The conventional sharing of information and education between doctor and patient is no longer what it used to be prior to Dr. Google’s entry into the mix with voluminous data, not only transforming but often threatening the patient-doctor relationship. While patients no longer seek basic information from their physicians since they’ve already consulted Dr. Google, the wise physician accepts that patients are now more aware, more involved in their own care, and more empowered with information.
The good old doctor who knew everything is now more a myth that exists largely in folklore. While doctors may be well versed in a variety of fields, they have often narrowed down their areas of specialisation, while they continue to apply what they learn from their daily encounters with patients, establishing a stronger relationship over time. The challenge arises when a patient, having consulted Dr. Google, starts to question their doctor with the little knowledge gained from the internet. Biased opinions based on prior knowledge, have lately placed the doctor-patient relationship in jeopardy.
Keywords: Autonomy, transparency, participatory approach, quality of care, doctor-patient relationship
In today’s digitally advanced world, using the Internet has become integral to everyday life. As of January 2023, there were 5.16 billion internet users worldwide, which is 64.4 percent of the global population [1]. Health information access is an important area where the Internet is becoming more significant. This has not just impacted professionals, but also become a resource for people who frequently approach their doctors with medical knowledge gleaned from the Internet, or “Dr. Google”. Patients access online information through several search engines as well as mobile applications, Google being the most used search engine. Knowledge has become widely accessible and free. However, this has created a predicament in which we are unable to distinguish between true and false information. It provides the same information to doctors and patients. While doctors are trained to separate medical facts from the vast amount of unreliable material available on the internet, patients are not. This often leads patients to misdiagnosis, misconceptions, and sometimes a feeling of mistrust of their treating physician. On the other hand, a well-informed patient can also result in a more informed and efficient doctor-patient bonding, helping the doctor to explain and treat more effectively.
In the internet era, Dr. Google can be a favourable addition to the doctor-patient interaction, especially in terms of collaborative decision-making and patient empowerment. Doctors are increasingly likely to have consultations with informed and empowered patients who will challenge them in a variety of ways as reported in a study on the European population by Santana et al [2].
Using reliable health information websites empowers patients to frame their queries better and focus on what they need medical help for. A majority of patients who search for health information online ask questions of their doctor based on what they have learned. This can enhance the clinical relationship when the physician responds positively to the patient, as suggested by Bylund et al [3].
A study by van Riel et al [4] explored the effects of searching for online health information — prior to a general practice consultation — on the actions, behaviour, and feelings of the Flemish population. The study showed that people usually make an appointment with their doctor after an internet search. Most people reported that a prior search did not make them more anxious. After an internet search, more than 80% of respondents reported no change in the intensity of their symptoms. New symptoms are rarely noticed, nor does the search usually lead patients to distrust their doctor, the study found [4].
Patients’ free access to online health information may widen the scope of the doctors’ legal duty of care to enquiring sensitively into the patient’s sources of information, since this may cause unexpected or seemingly unreasonable patient treatment decisions. Dr. Google isn’t perfect; thus a thorough examination is required to avoid erroneous interpretations. The Internet does not provide reliable health information for laypersons at present [5]. A patient’s knowledge base plays a crucial role in separating the medical wheat from the chaff during an internet search. Kim J and Kim S reported that the physicians they surveyed deemed that online information accessed was not relevant to the patient’s health condition (42.7%), and not correct (39.0%) [6]. In the same study, the participating physicians perceived that Internet health information may have a variety of negative effects such as raising healthcare costs by adopting “inappropriate health service utilisation” (56.2%); making patients excessively concerned about their health (74.5%); and negatively affecting the time efficiency of the visit (60.9%) [6].
Similarly, Jungmann et al [7] found that a health-related Internet use for symptoms has “stronger negative effects, increased health anxiety, and an increased need to consult a physician compared with the control condition”.
Despite the popularity of the Internet as a source of health information, further work is recommended by Lee et al, to “maximise its potential as a tool to assist self-management in consumers with chronic health conditions” [8].
As internet access becomes more readily available in outpatient clinics and hospital wards, the web is rapidly becoming an important clinical tool for doctors [9]. Physicians may find it crucial to use the Internet to improve upon their medical expertise and obtain up-to-date information about healthcare advances. The use of search engines could significantly assist clinicians, particularly when dealing with diagnostic or therapeutic challenges involving great complexity and multiple variables [9].
In a study by de Leo et al [10] most participant physicians indicated that they preferred targeted sites, such as PubMed, Medline, research databases providing access to medical journal publications, etc, rather than a search engine (such as Google) to gather medical information. A minority reported using sites which serve their specialty areas.
To what extent the internet has aided decision-making, access to factual knowledge, research, and the provision of better healthcare solutions is still to be explored.
Currently, the internet instantly provides a vast amount of information on any ailment, and this naturally affects the doctor-patient relationship when patients use this information to question the doctor. Patients misinterpreting the information available online and asking challenging questions, then doubting the doctor when an acceptable answer is not received is not unusual. Many doctors feel helpless after such a challenging interaction with a patient. Therefore, the “too-well-informed” patients are the doctors’ real fear rather than the Internet itself.
The doctor-patient connection has been and continues to be a critical component of care: it is via this interaction that diagnoses and plans are established, compliance is achieved, and patient care and support are delivered. Is this vital relationship disrupted by the internet’s impact? Laugesen et al, say physicians can put such concerns to rest because the quality of the physicians’ care and their recommended treatment plan has a much greater influence on patients than the impact of Internet health information on these same variables [11].
The patronising doctor may no longer be the norm; instead, patients must be seen as equal partners who have an equal and vital influence on their treatment decisions. The doctor should team up with them. After reading about new treatments for their ailment, patients can always return to the doctor to work on treatment suggestions. Thus, internet health information seeking can improve the patient-physician relationship by mutual discussion of the available information [12].
The pros and cons of the Internet in the healthcare system are debated endlessly. People are now interpreting their own test results, reading their ECGs and notes, accessing their charts, and following the doctor’s thought process as tests are ordered and medications prescribed. This is beneficial since it motivates them to be healthy while assisting them towards a better understanding of their ailment.
There is now an open window between the patient and the doctor where there was once a shut door, and the connection has evolved into a collaboration. However, people can become overly attached to what they find online, especially if it appears to fit their symptoms, confirm their beliefs, or solve their problems. This type of reaction puts an end to the discourse on both sides. Mistrust develops, and once trust is lost, the treatment is seriously disturbed.
In an ideal world, doctors would be prepared to collaborate, and patients would be more aware that heuristics and technology have to work hand in hand. Dr. Google would then play only a supporting role.
As technology advances, the barriers between man and machine will become increasingly blurred, necessitating the co-existence of the traditional doctor and Dr Google. The Internet has the definite potential to fill the gaps in the physician’s and patient’s knowledge. A participatory, inclusive, transparent, and honest approach by the healthcare provider in line with the ethical principles of autonomy where a well-informed patient can participate in the healthcare decision-making process, creating customised management plans, will improve satisfaction with care, quality of life, and the possibly strained doctor-patient relationship. We have to conclude that while the Internet is here to stay, it must be accepted as an opportunity to make the informed patient a partner in his care process, while carefully guiding him to distinguish scientific facts from noise. This will not only improve patient care but also reduce the strain on the crumbling doctor-patient bond.
Acknowledgement: Amit Sharma (University College of Medical Sciences, Dilshad Garden-110095, Delhi)