The Cyber-Doctor Will See You Now

A decade or so ago, troubling medical symptoms were almost always diagnosed by a trip to the doctor’s office or clinic. While a patient might gather anecdotal information from family members or co-workers prior to seeing a healthcare professional, for the most part, the doctor was considered the primary source when it came to diagnoses and treatment recommendations. From a relationship standpoint, physicians have historically been viewed as an authority figure, which makes sense, since they’ve always had almost exclusive access to necessary health information. But with the rapid proliferation of the Internet, the balance of power has shifted. As more and more people access the Internet to address their healthcare concerns, technology may actually be serving to alter the traditional relationship between doctors and their patients.

“I always Google my symptoms before I go to the doctor,” says Tammie Allegro, a marketing operations coordinator in Temecula, Calif. “Sometimes you only get a couple of minutes with the doctor, so I want to make sure I am asking all the important questions. If there’s something I think the doctor does not know or has not addressed, I feel confident I can find it online.”

From a patient perspective, having virtually unlimited access to healthcare information is both enlightening and empowering. The 24/7 availability of medical statistics, advice and online support groups allows patients to assume much greater responsibility for their healthcare. Essentially, the Internet alters the doctor-patient relationship by redefining who is in control.

“Many patients and their families are getting better informed through the use of the Internet. In most cases, this is helpful because it allows the patients to go through things at their own speed and go back through it again if they need to,” says Melvin Berger, MD, medical director at CSL Biotherapies, King of Prussia, Pa. “The better informed a patient becomes, the more they can participate in their own care.”

Does the Doctor Still Know Best?

Consumers who regularly use the Internet are generally savvier and more opinionated regarding their healthcare decisions than their computer-illiterate counterparts. In addition to being more vocal during checkups and consultations, these patients may exhibit different motivations for seeking medical care. And, instead of going to their physicians for clarification on what certain symptoms might mean, they may instead seek to confirm their own suspicions based on personal research.

“I definitely use the Internet to research conditions and symptoms and to gain a better understanding of an identified condition, either for myself or a family member,” says Janice Breuer, a trade show specialist in Murietta, Calif. “I have also consulted several blogs for anecdotal entries on prescription drug side effects, especially since I believe many doctors are quick to prescribe and tend to gloss over potential drug complications.”

Whether this changing dynamic of the doctor-patient relationship constitutes a positive evolution depends on who you ask. For progressive physicians who have a comfort level with the Internet themselves and do not feel threatened by highly proactive patient behavior, this new level of interaction can be mutually beneficial. But for physicians with patients who continually present them with reams of information from questionable sources, and for those physicians who prefer to practice in a more traditional mode or who are not Internet savvy, ongoing doctor-patient relations could be strained, if not severed.

Welcome to the “Misinformation” Age

The American Medical Association recommends that Internet users treat information on the web with a high degree of skepticism, and encourages patients to pay attention to the source of the information, citation of references, disclosure of competing interests, and timeliness of the information. Few consumers follow this advice.

Health information gleaned from the Internet can offer many benefits, including helping consumers manage their own care, but it can also lead to unwise decisions when the information accessed is confusing, inaccurate or both. One challenge consumers and physicians face is that information on the Internet is not regulated, which can create a challenge for doctors treating misinformed patients who believe everything they read. And while reputable sites like WebMD, Medscape and MayoClinic.com do exist, the hundreds of thousands of consumer health websites and the fallibility of search engines make the chance of accessing misinformation on the Internet extremely high.

“Every new technology has its downside. A lot of patients are getting, and posting, incomplete and/or incorrect information on the web,” says Berger. “This can particularly occur in chat rooms and unsupervised websites or blogs.” Berger adds that in order to correct a lot of misconceptions and incorrect impressions that were being posted in patient chat rooms regarding his own area of expertise, he and a colleague prepared an illustrated article targeted at patients, with corresponding FAQs. The posting was well-received and has since been repurposed on various industry websites.

To see how a consumer might access inaccurate healthcare information, consider your own search engine habits. For many people, a web search starts by entering a simple term or phrase, such as “abdominal pain,” into a popular search engine such as Google or Yahoo! Unfortunately, broad terms like this do not often lead to high-quality health websites. Only 35 percent of sites identified by these search engines were based on proven, scientific claims and did not endorse a product, according to research published in August 2003 by Michael Slater and Donald Zimmerman of Colorado State University’s Department of Journalism and Technical Communication, Boulder, Colo. The study went on to say that a significant number of promotional sites (20 percent) touted unproven treatments, and some of these included “pseudoscientific claims” that could be misleading. An additional investigation found that less than one-quarter of the first pages of links displayed by search engines led to relevant sites.

