Physicians, Patients, and the Internet

A patient, fearing she had a dire medical condition, walked into solo pulmonologist Frank Adams' office in New York City earlier this year. She was "petrified," says Adams. "She came in perspiring, [thinking] one of her lungs had collapsed." The patient had recently visited another physician for a chest X-ray, and she noticed that he had written the word "collapsed" on the X-ray image. After consulting with the physician, the woman went home and hopped on the Internet to learn more about the X-ray findings. "She did all this reading about collapsed lung and surgery and so on and so forth," says Adams. In reality, the woman had a much lesser cause for concern. After reviewing the X-ray, Adams realized the term "collapsed" referred to a few of her alveoli, the tiny air-filled sacs on her lung.

Situations like this one - in which patients search the Internet to learn more about health conditions - are common, Adams says. In fact, at least once a day, patients bring medical knowledge gleaned online with them to his office. But despite that their use of Google sometimes leads to misunderstandings, Adams says he welcomes it. "A well-informed patient is generally a healthier patient," he says.

Here to stay

Let's face it. The exam room is getting a bit more crowded these days as Google and other Internet search engines become part of the physician-patient dynamic. "Access to information which used to be available only to people who had been to medical school and/or had access to a medical library is now more broadly available," says patient empowerment advocate Dave deBronkart, a cancer patient and blogger known widely as "e-Patient Dave" who resides in Nashua, N.H.

According to the Pew Research Center (which oversees the Pew Internet & American Life Project, which explores the Internet's effect on a variety of societal issues), more and more patients are taking advantage of that outpouring of information. Sixty-six percent of Internet users look online for information about a specific disease or medical problem, according to the nonprofit; and 56 percent of them search the Web for information about medical treatments or procedures.

Naturally, many physicians are wary of these trends. At times the Internet can spread misinformation and it can lead to wasted time during appointments spent addressing what may be irrelevant information. "They see a stack of Google printouts and they think, 'Oh my God, this is going to take so much time - which I don't have,'" says patient advocate Trisha Torrey based in Baldwinsville, N.Y.

In addition, as Seattle-based family physician and physician development coach Lisa Duggan says, "It can be hard for physicians to acknowledge that sometimes what took us seven years to learn - you know, medical school, plus residency, plus all untold numbers of years - sometimes actually can be found on the Internet pretty easily," she says.

Still, it's essential physicians set their concerns or negative feelings about the Internet aside, says deBronkart. They "need to understand how to interact with [patients] who suddenly have new information at their disposal."

Friend not foe

In reality, the Internet is not such a bad thing, says Adams, noting that when patients use it correctly, they actually become better informed about illnesses or healthcare needs. "If there's a resource that will explain in layman's terms a lot of what [physicians are telling patients] then that's got to translate into someone not only being more versed in what's going on, but also in what makes [their illness] better and what could make it worse," Adams says. "That information I'm sure can, and has saved lives."

More informed patients also lead to increased patient engagement and involvement in healthcare decision making, says Duggan. "The fact that they're looking things up helps them get more invested and take responsibility for their own healthcare," she says.

In addition, as a result of the information explosion, it's impossible for physicians to stay informed of every cutting-edge medical development occurring, says deBronkart. "It is possible for a patient to come across valid information that their physician hasn't seen."

Positive partnership

When patients arrive at your office toting Internet printouts, do not dismiss their research immediately, Duggan says. Instead, acknowledge it and thank the patient for his interest and involvement. "Patients need to feel that their physician can handle whatever they bring into the office," she says.

In addition, it's important to make patients aware they are an integral part of the decision-making team. Welcome their thoughts and concerns, advises Torrey. "This is very much about participatory medicine, this is very much about developing the relationship, this is very much about mutual respect," she says.

But be sure to establish boundaries as soon as the Internet is brought up, cautions Duggan. This will help keep the appointment from running over, and it will ensure that the timeliest matters are addressed first. Emphasize that you are on a schedule and may not be able to address all the patient's questions during that visit, she says. And if you do run out of time during that appointment, encourage the patient to continue researching his concerns, make a follow-up appointment, and come back with a list of questions he'd like to ask.

At Adams' practice, it works well to provide patients with guidelines regarding how to bring research into appointments before they come into the office, says Adams. For instance, when patients call to make appointments, his staff provides them with an e-mail address to which they can send Internet links and/or include attachments with research they'd like to discuss in advance of the appointment. That way, Adams says, "I can have a little time to review it before they come in."

Best practices

Making sure your patients know where to find credible information online will save you time by eliminating the need to address misinformation, and it will save your patients unwarranted anxiety. Here's how to help them search the Internet productively:

• Inquire. Start by simply asking patients during appointments: Are there any websites you go to for health information? If the patient says yes, this is a great opportunity to outline the most productive and effective way to search, says deBronkart.

• Direct. Urge patients to search credible sites related to their particular illness or concern. For instance, Adams tells his patients to avoid entering search terms into Google. Instead, if the patient is encountering a specific health problem, say a lung problem, Adams advises them to visit the American Lung Association website.

• Provide. Give patients a handout that outlines best Internet search practices, says Torrey. For instance, she says, the National Library of Medicine provides great advice on how to weed out Internet sites that are not credible.

• Update. Send patients a weekly e-newsletter with relevant healthcare information. Adams' e-newsletter (his patients opt-in to receive it) contains health tips, research links, information on credible sites, etc. "I do encourage people to look and learn and be more informed," Adams says. "I tell everyone the more you know, the better."

• Join in. Meet your patients where they already are, online. Information about best research practices and a list of credible sites should be posted on your website if you have one, says Torrey.

Remember, in researching healthcare information online, the patient is not doing anything the physician wouldn't have done himself, says Torrey. "It's human nature to want to know more."

Aubrey Westgate is an associate editor at Physicians Practice. She can be reached at Aubrey.westgate@ubm.com.

This article originally appeared in the March 2012 issue of Physicians Practice.