Is There Pressure to be Informed?

I recently had the opportunity to speak to employees of King County, WA about finding credible health information online. During the Q&A a few interesting questions were posed (rephrased here):

  1. Does my doctor expect me to have looked up my symptoms online?
  2. Does it help my doctor get to the diagnosis faster if I look my symptoms up online and come up with diagnoses, as well?

The person who asked question #1 told a story about reviewing some symptoms with his doctor at an appointment and being taken aback when his the doctor asked him, “And what did you find on the internet?” The patient had indeed looked up his symptoms online, and was surprised that his doctor knew. However, he was left wondering if he was actually expected to research his symptoms online before his appointments.

The second question is actally a good question that I had not considered but makes sense when looking at it from a patient’s perspective. Should patients do some “homework” prior to their appointments to help a doctor get to a diagnosis faster?

Regarding question number one, I often ask if there was something my patient thought he/she might have in order to make sure I address some concern that might be otherwise left unspoken during the visit. But I do not have an expectation that patients come in having “researched” their symptoms.

My answer to question #2 is based only on personal experience. It does not necessarily help me get to a diagnosis faster if a patient looks up his/her symptoms online. I have certainly had some patients who were able to come up with diagnoses that were correct. More often than not, though, the scenario in my office is one where a patient is concerned about the worst possible outcome (which, luckily, is not often the actual case). Then there are others who may have figured out their diagnoses but never mentioned it. As I do not have a well-studied answer to this question, I am open to hearing from physicians who might have had a different experience. That being said, I would not discourage a patient from using his own resources to find out more about his symptoms. However, he should keep in mind that after a detailed history (which is the part of the visit where the doctor gathers information from a patient’s story) and exam, the diagnosis could be very different depending on the actual details elicited and findings observed.

These two questions from the audience, however, brings to light our changing roles in healthcare. Certainly, the doctor-patient relationship has undergone yet another evolution with the concept of the e-patient, distant now from its paternalistic beginnings. But, in the midst of (at the end of?) the Information Age and, perhaps, heading into an “Understanding Age,” are there now new expectations placed on patients by others or by themselves?  Is there a certain degree of pressure to be an informed patient on those who may or may not be comfortable synthesizing this type of information? Is there an expectation that one knows everything about his/her own medical condition? Is there more pressure involved in just being a patient today? Sometimes, I think there is.

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About Linda Pourmassina, MD

Internal Medicine physician.
This entry was posted in General Musings, Technology and tagged , , , , , , , . Bookmark the permalink.

7 Responses to Is There Pressure to be Informed?

  1. What a information of un-ambiguity and preserveness of precious familiarity on the topic
    of unpredicted feelings.

  2. Thank you for writing this post. I’m absolutely fascinated by your experience with the employees and find myself even more curious after reading your post.

    You bring so much insight to the very complex study of communication. Oh, how I wish we could have been there when the Physician responded to his patient “And what did you find on the internet?”
    This very simple question could have either helped connect and engage the physician and patient relationship or it could have placed a huge wall of condescending disrespect.

    When i was expecting my Ally, I was fortunate to have a physician friend recommend I make an appointment and meet her own OB/GYN. Richard G. Reuhland, M.D. was a perfect match. He quickly picked up that I’m curious and wanted to learn all I could about my health and body. When he would come into the room, he would latterly jump up on the counter to sit and with a hug grin on his face he would always say “O.K. Lisa, shoot.” This was his way of acknowledging and welcoming my stream of questions. Not only did this serve to bond our patient and physician relationship but I feel confident that it helped an expecting Mom with a high risk pregnancy deliver a very healthy almost 9 pound baby girl.

    During my delivery the anesthesiologist who administered my epidural chose to respond to my curiosity by responding “Oh look, another pregnant woman who has been reading Readers Digest.” His tone of voice, his lack of eye contact with me and glance at the nurse when he made such a hurtful and condescending comment was such a source of embarrassment during such a critical moment physically, mentally and emotionally.

    While the advance of social medial can impact our patient and physician relationship I think perhaps the the following question has nothing to do with technology “Does the physician consider the patient a vital partner in their healthcare?”

    • Lisa, Thanks for your thoughts and for your personal story. Yes, I do suspect the manner in which a physician asks about online research will reveal his/her opinion of such searching. I am sorry to hear about your experience with the anesthesiologist. My optimistic hope is that physicians do consider patients as partners in their healthcare sooner rather than later. That means trying – as best as possible – to address (and not dismiss) questions raised that relate to online health information.

  3. Carolyn Thomas says:

    As a heart attack survivor, I often reflect that if only the E.R. doc who misdiagnosed me with GERD and sent me home from hospital had bothered to Google my textbook cardiac symptoms himself at the time, he would have almost immediately arrived at the correct diagnosis of myocardial infarction, instead of insisting emphatically to me: “It is NOT your heart!”

    As reported in the NEJM, women under age 55 are in fact seven times more likely to be misdiagnosed in mid-heart attack and sent home from the E.R. compared to our male counterparts (JPope et al, N Engl J Med. 2000;342:1163-1170).

    So as long as physicians continue to do this, patients will continue to protect themselves and their health by researching online.

  4. I am thankful to Andrew Spong for scooping this post ( http://www.scoop.it/t/patient ) .
    Yes, I think its better for everybody if patients discuss their online research with their doctor.Any doctor who rubbishes your efforts to help yourself should be fired.
    And as mentioned above, doctors teaching their patients how to research their medical conditions online is a wonderful idea. Thanks for igniting some innovative ideas.

  5. Hats off to you, Linda. This is an article that really needed to be written. Technology has changed the landscape of doctor visits. Even informed patients feel the pressure to conceal or reveal prior research. I have seen extremes where some physicians diagnose solely based on patient research and others endeavor to discredit suggestions from laypersons. Hopefully, more physicians are in the middle. That’s why I have gotten behind the movement to have physicians post their personalized ePatient policy in an effort to alleviate exam room anxiety for both parties. http://bit.ly/z2FiCM

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