Guiding patients online is a new physician responsibility for the digital age

The following op-ed was published on February 22nd, 2011 in AOL News.

If you woke up one day with an earache, you could call your doctor’s office for help. Or you could do what the majority of patients do today and Google what to do first.

Type “earache” into your Web browser and the results can vary wildly. Search engines can return results saying that an earache can be from the common cold, needing nothing more than over-the-counter remedies. Or it could be a sign of a brain abscess, which requires emergency medical attention.

Only 7 percent of doctors e-mail their patients, let alone engage them on blogs, Twitter or Facebook. A recent international health survey conducted by the London School of Economics found that only one in four checked the reliability of online health advice. When you consider that nearly two-thirds of patients are consulting the Internet for their medical symptom or condition, that’s a lot of patients accepting what they read on the Internet at face value.

That can be dangerous. If a patient wanted to learn CPR, for instance, a typical Web search would lead to one of more than 50 such instructional videos on YouTube. But according to a recent study from the Medical College of Wisconsin, more than half of those showed improper technique; either the rate or depth of chest compressions was wrong. Worse, just a handful reflected the American Heart Association’s 2010 resuscitation guidelines update, which now advocates “hands only” CPR, without mouth-to-mouth breathing.

Patients not only are looking for health information on Google, but also on social networks like Facebook. These sites are popular with patients who, according to the Pew Internet and American Life Project, generally gravitate toward user-generated information. It’s no wonder that 22 percent of all online time is typically spent on a blog or social network, with patients reading other people’s commentaries or experiences with a particular test or treatment. But can these communities substitute for a qualified health professional?

A study last year from Harvard Medical School, which looked at 15 of the largest Facebook diabetes communities and analyzed close to 700 “wall” posts, gave some insight. Most of the comments provided support among diabetics and included strategy tips, personal advice and emotional outreach. But more than a quarter of posts were promotional in nature, advertising non-FDA approved products of questionable efficacy or safety. So although social networks have definite value in connecting patients, the information needs to be viewed with a critical eye.

With only 7 percent of doctors e-mailing their patients, let alone engaging them on blogs, Twitter or Facebook, the medical establishment needs to realize the influence of the Internet and social media on patients.

Guiding patients to better online sources of medical information should be a new physician responsibility for the digital age. Not only should doctors expect and be receptive to questions patients raise from Web research, they need to proactively engage patients online in order to dispel falsehoods and guide them to legitimate sites.

Until then, patients should be vigilant about checking the source of what they read on the Web. Ensure it comes from a reputable institution — such as a hospital, medical school or government agency.

The Internet has fundamentally changed the doctor-patient relationship by breaking down the information walls traditionally separating patients from their health professionals. How both parties navigate this new paradigm will determine how much the Web and social networks will benefit patients.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • http://www.pacificpsych.com/ pacificpsych

    Though some sites are beyond reproach, for example the CDC, they don’t necessarily answer a particular question someone might have. Other sites are good for most areas but follow the usual biological bias in psychiatry. And sites like WebMD, which I think is the single most visited health site, are pure Pharma sponsored junk.

    If we want our patients to get good info we need to put it out there ourselves. What’s really missing is an online physician owned multidisciplinary Q&A website. There are clever businessmen who set up huge sites where people pay $20 or so per answer. The doctor who answers the question gets paid about a dollar, or something like that. Just another way to use doctors.

  • http://www.patientpower.info Andrew Schorr

    Kevin,
    I totally agree with you that there is a new dynamic going on now with the Internet playing a key role and patients unsure that their doctor knows all there is to know about a given health concern. That’s why I wrote the just released new book: The Web-Savvy Patient: An Insider’s Guide to Navigating the Internet When Facing Medical Crisis (www.websavvypatient.com). It not only takes a close look at the web and social media but also coaches patients (I am a 15-year-leukemia survivor) on how to use the reliable information gained for productive discussion with their doctor. The big uptake by patients of online health information and discussion is part of a growing “patient power” movement where all of us want to be more in control of our own healthcare. The fractured healthcare delivery system leads us to that.

  • http://briarcroft.wordpress.com/ Emily Gibson

    In our University Health Center practice, we tell our patients that all non-urgent communication will be sent by secure patient portal messaging (email is never a secure way to send personal health information), including a copy of their chart note, copies of lab work with interpretation, copies of imaging reports with interpretation, and relevant patient education URL links or material we have written ourselves. We have found the best web-based patient education material is http://www.Mayoclinic.com or http://www.uptodate.com
    The information is kept current, is balanced and not overly inundated with promotional advertising.

