A little health info can be a
dangerous thing

Net savvy patients can be a real pain. Learn to use their diagnostic challenges to build a better relationship

By Abe Konigsberg

Headlines like this can send patients scurrying to your office

"It wasn't literally snake oil that she gave her little boy," recalls a veteran pediatrician in Oakville, ON, "but whoever heard of a little oregano to clear up a serious ear infection?"

It turns out that poor kid's mother read a little something on the internet about overuse of antibiotics and another little something in a health food magazine about oregano oil helping with ear infections. She decided her son's grey-haired pediatrician wasn't 'with it,' and eschewed his advice.

This mild mannered doc didn't bat an eyelash when the woman came crawling back, asking for a new antibiotic script (she threw out the prescription from the initial consultation, so confident was she in her internet research skills) but he wasn't happy that she put her child through unnecessary discomfort by second-guessing his orders.

TOO MUCH INFO
This case hits upon one of the biggest challenges in doctor-patient relationships in the 21st century — the baffling amount of health information freely available on the internet and how people process it. If patients approach online medical advice with a critical eye, then technology only serves to make them a more active partner in their own healthcare — such folks should be models of compliance — a pleasure to treat. On the other hand, if they misunderstand what they read — or worse — accept the first thing that pops up in a Google search as the gospel truth, you both may be in for some agony. With these patients, you can really wear yourself out debunking the claims of every potion they imbibe.

BLINDED WITH SCIENCE
Trouble can crop up even when patients use legitimate medical sources. With access to up-to-the-minute research, but without the diagnostic skills that take years of training to acquire, patients are prone to come to the wrong conclusion.

In days of yore — specifically before the 1997 launch of the free PubMed website — the fact-armed know-it-all patient was a rare bird indeed. Back then patients would have to drive to an academic library and rifle through stacks of journals and indices if they hoped to stump you on the latest news on an ailment. Now, with PubMed, anyone with a computer can print up a pile of oven-fresh abstracts — and claim some small inconclusive murine study from Ulan Bator as evidence that you don't know what you're talking about.

This is precisely the sort of cocksure patient who may forcefully demand that you write a script for an inappropriate medication.

TEACHABLE MOMENT
Of course times have changed and shared responsibility between patients and physicians is one of today's top primary care goals. Medicine has already drifted a long way from its paternalistic past. It's healthier to think of disagreements as challenges to the physician-patient relationship rather than proof positive of a "difficult patient." And it's important to accept that in this day and age some of your patients are going to question your advice, and keep you on your toes. You no longer have a monopoly on health information and this isn't necessarily a bad thing.

DOCS STILL TOPS
There are a couple of reasons to stay upbeat in the information age. First, there's a lot of good, accurate information out there — for both you and your patients. A British Medical Journal study from November found that Google web searches of health problems nabbed the correct diagnosis of illnesses about 58% of the time. However, it should be noted that in this study doctors were doing the searching, which probably skewed the results a bit.

But even if patients fail to get correct information on their own, chances are they'll still trust you ahead of their computer. An international study published by the World Medical Association in 2003 found that fully 81% of Canadians trusted their doctor's advice, and 95% claimed they were willing to follow your orders. Dr Google gets precious little respect by comparison. Only 17% of Canadians claimed they trusted the medical advice on the internet and 47% said they would follow advice they found online.