Skip to main content

Main menu

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums

User menu

  • My alerts

Search

  • Advanced search
The College of Family Physicians of Canada
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums
  • My alerts
The College of Family Physicians of Canada

Advanced Search

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • RSS feeds
  • Follow cfp Template on Twitter
Research ArticlePractice

Effects of the Internet on patient consultations

Marie-Thérèse Lussier and Claude Richard
Canadian Family Physician January 2010, 56 (1) e4-e5;
Marie-Thérèse Lussier
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: mtlussier@videotron.ca
Claude Richard
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • eLetters
  • Info & Metrics
  • PDF
Loading

Physicians are placed in a delicate situation when confronted with information that suggests approaches or diagnoses that they did not propose. Certainly when patients arrive with their own information, they are suggesting a new type of relationship with the physician by openly challenging the traditional authority of the health care provider.1 This becomes a potential source of uneasiness, and sometimes even conflict, between the 2 parties because each is breaking the usual conversation rules that exist in a service relationship. Typically, the person seeking advice does not suggest his or her own solutions at the same time. Challenging medical authority is not new; what is new is that it is being challenged at the time of the consultation, which might alter how the meeting unfolds.1

Why do patients bring documents?

One reason patients bring in outside “expert” opinions is that they genuinely believe their physicians do not have the information and they simply wish to provide it. Or perhaps, in their opinion, their physicians are not placing enough importance on certain aspects of their care. In this case, the physician’s reaction is more important; the relationship with the patient might be jeopardized if the physician does not pay attention. A hierarchy of possible scenarios is presented in Box 1. Although providing additional or alternative information could reflect doubt, it might also reflect the patient’s desire to be actively involved in his or her treatment. Physicians might feel the doctor-patient relationship is being questioned.2 This reaction comes as no surprise—when patients do not blindly follow what their physicians say, this challenges a way of functioning in which the physician suggests a solution and patients accept it, at the very least during the consultation.

Box 1.

Reasons patients might provide outside information for physicians, in order of frequency:In some cases, a patient might simply choose to stop coming to appointments, in which case they have likely sought treatment elsewhere.

  1. To inform the physician

  2. To present alternative treatments available

  3. To encourage the physician to consider other interpretations of their symptoms

  4. To confront the physician’s decision

  5. To express doubt over the diagnosis

  6. To affirm that the physician is wrong

There are, however, some positive aspects of this new dynamic: 1) patients are talking openly, which gives physicians the opportunity to learn about any other treatments patients might be following; and 2) patients are suggesting a relationship in which collaboration will play a more substantial role. The latter is particularly important because it is an indication that patients want to be more active in maintaining their health and managing their care.

Reliability of on-line sources

It is often very difficult for a nonphysician to pick and choose among all the health websites available. This is even more troubling when you consider that these websites are among the most frequently visited types of Internet sources.3 In addition, websites that suggest solutions to health problems often mimic official sites of recognized organizations (government or professional bodies). For patients who are suffering and looking for solutions, these resources often suggest the miracle they have been searching for.

It is important to know how to make sense of all the material that can be accessed on the Internet and how to help patients make sense of it, without spending hours checking the information. Certain criteria can help: Do the authors have training recognized by a university or professional association? If there are references, where were they published? Evaluating the reliability of a website sometimes involves detective work. Obviously, the website’s affiliations provide a good indication of the reliability of its documents and its credibility—look for government, professional, or university endorsement. Further, there is a particularly useful tool developed by the Health On the Net Foundation. This nonprofit, non-government organization promotes and guides the deployment of useful and reliable on-line health information. This site can be used to find quality websites to suggest to patients.4

Even if the information taken from websites is of good quality, physicians must put the information into context and help patients interpret it. Although the reported information might be accurate, it might not apply to a particular patient or situation. Explaining takes time, but when patients have made the effort to bring in materials that they think are relevant to their health problems, it is not acceptable for the physician to ignore them or reject them without review. In either case, such an attitude will be interpreted by patients as blatant disregard.

Opportunity for dialogue

When patients bring medical documents to their appointments, it is an opportunity for physicians to collaborate with them about the management of their health. Patients tend to search for information at the beginning of their relationships with their physicians or when new problems develop; once patients are reassured, requests for information usually decrease and physicians can focus on the treatment plan agreed upon. Box 2 provides an example of the best way to have a conversation with a patient who has brought extra information to the physician’s attention concerning an alternative treatment suggestion.

For patients with chronic diseases who are desperate to find solutions to their pain and discomfort, the search for “alternative” solutions might continue for a long time and can include visits to other physicians (who might offer novel therapies) or alternative treatment centres. The important thing in these cases is to be accepting of patients’ search for solutions and guide them away from false information and quackery.

Box 2.

