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JMIR-Internet Health Information Seeking and the Patient-Physician Relationship: A Systematic Review | Tan | Journal of Medical Internet Research
Published on 19.01.17
Discussion
Principal Findings
Based
on our review of the 18 empirical studies that examined patients’
Internet health information seeking and the implications for the
patient-physician relationship, we found that a greater proportion of
patients did not feel that their Internet health information-seeking
activities had an adverse impact on the patient-physician relationship [ , , , ].
The recent proliferation of health information on the Internet has
resulted in a shift in the traditional information balance [ , ],
where patients are increasingly equipped with health information
related to their conditions, eroding the prior exclusivity of health
information among health professionals. However, our findings show that
patients’ positive attitude toward physicians did not change unless
physicians imposed restrictions on their online information sharing
during consultations (eg, [ , , ]).
Patients went on the Internet mostly to be actively involved in the
decision making related to their health. Patients still valued
consultations with physicians [ [ ], and their trust in physicians remained very high , ].
Patients used the information found on the Internet to help them
prepare for their visit, ask better questions, and understand what the
physicians told them. These were shown to empower patients to play a
more active role in their disease management and to be more effective in
understanding and communicating with their physicians [ ]. Internet-informed patients were also more confident in and comfortable with their physicians’ advice [ ].
In
the studies we reviewed, some looked at how Internet health information
seeking affected the patient-physician relationship, while others
focused on how patients’ use of the online health information affected
the patient-physician relationship. Although we identified 5 different
types of strategies in the literature (including silently verifying
information, bringing printouts, explicitly verifying information by
asking questions, and asking extra questions without directly revealing
their Internet search), most studies focused simply on whether patients
discussed the online health information during physician consultations
and the associated outcomes. Among these studies, evidence showed that
patients experienced a better patient-physician relationship when they
had the opportunity to discuss their online health information with
their physicians, and their physicians were receptive to discussing the
online information. However, if patients experienced resistance from
their physicians to their discussion of online information, patients
were found to become frustrated and anxious [
] and would withhold their discussion [ , ].
Conflicts arising from physicians and patients having different
interpretations of the online information and when patients valued this
information more also had adverse implications for the patient-physician
relationship [ ]. In general, we found more evidence of positive than of negative implications of discussing online health information.
As
patients become better informed and like to be more actively involved
in decision making about their health, traditional models of the
patient-physician relationship need to be adapted to patients’ changing
needs by incorporating their perspective into a relationship-centered
medical paradigm [
].
In contrast to the physician-centric paternalistic models of care, a
deliberative or participatory model has been recommended for encounters
with Internet-informed patients [ ],
where physicians delineate the patients’ clinical situation and provide
help in explaining and deciding on the available options [ ].
Under this model of care, the physician acts as a teacher or a friend
by engaging patients in a dialogue through the decision-making process [ ].
Allowing
or encouraging patients to discuss their Internet information searches
with physicians is increasingly important, given that acquiring
information on the Internet has the potential to misguide patients with
inaccurate information and make them excessively anxious [
]. Therefore, the information patients wish to use in decision making ought to be verified to ensure that it is based on facts [ ].
Additionally, not disclosing their Internet information searches could
erode patients’ trust in their physicians if the diagnosis or the
recommendations are different from their Internet research findings [ ].
Our findings showed that enabling patients to communicate their
Internet research was one of the key mechanisms to ensure that patients’
opinion was valued and to enhance physicians’ relationships with their
Internet-informed patients. When physicians embrace openness to online
information [ , , , ]
and encourage patients to discuss the online information they have,
patients’ perception of physician resistance and fear of embarrassment
could be reduced and patients are more likely to discuss online
information with their physicians.
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