The Internet is changing the traditional doctor–patient relationship.1 Increasingly, rather than provide information directly to patients, the doctor assists them with health decisions by recommending particular health information websites1 — these recommendations can be thought of as “Internet prescriptions”.1 Doctors have adopted recommending or prescribing health websites to educate their patients about particular conditions or diseases, or to help patients cope with their medical conditions.1
Many general practitioners are reluctant to recommend websites to patients,2 as they remain sceptical about the advantages of using the Internet more actively and are concerned that their patients may turn to websites for information instead of consulting a health professional about potentially serious health conditions.3 Some doctors who are willing to recommend health websites to patients would only do so if the websites are guaranteed to contain quality content,4 but many doctors do not have the time or technical expertise for this analysis.5 GPs frequently express concerns about the validity and accuracy of health information found on the Internet.1
A survey instrument consisting of 17 questions was mailed to 250 of the 410 GPs (61%) practising on Queensland’s Gold Coast. Participants were randomly chosen from an online telephone directory (http://www.yellowpages.com.au) and the survey was conducted between 9 October and 11 December 2006. The questions were designed to measure the proportions (0%, 1%–20%, 21%–40%, 41%–60%, 61%–80%, over 80%) of patients and websites associated with GPs’ website recommendations. Data were analysed using SPSS software (SPSS Inc, Chicago, Ill, USA). Ethics approval for the study was obtained from the Griffith University Human Research Ethics Committee.
Of the 250 GPs contacted, 108 (43%) returned a completed survey; 72 (67%) were male and 36 (33%) female. The majority of participating GPs were aged 41–50 years (38%, 41/108), and 81% (88/108) had been practising for 10 or more years.
Fifty-nine per cent (64/108) of the surveyed GPs reported recommending health websites to their patients during consultations. Of the male GPs, 63% (45/72) indicated that they actively recommend websites, compared with 53% (19/36) of female GPs. The majority of GPs (55%, 35/64) who recommend websites were 41–50 years old, compared with 31% (20/64) of GPs aged 51–60 years. Sixty per cent (12/20) of GPs with < 10 years experience reported recommending websites. The top four reasons why surveyed GPs recommend health websites are presented in Box 1.
Thirty-four of the 64 GPs (53%) indicated that they recommend websites to 1%–20% of their patients. The majority of GPs (69%, 44/64) reported that they most often recommend websites to patients aged 26–45 years. Furthermore, the majority of GPs indicated that they recommend websites to 1%–20% of their male patients (53%, 34/64), and 21%–40% of their female patients (47%, 30/64). The top four health issues for which GPs recommend websites are presented in Box 1.
Forty-seven of the 64 GPs (73%) indicated that 1%–20% of their patients asked them to recommend websites. Similarly, 51 GPs (80%) indicated that 1%–20% of their patients brought online health information to them for discussion; this was most often patients aged 26–45 years (59%, 38/64). Forty-nine GPs (77%) indicated that 1%–20% of their male patients brought online health information to them, while 47 (73%) indicated the same proportion for female patients. Twelve GPs (18%) indicated that 21%–40% of their female patients brought online health information to them, while two (3%) reported that more than 40% of their female patients did this. The top four issues for which patients brought health website information to GPs for discussion are presented in Box 1.
Forty-one per cent (44/108) of the surveyed GPs indicated that they do not recommend websites to their patients. Thirty-eight per cent (27/72) of male GPs do not recommend websites, compared with 47% (17/36) of female GPs. Fifty-two per cent (23/44) of GPs who do not recommend websites are over 60 years of age. Forty-one per cent (36/88) of the GPs practising for 10 years or more do not recommend websites, compared with 40% (8/20) of GPs with < 10 years experience. The top four reasons why surveyed GPs do not recommend health websites are presented in Box 2.
