Patient Perception, Preference and ParticipationInternet information and medical consultations: Experiences from patients’ and physicians’ perspectives
Introduction
The Internet enables patients to inform themselves independently from physicians about health-related issues. In industrialised countries many patients use the Internet to obtain health-related information. Two North American studies showed that 50% of patients searched for health information on the Web [1], [2], without showing any differences between subsamples. A Swiss survey demonstrated that 30% of patients who had access to the Internet used the Internet to obtain health-related information [3]. Today physicians are faced with patients who use health-related Internet information (HRII) before or after the consultation.
Consultations are likely to change in response to HRII [4], [5], [6], [7], [8] and at least two scenarios are discussed [5], [9]: first, consultations with patients using HRII could become more controlled by the health professionals since they want to regain control over the situation. In this scenario physicians ignore patients’ HRII or determine its direction through “prescribing” websites favoured by themselves [5], [9], [10], [11], [12]. The second scenario anticipates that consultations with Internet-informed patients involve a more patient-centred consultation in which the health professional and patient collaborate in a mutual manner [1], [5], [9], [13]. This scenario goes along with the assumption that the use of the Internet reflects a shift in the patients’ role from passive recipients to active consumers of health services [14]: the Internet offers patients the opportunity “(…) to increase their [patients] knowledge, become more informed, and increase their involvement in their health care decision-making process” [2, p. 184].
These scenarios indicate two different directions in which consultations with Internet-informed patients can develop. But they do not explain which established processes are affected during consultations. Information on changes to consultation procedures in response to HRII is rare. One recent study by Bylund et al. [15] found that half of the patients use hidden strategies to introduce HRII, which points to the difficulties in integrating HRII into consultations. A further study from Ahmad et al. [16] indicates that the critical evaluation of HRII is becoming a new task for physicians during consultations. Since the consultation between physician and patient is a crucial point for treatment planning, adherence and long-term perspectives, more information on the impact of HRII on behaviour during consultations is urgently required.
As data on the personal experiences of consultations with Internet-informed patients are limited, this article explores these issues from the patients’ and physicians’ perspective. It investigates the meaning of the consultation for patients who have searched the Internet and explores the motives and strategies of patients for the introduction of HRII information in the consultation. From the physicians’ perspective this study describes the changes in consultation procedures due to dealing with Internet-informed patients, including benefits and problems that occur during consultations with Internet-informed patients.
Section snippets
Study setting and recruitment of participating patients and physicians
The study was conducted in the city of Bern (Switzerland) from December 2005 to September 2007. Patients and physicians from primary care and medical specialist practices were asked to participate. For the recruitment of the physicians a list of all practices in Bern was generated and 104 randomly selected medical practices were asked by letter for their participation. Twenty physicians agreed to give an interview about their experiences with Internet-informed patients. They further agreed to
Results
The results section is divided into two parts: the first part explores the relevance of the consultation mainly from the patients’ perspective. The second part describes consultations with HRII patients from the physicians’ view. At the end of each part, a figure structures and summarises the main results.
Discussion
We explored the consultation practice with Internet-informed patients from the patients’ and physicians’ perspective. Our work supports earlier studies showing that Internet-informed patients actively used the consultation to understand and validate health-related Internet information and that physicians supported patients’ appraisal of HRII by evaluating and contextualising it [19]. Discussing HRII with their physicians helped patients to achieve clarity, orientation and certainty. Our study
Acknowledgements
This research was supported by the Swiss National Science Foundation (Project 100013-109972). Thanks go to all patients and physicians who participated in this interview study and to Liliane Meyer for transcribing the interviews.
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Both the authors contributed equally to this work.