Patient Self Diagnosis and its Impact On Physicians

As online media publishing and online health information have become more widespread, the number of people turning to websites for health-related information continues to grow. According to a study conducted by the American Clinical and Climatological Association, medical knowledge is growing exponentially. In the 1980s it doubled every seven years. The current rate of expansion is so rapid that by 2020 this data is expected to double every 73 days. This is a boon for the public, particularly as information finds its way to the Internet, ready for search by the patient. For the physician, it is difficult to keep abreast, so they too turn to the Internet for answers. A 2014 IMS Institute study found that 50% of physicians use Wikipedia for information.

The Internet has empowered patients due to the wealth of information available to them. But, this has caused doctors to be concerned about how it will impact the physician-patient dynamic.

From a clinical perspective, medical information found on the Internet is meant to be supplemental (as there is no guarantee regarding its accuracy and consistency), best used to inform medical-decision making, not replace it. It should not guide self-diagnosis or treatment.

A study conducted by Drs. Susan Dorr Goold, and Mack Lipkin, Jr. on the doctor-patient relationship, shows patients typically use the Internet in two ways:

1. To seek information before a clinic visit to decide whether they need to see a healthcare professional.
2. They search the Internet after an appointment for either reassurance or due to dissatisfaction with the amount of detail provided by the healthcare provider.

How do healthcare professionals respond to the “Internet informed” patient?:

• They feel threatened and respond defensively by asserting their “expert opinion” which can leave the patient frustrated.
• The healthcare professional guides the patient to reliable health information websites.
• The healthcare professional and patient collaborate in obtaining and analyzing the information.

With sites like WebMD’s symptom checker relying on the same algorithm that doctors use in traveling down a symptom decision tree with patients to determine a diagnosis, search results are improving. However, patients must use caution, as diagnoses cannot be based solely on Internet search results. A headache may be just that, or it may be stroke-related. Diagnosis is best practiced by a professional relying on clinical acumen, training, and experience, conducting physical exams and diagnostic tests to confirm the diagnosis.

With constraints on a physician’s time, a patient who has researched his condition may have more directed questions during his office visit, and can make for a more efficient conversation. On the other hand, a patient who comes in with pages of online health information may make for a difficult consult.

Physicians are becoming more used to the idea that patients will be conducting their own online research, and this change needs to be included in the overall collaboration of their treatment.