Consumer access to health info online affects doctor-patient relationship, survey finds

Physicians may be acquiescing to clinically inappropriate patient requests for care, for fear of damaging the physician-patient relationship, a survey of U.S. physicians suggests.

Physicians responding to the nationwide survey indicated that, although relevant information patients glean from the Internet can be beneficial to health care, inaccurate or irrelevant information harms health care, health outcomes and the physician-patient relationship.

Elizabeth Murray, MRCGP, PhD, and colleagues in England and the United States conducted the survey regarding patients’ access to health information, to which 1,050 physicians in the United States responded. To be targeted for the survey, physicians had to spend more than 20 hours a week on direct patient care. The sample was nationally representative, and the response rate was 53%. About half of the respondents (515) answered a set of questions specifically pertaining to information patients obtained on the Internet.

Of total respondents, 61% said they used the Internet in their own practice, mostly to obtain scientific articles or guidelines (88%) or to exchange e-mail with colleagues (63%). Retrieving lab information about a patient or directly contacting patients via the Internet was a less common practice.

In general, physicians were positive about the recent increase of health information on the Internet, with 75% indicating it was a good or very good thing. Most physicians (77%) said they have encouraged patients to look for information on the Web, although only 35% said they had directed patients to particular sites.

Fully 85% of respondents reported at least one occasion in which a patient brought information obtained on the Internet to an appointment. This is still a relatively new trend, however; 59% of respondents said fewer than 20% of their patients had done this.

Of the 430 physicians who said patients had brought them information obtained from the Web, 90% said they thought the patients did so because they sought the physician’s opinion. Patients also sometimes requested a change in medication (31%), a test (26%) or a referral to a specialist (13%).

Usually the physicians reported doing what the patient wanted, either completely (23%) or partially (59%). According to a multivariate analysis, three factors independently predicted not doing what the patient wanted. The physician did not accede to the request if the requested action was not appropriate for the patient’s health or if the physician thought information the patient presented was inaccurate. A third predictive factor was the specialization of the physician. Medical specialists were less likely than surgical specialists or primary care physicians to honor a patient request.

Most physicians surveyed said that the patient’s bringing information to their attention had a beneficial (38%) or neutral (54%) effect on the physician-patient relationship.

“Physicians believed that inaccurate or irrelevant information harms the quality of care, health outcomes, time efficiency and the physician-patient relationship,” the authors reported in the Journal of Medical Internet Research. “Thus, improving the accuracy and relevance of online information available to patients may improve outcomes of interest to health care providers, payers and consumers.”

The authors said the medical field faces a challenge in improving the quality of health care information found online. They suggested assigning seals of approval to quality medical Web sites, creating codes of conduct for the development and content of Web sites, having physicians direct patients to trusted Web sites and implementing a concerted effort to educate the public about the quality of medical information that can be found online.