Dialogue between patient and physician during a follow-up appointment, for which the patient has brought in information from an outside source

FP: Hello, Ms X. Today we had planned to follow up on your asthma, I believe. Is that correct?
Pt: Yes. I’m still coughing quite a bit and it’s hard for me to sleep. I often wheeze. I have to use my inhaler often in order to function.
FP: The treatment that I prescribed to you last time doesn’t seem to be effective?
Pt: I don’t know; I read that the new inhaler that you prescribed could be dangerous. All these stories made me worry.
FP: What stories?
Pt: I went on the Internet and I searched for asthma and cortisone. I printed the articles I found the most worrisome. Look, Dr Vit says here that cortisone can cause damage and harden the arteries. I highlighted the important parts in yellow.
FP: Hmmm, it doesn’t say “Dr” Vit but “D.” Vit, and he writes that doctors recommend the product that he has developed. But this is the first time I’ve heard of it. Just a minute, I’ll check. No, this drug does not appear in the CPS, a volume prepared by the Canadian Pharmacists Association in which you can find information about all the drugs available in Canada.
Pt: Ah ... even so ...!
FP: It means that we don’t know what this product does. It has not been approved as a prescription drug in Canada.
Pt: But I have other articles here that say it’s all right, and that standard treatments might be harmful.
FP: Well, I can’t read all of this today, but what I have seen leads me to doubt the reliability of these articles. Could you leave your copies with me and I can give you a more informed opinion the next time we meet? In the meantime, because your asthma does not seem to be well controlled, I would like to explain to you again how the drugs that I prescribed work and why I would like you to take them. All right?
Pt: Okay, but I would really like your opinion on this product because it seems like it could be an alternative to cortisone, which scares me.
FP: I promise to look into it; in the meantime, let’s continue as usual.
  • CPS—Compendium of Pharmaceuticals and Specialties, Pt—patient.

  • Acknowledgments

    This article is an adaptation of an article previously published in MedActuel. We thank AstraZeneca Canada for covering the costs of adaptation and translation.

    Footnotes

    • Competing interests

      None declared

    • Copyright© the College of Family Physicians of Canada

    References

    1. 1.↵
      LowreyWAndersonWBThe impact of internet use on the public perception of physicians: a perspective from the sociology of professions literatureHealth Commun200619212531
      OpenUrlPubMed
    2. 2.↵
      CastelPLe médecin, son patient et ses pairs: une nouvelle approche de la relation thérapeutiqueRev Fr Sociol200546344367
      OpenUrl
    3. 3.↵
      1. Alexa
      The Web Information Company [website]. San Francisco, CA: Alexa Internet; 1996. Available from: www.alexa.com. Accessed 2009 Dec 22.
    4. 4.↵
      1. Health On the Net Foundation [website]
      . Geneva, Switz: Health On the Net Foundation; 2009. Available from: www.hon.ch. Accessed 2009 Dec 22.
    PreviousNext
    Back to top

    In this issue

    Canadian Family Physician: 56 (1)
    Canadian Family Physician
    Vol. 56, Issue 1
    1 Jan 2010
    • Table of Contents
    • About the Cover
    • Index by author
    Print
    Download PDF
    Article Alerts
    Sign In to Email Alerts with your Email Address
    Email Article

    Thank you for your interest in spreading the word on The College of Family Physicians of Canada.

    NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

    Enter multiple addresses on separate lines or separate them with commas.
    Effects of the Internet on patient consultations
    (Your Name) has sent you a message from The College of Family Physicians of Canada
    (Your Name) thought you would like to see the The College of Family Physicians of Canada web site.
    CAPTCHA
    This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
    Citation Tools
    Effects of the Internet on patient consultations
    Marie-Thérèse Lussier, Claude Richard
    Canadian Family Physician Jan 2010, 56 (1) e4-e5;

    Citation Manager Formats

    • BibTeX
    • Bookends
    • EasyBib
    • EndNote (tagged)
    • EndNote 8 (xml)
    • Medlars
    • Mendeley
    • Papers
    • RefWorks Tagged
    • Ref Manager
    • RIS
    • Zotero
    Respond to this article
    Share
    Effects of the Internet on patient consultations
    Marie-Thérèse Lussier, Claude Richard
    Canadian Family Physician Jan 2010, 56 (1) e4-e5;
    del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
    • Tweet Widget
    • Facebook Like
    • Google Plus One

    Jump to section

    • Article
      • Why do patients bring documents?
      • Reliability of on-line sources
      • Opportunity for dialogue
      • Acknowledgments
      • Footnotes
      • References
    • Info & Metrics
    • eLetters
    • PDF

    Related Articles

    • No related articles found.
    • PubMed
    • Google Scholar

    Cited By...

    • No citing articles found.
    • Google Scholar

    More in this TOC Section

    Practice

    • Is 45 the new 50 in colorectal cancer screening?
    • Approach to diagnosis and management of childhood attention deficit hyperactivity disorder
    • Determining if and how older patients can safely stay at home with additional services
    Show more Practice

    Communication Tips

    • Avoiding tension in the medical interview
    • CASE: convince, action, support, empower
    Show more Communication Tips

    Web exclusive

    • Interventions to address polypharmacy in older adults living with multimorbidity
    • Acceptability of a short list of essential medicines to patients and prescribers
    • Partner notification by family physicians for sexually transmitted infections
    Show more Web exclusive

    Similar Articles

    Navigate

    • Home
    • Current Issue
    • Archive
    • Collections - English
    • Collections - Française

    For Authors

    • Authors and Reviewers
    • Submit a Manuscript
    • Permissions
    • Terms of Use

    General Information

    • About CFP
    • About the CFPC
    • Advertisers
    • Careers & Locums
    • Editorial Advisory Board
    • Subscribers

    Journal Services

    • Email Alerts
    • Twitter
    • RSS Feeds

    Copyright © 2022 by The College of Family Physicians of Canada

    Powered by HighWire