that patients who had accessed medical information on the Internet were better educated and had a higher socioeconomic status [6]. Yet by the end of the decade, a study published in the Journal of Health Communication in 2008 noted that while sociodemographic factors contributed to some of the variance in whether or not a physician was contacted after turning to the Internet for research, Internet research was positively linked to physician visits, even when sociodemographic factors were controlled [7]. Regardless, it is clear that Americans are increasingly turning to the internet to fill gaps in their own knowledge about medical conditions.

The early evidence of this shift in patient‐centered information resulted in a number of theories on how the change would affect the doctor‐patient relationship. The multitude of medical information online allowed for potential positive effects for the patient; the access to knowledge had the potential to democratize the healthcare process. Patients would theoretically have the ability to play a larger role in medical decision‐making, while the clinician would serve as an informed guide [8]. This drive to the Internet for information may have been fueled by an already strained doctor‐patient relationship. As the time doctors spent with their patients declined, the power of the Internet grew, and patients began to use the Internet out of frustration [9]. The benefits of the Internet do not end with access to information, as support groups for individual disease have grown in popularity, and a number of studies suggest that patients who participate in these groups “gained satisfaction” with their medical experience [10].

Furthermore, a Harris Interactive poll conducted in 2001 indicated that patients who have done research are more likely to have more educated interactions with their physicians, where they ask more detailed questions regarding their conditions and proper treatment [11]. A British study published in BMC Family Practice in 2007 confirmed this poll, as patients reported feeling that they had used the limited time they had with their physician more effectively when equipped with the proper information before making a visit [12]. As medical information has become widely accessible online, its use has grown to be second‐nature for patients, who can research their symptoms and ailments to complement the information they receive from medical professionals. Ultimately, this research positively reinforces interactions with physicians, as patients are not relying on online information, but rather using it to augment the traditional clinical experience.

The resistance to the use of online medical information is often rooted in questions about the quality of the available information. Physicians have indicated that only a small percentage of the information that patients bring is either “very relevant” or “very accurate” to their condition, yet the same physicians report that in the majority of cases, this information has little effect on the outcome or quality of care [13]. Although there are authoritative websites, the medical information available online is often unscientific and self‐published, by other patients reporting their personal experiences, rather than by clinicians submitting a peer‐reviewed report of an ailment. A substantial concern about online medical information is that it will dissuade patients from pursuing medical care because they feel as if they have sufficient information for self‐treatment or do not need to seek treatment; however, patients appear to turn to their physicians to evaluate the information they find online [14].

Another significant and potentially negative effect of online medical information relates to the historical nature of the doctor‐patient relationship. The use of online medical information by a patient in a clinical setting can be interpreted as a challenge to the authority of the doctor. This challenge is exacerbated when patients decide to follow a course of treatment based on their own research that is contrary to the advice of their physician. Historically, patients have abided by the advice of physicians without the resources to question this information. Unfortunately, physicians are often unfamiliar with the medical resources their patients use, and physicians retain a higher degree of skepticism about online data than their patients [15]. The potential for this antagonistic relationship becoming the standard dynamic, however, is slim. With the excess of information online, doctors can become “partners” to their patients rather than authoritarian guides, but still retain their clinical authority during this transition [16].

Doctors, especially primary care physicians, have the opportunity to take an active role in how their patients use the Internet. If clinicians accept that their patients are likely to use online resources, they can assist their patients by providing a list of websites that have been noted for scientific accuracy and peer review. Patients may read extensively about treatments on the Internet, but they are still required to visit a physician to receive any of those treatments. Recently, a number of medical websites have contracted physicians to write articles and give advice on content. Although physicians must take great care when providing advice online, an appropriate intersection between in‐office care and virtual advice contributes to better patient well‐being. If doctors do not focus on authority structures but instead anticipate the incorporation of online information into their practice, the dynamic between doctor and patient may successfully be transformed into a partnership.

References
1. Akerkar, SM, and LS Bichille. “Doctor Patient Relationship.” Journal of Postgraduate Medicine 50.2 (2004): 120‐122. Print.
2. Lee, Chul‐Joo. “Does the Internet Displace Health Professionals?” Journal of Health Communication 13.5 (2008): 450‐464
3. Murray, Elizabeth. “The Impact of Health Information on the Internet on Healthcare and the Physician‐Patient Relationship.” Journal of Medical Internet Research.
4. Ibid.
5. McMullan, Miriam. “Patients Using the Internet to Obtain Health Information.” Patient Education and Counseling 63 (2006): 24‐28. Print.
6. Diaz, Joseph. “Patients’ Use of the Internet for Medical Information.” Journal of
General Internal Medicine 17.3 (2002): 180‐185. Print.
7. Lee, Chul‐Joo. “Does the Internet Displace Health Professionals?”
8. Chin, JJ. “Doctor‐Patient Relationship: From Medical Paternalism to Enhanced Autonomy.” Singapore Med 43.3 (2002): 152‐155. Print.
9. Anderson, James, Michelle Rainey, and Gunther Eysenbach. “The Impact of CyberHealthcare on the Doctor‐Patient Relationship.” Journal of Medical Systems 27.1 (2003) Print.
10. Akerkar, SM and LS Bichille. “Doctor Patient Relationship.”
11. Ibid.
12. Stevenson, Fiona. “Information from the Internet and the Doctor‐Patient Relationship.” BMC Family Practice 8.47 (2007). Print.
13. Murray, Elizabeth. “The Impact of Health Information on the Internet on Healthcare and the Physician‐Patient Relationship.”
14. Lee, Chul‐Joo. “Does the Internet Displace Health Professionals?”
15. Diaz, Joseph. “Patients’ Use of the Internet for Medical Information.”
16 . Anderson, James et. al. “The Impact of CyberHealthcare on the Doctor‐Patient Relationship.” 17Ibid.

This article was originally published in The Science in Society Review at Harvard University by The Triple Helix Inc. Follow The Triple Helix Online on Twitter. Join us on Facebook

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