Strategies for Engaging Patients Who Self-Diagnose via the Internet

Time pressures¹ and lack of patient trust² are factors that can contribute to physician burnout. Patients who self-diagnose based on internet research combine these factors. Expecting self-diagnosing-patients to passively receive physician-delivered medical information will likely increase the frustration of both parties. Therefore, it can be more productive with these challenging patients to integrate their internet information into patient education.

This approach can improve clinical communication, strengthen the physician-patient partnership, increase patient satisfaction, and result in better outcomes. Time management strategies can help physicians keep discussions about internet content limited to the confines of the scheduled visit. When handled correctly, there is a silver lining to patient internet use.

Be Prepared

• In patient pre-exam paperwork, ask patients which websites they use for health-related research.
• Provide a list of trustworthy patient health information websites.
• Develop single sheet handouts of health issues patients repeatedly ask about (e.g., flu vaccinations). Having these sheets available can reduce the amount of time you spend answering questions and correcting misinformation.
• Schedule a patient who needs time to discuss internet content for a longer appointment time near the end of the day.

Take Control of the Encounter

• If the patient lists a variety of symptoms and complaints, negotiate a reasonable number of issues to address in the timeframe of that day’s appointment, ask the patient to prioritize the issues, and schedule additional appointments for unaddressed issues.
  • Keep the attention focused on the agreed upon medical complaints.
  • Provide patients with a form to help them organize and present their symptoms and concerns.
• At the beginning of an appointment, inform the patient of the appointment length and end the appointment at the designated time.
• Ask the patient about concerns that have arisen due to internet research.
• Refuse to provide treatment that is not consistent with the standard of care. Be direct, provide the reasoning behind your refusal, and encourage patient input.

Be Positive and Empathetic

• Acknowledge the patient’s self-diagnosis or request for a particular drug, treatment, or study.
• Be empathetic. Let patients know that you care about their health, that their symptoms are valid, and that you are willing to work toward a long-term resolution of their symptoms.
• Avoid becoming defensive if the patient challenges your medical knowledge.
• Defer judgment and aim for a relationship in which you are perceived as a healer and ally, not simply a service provider.
• Explain why you need to consider all the differentials, not just what the patient has discovered on the internet.
• Make use of relaxation strategies such as deep breaths before seeing a challenging patient.

Bill for Your Time

• Consult with your billing specialist to determine appropriate codes for time spent discussing internet content introduced by the patient.

Debrief

• Discuss frustrating patients with a trusted colleague to put the situation into perspective.
• Adequately summarize the patient’s issues and your recommendations in a way that will facilitate the next office visit.

Internet Websites for Patient Education

There are many websites that offer health advice and information. The Medical Library Association provides guidance on finding good health information. The websites listed below can get you started on your own recommendations for patients:

• Choose Wisely campaign patient resources (American Board of Internal Medicine Foundation)
• Diseases & Conditions database (Centers for Disease Control and Prevention)
• MedlinePlus (National Institutes of Health, National Library of Medicine)
• OncoLink (Abramson Cancer Center of the University of Pennsylvania)

References

1. Cory Pitre, et al. “Physician Time Management.” MedEdPORTAL, February 2018.

2. James F. Sweeney. “The Eroding Trust Between Patients and Physicians.” Medical Economics, 4/10/2018.