  • http://www.pacificpsych.com/ pacificpsych

    Mayo is problematic when it comes to psychiatry. It repeats bio-psychiatry’s mantra, yawn. Example:

    >> Depression is a medical illness that involves the mind and body…

    …Depression is a chronic illness that usually requires long-term treatment, like diabetes or high blood pressure. But don’t get discouraged. Most people with depression feel better with medication, psychological counseling or other treatment…<<

    Depression is a *human* condition, not a medical illness. The comparison to diabetes and high blood pressure is part of the Pharma-generated meme: it's biological, you need to take your meds, and do so for life. Wrong, wrong and wrong. As for "feeling better with medication", antidepressants are no more effective than placebo.

    They don't tell you that, do they? They don't talk about all the corruption and distortion behind the trials of antidepressants. They just repeat the same old incorrect info that fills the internet. Then laypeople and therapists repeat this, and everyone wallows in their ignorance, convinced they "know" stuff.

    • http://offwhitecoat.wordpress.com The Scrivener

      pacificpsych, I’m intrigued. My understanding of the literature is that both meds and psychotherapy are effective compared to placebo; and combined therapy is better than either alone. To be sure, more funding through the NIMH (only 9% in 2008!) rather than directly by drug companies would alleviate bias. But the govt-sponsored trials still show a clear advantage to treatment over placebo.

      I do think, though, it’s important to help the patient understand that psychiatric illness *is* treatable. There’s such a huge public stigma against psychiatric illness, and many patients, especially those with depression, may feel it’s their fault or their case is hopeless. Comparing depression to other chronic illnesses can help normalize the patient’s experience. It seems to me that’s what the Mayo website is doing.

  • http://www.doctortipster.com Riciu

    I am a physician from Europe who tries to build up quality articles to inform the population about different diseases and deliver some good tips on my personal blog. I do not intend to make money with my blog, or ask people money for my advice. I just want to help when i have time to spear. There are lots of people who need help and can not afford it in the EU or US. The hard thing isn’t writing an article and hitting the publish button. The hardest thing to do is explaining to common people medical terms and what they sould or not do, in most cases common people tend to follow medical advices better then physicians confrunted with a disease.
    If we look at the age factor, many good and experianced physicians were born and formed in an age when the Internet was science fiction,they are simply “scared” of it, or do not want to know how use it in favor of the patients. Best Regards. Richard MD

  • http://www.pacificpsych.com/ pacificpsych

    I agree that there is a huge gap in the information available on the net, in giving simple explanations tailored to the individual’s specific question.

    As for pay, if you get a salary from somewhere and can afford to do this for free because your bills are already paid, be my guest. But if you don’t, you might think differently about it. Here’s a rant from Harlan Ellison, a Sci-Fi writer, which says it very well:

    http://www.youtube.com/watch?v=mj5IV23g-fE

  • SidewaysShrink

    I agree with pacificpsych. As a solo practitioner with no office staff, I have a hard enough time keeping up with scheduling, pharmacy fax backs, charting, billing and emergency patient events for which there is no reimbursement. We are on call 24/7 for which there is not CPT code unless the crisis is handled face to face. We do this out of a sense of ethics and duty. This works well in a fee for service world in which insurance companies have no ethical responsibilities except the fiduciary one to stock holders while in psych our fees have been manage cared down into ridiculously low reimbursement rates. And the last thing I need is daily extensive reports on each nuance of feeling and memory a therapy patient is having. The “patient agreement” all patient’s sign states that I charge my full hourly rate in 1/4 hour increments to read or write emails, letters, reports, etc. That makes patients stop the long emails. I do use email to schedule appointment with on going patients or for them to communicate about problems with a pharmacy. I live an area known for high tech and most of my patients are under 45 and have no problem with these limitations.
    Patient visits are the appropriate time for me to answer their questions about things they have read on the internet, etc. This strengthens the doctor-patient relationship in “face time” which increases human contact which a lot of people are craving these days.