The large amount of health information available on the Internet is changing, and some may say “challenging”, the traditional doctor–patient relationship.3 The new trend is to empower the patient — a move away from the older paternalistic relationship to one more patient-centric.6 I found that GPs recommend health websites primarily to educate the health consumer about specific diseases, drugs and health care delivery. Consumers want education and prevention information, to help them take care of themselves and participate in health discussions with their doctor in a more informed way.7
Many older people view computer technology with a degree of uncertainty and apprehension, resulting in many “pockets” within professions being reluctant or slow to adopt innovative approaches to emerging technologies.1 This trend, displayed by GPs in this survey, is reflective of a younger generation that has been immersed in such technologies as the Internet for many years. One of the reasons progress in addressing this issue has been slow is the lack of understanding of how to design, implement, and evaluate health websites that impart trust to health consumers and GPs.8
A study on the “gender gap” in Internet use revealed that females tended to be more anxious about Internet use than males,9 and this was demonstrated by the female GPs in my survey. This “resistance profile” warrants further study to develop strategies that will encourage female GPs to adopt innovative technologies. Interestingly however, my research also found that female patients are more inclined than male patients to bring online health information to their GPs for discussion.
With the increasing interest in Internet use and website recommendations in health care, many health professionals would be willing to take certified web-based continuing medical education courses.6 Similarly, the inclusion of programs and curricula in medical schools is a possible strategy for preparing future GPs for Internet prescribing.2 These are important initiatives towards creating a more reliable and safer e-health care environment for all.
This study is the first exploration of GPs’ views of Internet prescribing in Australia and may help guide future research and policy, to help doctors develop the skills necessary for the delivery of effective e-health care.
1 General practitioners who do recommend websites (n = 64)
- Wayne T Usher
- Education and Professional Studies, Griffith University, Gold Coast, QLD.
I would like to thank those Gold Coast general practitioners who took the time to complete my survey. I greatly appreciate their input.
None identified.
- 1. Eysenbach G, Diepgen TL. Towards quality management of medical information on the internet: evaluation, labelling, and filtering of information. BMJ 1998; 317: 1496-1500.
- 2. Decco DL. Concerns of family practice physicians recommending medical web sites to patients [PhD dissertation]. Laramie, Wyo: University of Wyoming, 2003. (UMI Microform 3092495, Proquest Information and Learning Company.)
- 3. Anderson JG, Rainey MR, Eysenbach G. The impact of CyberHealthcare on the physician–patient relationship. J Med Syst 2003; 27: 67-84.
- 4. Murray E, Lo B, Pollack L, et al. The impact of health information on the internet on the physician–patient relationship: patient perceptions. Arch Intern Med 2003; 163: 1727-1734.
- 5. Kassirer JP. Patients, physicians, and the Internet. Health Aff (Millwood) 2000; 19: 115-123.
- 6. Podichetty VK, Booher J, Whitfield M, Biscup RS. Assessment of internet use and effects among healthcare professionals: a cross sectional survey. Postgrad Med J 2006; 82: 274-279.
- 7. Quintana Y, Feightner JW, Wathen CN, et al. Preventive health information on the Internet. Qualitative study of consumers’ perspectives. Can Fam Physician 2001; 47: 1759-1765.
- 8. Berland GK, Elliott MN, Morales LS, et al. Health information on the Internet: accessibility, quality and readability in English and Spanish. JAMA 2001; 285: 2612-2621.
- 9. Sherman RC, End C, Kraan E, et al. The Internet gender gap among college students: forgotten but not gone? Cyberpsychol Behav 2000; 3: 885-894.
Abstract
Objective: To identify trends associated with health website recommendations by selected general practitioners to their patients.
Design and setting: Quantitative data collection using a prepaid postal survey, consisting of 17 questions, mailed to 250 of 410 GPs (61%) on the Gold Coast, Queensland. The survey was conducted between 9 October and 11 December 2006.
Main outcome measures: GPs’ website recommendations to patients; associated GP demographic variables (age, sex and years of practice).
Results: 59% (64/108) of participating GPs recommend health websites to their patients during consultations. Male GPs (63%, 45/72), those aged 41–50 years (55%, 35/64), and those practising for < 10 years (60%, 12/20) are more inclined to recommend a health website to a patient. The majority of GPs (69%, 44/64) reported that they most often recommended websites to patients 26–45 years old. 53% of GPs (34/64) recommended websites to 1%–20% of their male patients, while 47% (30/64) recommended websites to 21%–40% of their female patients. A greater proportion of participating female GPs (47%, 17/36) do not recommend health websites, compared with male GPs (38%, 27/72).
Conclusions: More than half the surveyed GPs actively recommend websites to their patients, with a GP’s sex, age and years of experience influencing his or her recommendation decisions. Web-based continuing medical education courses or programs in medical schools may help doctors develop the skills necessary for the delivery of effective e-health care.