The Doctor-Patient Relationship in the Internet Age

Introduction

The advent of the “information technology age” has led to a rapid change in the doctor‐ patient dynamic. Before the Internet became host to a plethora of medical information and advice, the doctor‐patient relationship was
confined primarily to office consultations. In that setting, doctors advised patients on the best course of medical action, and the patients weighed their options before proceeding. Now, the modern patient has the ability to access extensive information on nearly every medical condition. Today, the patient arrives armed with information about potential diagnoses and courses of treatment. This inversion of roles presents a number of ramifications for the routine practice of medicine. Patients are in a position to lobby their doctors about treatment, and treat medical advice with skepticism and concern.[1] However, despite the fact that access to a wealth of online resources has the potential to alter the doctor‐patient dynamic, it has not necessarily replaced healthcare providers as the essential medium of care.[2] The full scope of this new doctor‐patient relationship involves access to information, the quality of the information accessed, and how that information is interpreted by patients.

Use of the Internet for Medical Research

In a study published by the Journal of Medical Internet Research in 2003, 85% of American physicians surveyed indicated that a patient had researched medical information online and brought that information to a visit.[3] This high percentage is mitigated by the fact that the same physicians reported that less than one‐fifth of their patients had come to an appointment with Internet research.[4] This suggests that only a small number of patients were presenting research found online to their physicians. In that same year, however, a poll published in the Journal of Patient Education and Counseling reported that 80% of American adults who used the Internet had researched health information, and the share of adult Internet users searching for medical information had been rapidly increasing since the proliferation of the Internet.[5] At the beginning of the decade, a study published in the Journal of General Internal Medicine in 2002 indicated that patients who had accessed medical information on the Internet were better educated and had a higher socioeconomic status. [6] Yet by the end of the decade, a study published in the Journal of Health Communication in 2008 noted that while sociodemographic factors contributed to some of the variance in whether or not a physician was contacted after turning to the Internet for research, Internet research was positively linked to physician visits, even when sociodemographic factors were controlled.[7] Regardless, it is clear that Americans are increasingly turning to the internet to fill gaps in their own knowledge about medical
conditions.

Effects of Online Research

The early evidence of this shift
in patient‐centered information
resulted in a number of theories on how the change would affect the doctor‐patient relationship. The multitude of medical information online allowed for potential positive effects for the patient; the access to knowledge had the potential to democratize the healthcare process. Patients would theoretically have the ability to play a larger role in medical decision‐making, while the clinician would serve as an informed guide.[8] This drive to the Internet for information may have been fueled by an already strained doctor‐patient relationship. As the time doctors spent with their patients declined, the power of the Internet grew, and patients began to use the Internet out of frustration.[9] The benefits of the Internet do not end with access to information, as support groups
for individual disease have grown in popularity, and a number of studies suggest that patients who participate in these groups “gained satisfaction” with their medical experience.