Redefining the physician’s role in the era of online health information

Clinicians are no longer gatekeepers to privileged information, but rather interpreters, problem solvers, and advisers

Many readers will be accessing the MJA via the internet: on computers, laptops, phones, or tablets. It is therefore essential that we discuss and understand how the internet and social media are used by patients to find health information, as well as the influence that the medical profession might have on such online information.

In this respect, the study published in this issue of the MJA1 is timely. Cocco and his colleagues surveyed patients presenting to two large emergency departments in Melbourne about their internet searches, both regarding the health problem that had brought them to emergency and for health information in general.

Despite the reservations many doctors may hold about “Dr Google”, the authors found that online research by patients had largely positive effects on the doctor–patient relationship, particularly improving their communication with their health provider. In general, their internet searches did not lead to loss of confidence in their doctor’s advice nor reduce their willingness to follow their recommendations. On the other hand, the online information found did cause some anxiety for 40% of searchers.1

These findings are important for the evolving role of the clinician. With so much detailed information available online, the clinician is now less a gatekeeper to privileged information than an interpreter, problem solver, and adviser. Patients can easily look up the “what” — that is, to search for information about their particular symptoms — but it is the doctor’s role to interpret the “why” and the “how”, to place the searchers’ findings in context. The intimate understanding of pathophysiology gained during medical training, together with skills in patient assessment and therapeutics, as well as clinical experience, allows the doctor to play a genuine consultant’s role: to elicit information from the patient, to interpret it, and to then advise them about the best course of action.

The author of an article that discussed internet searching by parents with sick children noted that Hippocrates had advised that “any man who is intelligent must, on considering that health is of the utmost value to human beings, have the personal understanding necessary to help himself in diseases, and be able to understand and to judge what physicians say and what they administer to his body, being versed in each of these matters to a degree reasonable for a layman.”2 This ethos is consistent with the role of the clinician as interpreter and adviser to their patients.

As it can now be assumed that many patients have searched the internet before visiting a doctor, the clinician must also be alert to the fact that misinformation and misunderstanding can cause unnecessary anxiety (“cyberchondria”).2 Rather than resenting the fact that the patient has attempted self-diagnosis, the encounter allows the doctor to explain, contextualise and correct any misunderstanding. Education is an important part of the collaborative therapeutic relationship. As noted in 2010 in the New England Journal of Medicine, “while previous technologies have been fully under doctors’ control, the Internet is equally in the hands of patients. Such access is redefining the roles of physician and patient.”3

Beyond the doctor–patient encounter, it is also important to recognise the role of medical practitioners in providing, evaluating, and scrutinising information available online. On the one hand, the internet hosts the full range of scams, conspiracy theorists, and anti-science activists, spreading messages from anti-vaccination and anti-fluoridation to phony cancer cures and fad diets. On the other hand, doctors can play a role in both creating and maintaining accurate health information, as well as correcting misinformation.

Opportunities exist for writing for medical news sites, online newspapers and blogs, and for contributing comments on articles and opinion pieces. An awareness of current social media trends allows the doctor to engage patients in discussions of topical themes and to correct myths that are circulating. Active participation in social media can alert doctors to current questions and provide a means for communicating sound scientific information to the community. While hardline anti-scientists and those with vested interests in spreading misinformation may resist conversion, the much larger group of silent readers may be open to correction from credible, informed sources.

There is a new foil for Dr Google: the doctor who is willing and able to meet the challenges and exploit the opportunities of the new era of online health information. The internet-literate doctor knows how and where to find health-related content, assists their patients to navigate the complex world of health information, and contributes to raising the level of information available online to interested patients and their communities.