  • http://www.pacificpsych.com/ pacificpsych

    That didn’t come out right. Please delete that. I’ll try again:

    http://www.amazon.com/Emperors-New-Drugs-Exploding-Antidepressant/dp/046502016X/ref=cm_pdp_lm_itm_title_2

    http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowFulltext&ArtikelNr=318293&Ausgabe=254424&ProduktNr=2238643

    Quote: Results: Meta-analyses of FDA trials suggest that antidepressants are only marginally efficacious compared to placebos and document profound publication bias that inflates their apparent efficacy.

    http://bjp.rcpsych.org/cgi/content/full/185/1/37

    Quote: According to clinical lore, the combination of antidepressants and psychotherapy is preferable to psychotherapy alone in the treatment of depression. However, this view is not corroborated by empirical evidence

    http://www.upi.com/Health_News/2010/09/16/Stigma-of-mental-illness-no-better-in-US/UPI-22501284618593/

    • gzuckier

      I’ve often felt that placebos are woefully underprescribed. Seriously. Better than handing out antibiotics for common cold, anyway.

  • http://www.doctortipster.com Riciu

    @pacificpshyc , nothing is for sure until you start trials.

    • http://www.pacificpsych.com/ pacificpsych

      Not sure what you mean. Nothing is sure in medicine and especially in psychiatry. My point in all this is that if Mayo were a good informational site, it would say: “some view depression as a human condition, some view it more as a medical illness, read about the different views here [link, link]…”

      And: “In recent decades, antidepressants have come to be the first choice in treatment of depression, but increasingly, their usefulness has come into question. Read more here [link]“.

      And: “The two most important factors in relief of mild to moderate depression are a supportive relationship and the tincture of time. Most patients get better on their own. If you have X, Y or Z, OTOH, you should see a psychiatrist ASAP”

      Etc…something like that, just threw it together. This is what patients (and many doctors) don’t hear, because all they get is regurgitated Bio info. The Net perpetuates the problem of this so-called knowledge.

  • http://www.ictconsequences.net Francisco Lupiáñez-Villanueva

    Recentrly I have posted about this topic focus on the elderly. I have mentioned that eHealth literacy could be a catalyst to overall digital literacy among the elderly. Of course Guiding patients online is needed!

    1. Health could be a motivation for the elderly to use the Internet (e-awareness)
    2. This motivation could be used as a trigger to learn how to use this technology (e-readiness)
    3. Health professional and/or health care workers as well as relatives and/or friends could facilitate this learning process (ehealth literacy)
    4. Use of the Internet for health could open new fields of participation in society for the elderly.
    5. These new fields of participation in society could diminish categorical inequalities and unequal distribution of resources.

    eHealth Literacy as a catalyst to overall digital literacy among the elderly
    http://www.ictconsequences.net/2011/03/13/ehealth-literacy-as-a-catalyst-to-overall-digital-literacy-among-the-elderly/

  • http://minochahealth.typepad.com doc

    The intersection of medicine, health, and media is a dynamic, fast-moving target. It is difficult to visualize where and how it will crystallize and what role each of the stake-holders will play. In the meantime, I am keeping fingers crossed.

  • http://www.elizabethdohertythomas.com Elizabeth Thomas

    I would LOVE to know how many online health surfers (I’m one of them!) actually BELIEVE, TRUST, and ACT on what we find online. I’m guessing that % is way lower. It is easy for professionals to worry about the crap online and not get a sense that most people have a pretty good filter for crap.

    I do not believe most drs have figured out how to do patient engagement better… I’m sure most would agree. So the question is why would it be best for overworked doctors to write generic health information when they could be working harder on dealing with their actual patients? For example, very few systems have any form of follow-up, say, calling the patient confirming they started their BP meds, or started the treatment they were assigned. And then following up a month later that it’s still going on.

    There is a new model in the early phases towards a team-based approach. At least 4 people would know your case, there would be mandatory meetings every day with the bigger medical team, and the focus would be on the above follow up pieces and better addressing basic patient questions, potentially without a visit (costs would be incurred for this new patient-clinic communication, but overall savings could be huge if health care costs could be decreased.)

    It seems the fundamental issue with health care medical stuff is the need to see the patient in person. Isn’t observation a key component of diagnosis? The subtle stuff, the dr intuition, seeing, hearing, noticing of the actual body?

    The “good news” is now that the US government insures more American’s than any other health plan, they have a personal incentive to find ways to both INCREASE patient health while decreasing costs.

  • http://pulse.yahoo.com/_DNQOE644CF6FSFZBTJQBZG5K4E Johanna

    I happen to be a medical librarian and I am paid to search out health information wherever it may be. I wish more physicians would make themselves aware of what lies in wait for their patients on the internet. I’m forwarding your piece to my personal doc. Thanks.