In another study conducted by the Department of Psychology, Rice University, Houston, Texas, a group of 34 students from the science magnet high school in Houston searched for the terms “vaccine safety” and “vaccine danger” using Google and then answered questions regarding the accuracy of the health information on the returned sites. The students were also asked to describe the lessons they learned in the exercise and to answer questions regarding the strength of evidence for seven statements regarding vaccinations. The results were telling: Of the 34 participants, 59 percent thought that the Internet sites were accurate on the whole, even though more than half of the links that the students viewed were, in fact, inaccurate on the whole. A high percentage of the students left the first exercise with significant misconceptions about vaccines; 53 percent reported inaccurate statements about vaccines in the lessons they learned. Of the 41 verifiable facts about vaccines that were reported by participants in their lessons-learned statement, 59 percent were incorrect.

Regulating Content: An Uphill Battle The sheer mass of information on the Internet makes regulation very difficult if not impossible. Currently, agencies regulate only overtly dangerous health information that violates laws protecting consumers. There are also a few organizations such as URAC (formerly known as the Utilization Review Accreditation Commission) and HONcode (Health on the Net Foundation) that rate health information websites, and while both organizations aim to keep consumers informed about the quality of website content, results are mixed. Unfortunately, the efficacy of these rating systems is questionable since it can prove difficult to verify the reliability of information on approved sites. Part of the reason for this is that websites are constantly changing; what is deemed accurate today could be completely inaccurate tomorrow, and there’s simply not enough manpower available to keep round-the-clock tabs on individual sites.

Given the lack of an industry-wide rating or monitoring system, some healthcare providers and larger healthcare organizations are taking matters into their own hands through proactive communications aimed at consumers. A few years ago, Kaiser Permanente launched an online health education site with more than 40,000 pages of physician-approved health-related information. The idea of using a health plan’s website to house healthcare information is a good one, and, with physician support, can encourage consumers to use the web as a supplement, not a substitute, for face-to-facephysician visits.

The Internet and the Future of Healthcare

Many economists believe that the healthcare system of the future will be completely patient-centric, a revolution triggered in part by access to medical information via the Internet. Even the selection of a physician typically begins in a web browser these days. Reports, practice profiles and performance reviews of healthcare professionals and organizations are increasingly available online, and more and more patients are basing their decisions — at least in part — on information acquired on the web. Consumer advocates argue that the disclosure of performance data is helpful because it encourages consumers to choose qualified providers. Opponents, however, argue that performance ratings may not tell the whole story, and unfairly penalize practitioners that treat high-risk patients. Other arguments suggest that such ratings may discourage physicians from treating high-risk patients for fear of losing credibility.

Another way the Internet is affecting healthcare is that it has diminished the consumer’s reliance on the choices of managed care providers. Today, a consumer can research various procedures online, select the one they prefer and demand the selected treatment from their physician. If the physician is unwilling to offer the requested treatment or services, in many cases, the consumer may simply find another physician who will meet their demands.

“Once patients and families learn of a doctor’s special expertise or interest, they may specifically seek out the doctor who can best help with their particular problem,” says Berger. “We have gotten many patients specifically seeking help with adverse reactions to certain treatments or wanting assistance with various protocols because they learned of our expertise via the Internet.”

Embracing a 21st Century Practice Model

There are many reasons why consumers are increasingly drawn to the Internet for health-related information. For one thing, the rapidly changing landscape of treatments, technology and medical breakthroughs makes it impossible for any single clinician to keep completely up to date, and consumers know it. Add to that the cost-containment efforts of current healthcare models that reduces clinicians’ time with patients; patients who feel rushed often leave frustrated and have the impression that their concerns were not adequately addressed. Turning to the Internet to get the answers they seek has become a common next step. Other factors include increased consumer interest in alternative approaches to healthcare, which are freely promoted online; the anonymity offered by Internet research (answers to questions can be sought without the embarrassment of face-to-face communication with a physician); and the convenience of being able to access health information from the comfort and privacy of the home. These behaviors are all part of the changing attitudes of healthcare consumers, and with a new generation of future patients for whom “Google” is a commonly used verb, it’s less of a trend and more of a 21st century paradigm shift — one healthcare providers may do well to embrace.

When you look at the Internet’s influence on the future of healthcare and the changing roles between physicians and the patients they care for, it’s clear that physicians who want to remain relevant and progressive may want to familiarize themselves with some of the most accessed healthcare websites, and have a working knowledge of sites that deal with their areas of expertise. For those willing to take an even bolder step forward, the opportunity exists to get involved in a more handson way by creating consumer-centric content for websites, authoring relevant blogs or contributing articles and commentary to existing reputable sites. By doing so, physicians can begin to bridge the communication gap created by the worldwide web, and partner with consumers to create the healthcare model of the future.