The ability to access health information via the Internet is creating a generation of empowered, informed patients. While this is almost always beneficial to both patients and the patient-physician relationship, it does call for changes to traditional counseling methods. Widespread access to myriad health information sources has divided patients into two subsets: those who prefer traditional counseling and those who become “personal health researchers” or PHRs.
While some patients will continue to enjoy the freedom of arriving with a question or concern, getting a diagnosis and following a treatment plan, others feel more satisfied with their care if they are able to actively participate. Neither method is superior, simply different and important to delineate. Patients who adopt the role of PHR require open discussion and call for a change to traditional office counseling in order to continue providing personalized, patient-centered care.
While traditional counseling patients will likely come to their appointments expecting a diagnosis, brief explanation, and treatment plan, PHRs have different needs. Frequently PHRs present with an idea of what their diagnosis could be and what that means to them personally. Whether the initial diagnosis was correct or not, PHRs will enjoy having more information and detail to help them gain an understanding of how you arrived at the diagnosis and why other considerations were ruled out.
Identifying which mindset a patient has adopted can easily be done during a visit by including questions like “What do you think is going on?” or “What have you read about this on the Internet?” in the HPI discussion. This type of question will typically reveal which patients will be included in the PHR group and allow us to tailor the remaining conversation and visit to their personal needs.
In general, when seeing a PHR, we can build on their pre-developed knowledge base and aid them in broadening their understanding. Rather than a traditional double monologue (beginning with patient monologue regarding the problem and ending with physician monologue targeted to diagnosis/treatment), the PHR visit will have a more conversational, question-and-answer feel throughout.
PHRs will never have all the information they desire when leaving your office. This makes discussion of evidence-based, reliable resources even more important. Personal health researchers will often feel most satisfied with their care when we can direct them to evidence-based information (and specifically away from hype and medical garbage).
While the delineation may seem daunting in this era of shorter visits and lengthier documentation requirements, the actual time required is not significant. With appropriate understanding of where patients find health information and an ability to identify personal health researchers, we can be an ally to the ever-changing needs of our patient populations.
Danielle Jones is an obstetrics-gynecology chief resident. This article originally appeared in the American Resident Project.
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