Strategies for Shared Decision-Making and Communications
With the prevalence of online self-diagnosis tools, the nature of physician-patient exchanges has shifted significantly. Search trends show that a large number of people research their symptoms online. In the U.S., one third of adults say that they have gone online in an effort to self-diagnose. 77% of these online searches begin with a major search engine such as Google, Yahoo, or Bing.1 With Google reporting in 2016 that they handle more than 2 trillion searches per year,2 and that 1% of all searches were related to medical symptoms,3 that’s more than 20 billion web searches for medical symptoms on Google alone every year.
The U.S. National Institute of Health warns of a deficit in accuracy for online symptom checkers. After studying 23 free symptom checkers, researchers found that the correct diagnosis was given first 34% of the time. Triage advice administered by the symptom checkers varied based on the urgency of the case, giving more appropriate triage advice to urgent cases and less appropriate triage advice to non-emergent cases. Less urgent cases were frequently encouraged to seek unnecessary medical care, suggesting that patients may come to physicians with a distorted sense of their condition’s severity.4
With the convenience of the internet becoming commonplace at a rapid rate (77% of Americans now own a smartphone, more than doubling from 20115), “googling” symptoms is not likely to slow down. Physicians should be ready to have conversations with patients about at-home research they bring to their office visits.
Physician-patient relationships continue to evolve as healthcare shifts to a model valuing more patient input.
“In days gone by, a so-called paternalistic model of patient care reigned supreme, and patients followed doctors’ orders. Doctors rarely explained their reasoning, and patients rarely voiced objections. Now, a different model of patient care has evolved — a collaborative model in which the patient takes a more active role in healthcare decision-making.” NORCAL Group Risk Management, Patient Demand for Unconventional Care Presents an Ethical Dilemma for Physicians.
Armed with information found online, patients may make more of an effort to be a part of their care plan. In some cases, a patient might make a demand that goes against the standard of care. A clash of medical ethics principles can arise from trying to find a balance between physician beneficence and granting a patient autonomy. In other words, when your professional opinion of what care plan is best for the patient differs from the patient’s demands for unconventional care. A patient may come to the appointment convinced they need medications or treatments for an illness they discovered online. However unwarranted the patient’s demands may be, try to listen and validate their concerns while educating them on their condition. Dismissing a patient’s concerns will likely lead to defensiveness.
“Patients often become difficult when they perceive that their concerns are not being heard, that they don’t have access to care, or they are not being informed or educated about their condition and treatment.” NORCAL Group Risk Management, Patient Demand for Unconventional Care Presents an Ethical Dilemma for Physicians.
Studies show that patients have overwhelmingly positive views of the clinical skills of their physicians: only 4% of complaints in online reviews of doctor visits are related to their physicians’ clinical skills, while 96% of patients report poor communication, disorganization and bedside manner as being their biggest complaints.6 This suggests that patients welcome the clinical assessment of their physician — even if it differs from their own research — if it’s presented with empathy and respect. With this in mind, consider these recommendations:
- Be patient and receptive to questions; do not appear dismissive or arrogant.
- Ask the patient what self-treatment they may have already undertaken.
- Instead of immediately dismissing patients’ research, work with them to research effectively by providing them with trustworthy sources for gathering information.
- Consider referring the patient to credible websites of organizations formed for their disease or condition and patient support groups and forums related to their disease or condition.
- The U.S. National Library of Medicine offers a website with trusted health information and resources.
- Ensure that the conversation is two-sided. Avoid monologues and consistently reach out to patients for their input in decision-making processes.
- Advise patients about the risks and benefits of treatment options, and the risks of declining the recommended treatment.
- Document the rationale for care decisions in the patient’s record.
- Include details of efforts to educate the patient about treatment recommendations.
- Don’t give in to patient demands that go against your medical judgment.
While patients coming to a visit with information they have found from alternative sources might frustrate some physicians, making patients feel valuable as consumers, as well as valuing their contributions to the shared decision-making model of patient care, can allow for a more productive visit that preserves the physician-patient relationship.7
1. Fox, S., Duggan, M. “Health Online 2013.” January 15, 2013. Pew Research Center. (accessed 10/11/2017)
2. Sullivan, D. “Google now handles at least 2 trillion searches per year.” Search Engine Land. May 24, 2016. (accessed 10/11/2017)
3. Pinchin, V. “I’m Feeling Yucky :( Searching for symptoms on Google.” Google Blog. June 20, 2016. (accessed 10/11/2017)
4. Mehrotra, A., Gidengil, C., Linder, J., Semigran, H. “Evaluation of Symptom Checkers for Self Diagnosis and Triage: Audit Study.” July 8, 2015. (accessed 10/11/2017)
5. Smith, A. “Record Shares of Americans Now Own Smartphones, Have Home Broadband.” Pew Research Center. (accessed 10/11/2017)
6. Vanguard Communications. “Doctor Complaints Online? Blame Customer Service, Not Doctors’ Care.” (accessed 10/11/2017)
7. U.S. Department of Health and Human Services Agency for Healthcare Research and Quality. “Shared Decision-Making.” 2017. (accessed 10/11/2017)