Second of a series, from my lecture “Dealing with Patients Who Surf the Net” at the 2011 Philippine College of Physicians Annual Convention last May. Available at Slideshare.net.
The physician-patient relationship in the Philippines remains mostly paternalistic but I think that the time will come when more patients will become empowered by the health information available online and become active partners in medical decision making. Gerber BS and Eiser AR (The Patient-Physician Relationship in the Internet Age: Future Prospects and the Research Agenda J Med Internet Res 2001;3(2):e15) describe this change in the physician-patient relationship:
“Until recently, in the clinical visit the physician had the sole responsibility for medical knowledge, whereas the patient was only accountable for his or her own preferences. Now, by more easily obtaining medical information prior to seeing their doctors, patients potentially have a different position in the decision-making process; possessing both preferences and knowledge prior to any physician contact.”
And so I ask, are doctors threatened by the Internet savvy patient? Certainly, there is a “leveling effect” since patients can now have access to health information previously made available only as their doctors saw fit to disclose to them. Interestingly, Geiber & Eiser had this to say in their paper –
“Paradoxically, a patient’s interest in knowledge may not always accompany an interest in the medical decision-making process.“
Geiber and Eiser then go on to discuss two kinds of patient-physician encounters:
- The Physician & the Informed Decision Maker – The patient has done a Web search prior to the clinic visit and is equipped to weigh the alternatives the doctor offers and decide on treatment. Pros: There is truly an informed consent. Time can be wisely spent on an in-depth discussion during the clinic visit since the basics have already been researched and understood by the patient. Cons: Physician may need to spend more time with the patient debunking alternative or complementary treatments and/or correcting wrong information.
- The Physician & the Knowledge Acquirer – The patient discusses his values and beliefs with the physician who then is able to decide more ably for the patient. The patient may then browse the Web after the clinic visit, which serves to reinforce the medical decision that has been made by his physician. In this situation, Geiber & Eiser describe the physician-patient encounter as having a “priming effect” on the patient’s behavioral response to subsequent information provided by the Internet.
In my endocrine practice, I find that for the less common hormonal disorders such as those involving the adrenal or pituitary glands, patients need to read up after the clinic visit to fully understand the concepts I’ve explained during the encounter. I then find myself recommending websites to the patients or their more internet savvy relatives. This is what is called an Internet prescription. More about this in a future post. 🙂
Photo credit: http://www.flickr.com/photos/dannysullivan/273838692/