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How are patients influenced by online health information?

Third 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

In my last post, I talked about how access to health information online is transforming the physician-patient relationship. Apparently, the impact of online health information is determined by the severity of the patient’s medical condition and the patient’s attitude towards his physician. This is according to a Vital Signs report (E-Health in the United States, Boston Consulting Group, 2003) by Carina Von Knoop, Deborah Lovich, Martin B. Silverstein MD and Michael Tutty from which I got this figure below:

The Vital Signs report categorizes the online patient population into the following segments:

  1. The Accepting (“doctor-dependent and uninformed”) – These patients rarely go online to seek health information even if they have Internet access, as they are comfortable with a paternalistic relationship with their doctor. Most of my patients fall in this group, though I often wish that they become more involved in decision-making. It can become quite frustrating when after I patiently explain all the options, the patient says, “Kung ano po ang sa tingin ninyo ang mabuti Dok.” Translated, “Whatever you think will be best, Doctor.”
  2. The Informed (“doctor-dependent but informed”) – This group still depends on the doctor to make decisions but they are likely to seek more information online before or after a clinic visit. I encourage this by giving “Internet prescriptions” – a list of websites that patients can visit. My dream is for the Philippine Society of Endocrinology & Metabolism (PSEM) website ( to be the leading resource for Filipino endocrine patients. Malayo pa 🙂
  3. The Involved (“junior medical partners”) – These patients are fairly well-informed and somewhat involved. They visit websites and discuss these actively with their physician. While they prefer to make joint decisions, they usually defer to the doctor. These patients respond well to Internet prescriptions.
  4. The In-Control (“autonomous patients”) – These patients seek online information to be able to diagnose their condition and decide the treatment for themselves. They may even attempt to update their doctors on the latest treatments or studies. They may be active members of online patient communities and contribute to blogs.

As can be seen from the figure, the more severe the medical condition is, the more involved the patient becomes in his care and the doctor’s role is lessened from being Godlike to becoming merely a supplier of information and/or treatment. I know this from my experience when I diagnosed myself as having a prolactin-secreting pituitary adenoma last 2000. The prevailing treatment then was surgery but I reviewed all the literature (did an extensive MEDLINE search) and decided on medical therapy, despite the advice of consultants in both endocrinology and neurosurgery (I was only a medical resident then).

I must confess I feel more comfortable with The Involved. I’ve met a few of The In-Control and the encounters have been particularly stressful. I guess it’s because these autonomous patients most often show their distrust (often a result of previous encounters with other physicians before they come to see me :(). I then have to demonstrate to these patients that they can trust me, more than or maybe just as much as what they read online.


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