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A stepwise framework for discussing information your patients found online
Clinical Question
What strategy can be used to integrate internet information identified by patients into shared decision-making?
Bottom line
There is an unseen presence accompanying many patient visits: the second opinion from Dr. Google. The authors of this commentary suggest a stepwise approach of bringing Dr. Google into the open by asking for the patient's internet findings. They then suggest following a framework of waiting to respond, sharing empathy and support, demonstrating curiosity, and negotiating a plan that factors in the possible risks and benefits of Dr. Google's recommendation. 5
Reference
Study design: Other
Funding: Self-funded or unfunded
Setting: Other
Synopsis
The authors of this commentary suggest a four-step process for discussing patients' pre-visit internet findings in a way that creates psychological safety, builds a therapeutic alliance, and empowers collaborative treatment planning and shared decision-making. They acknowledge the current reality and begin by asking patients whether they did an internet search before the visit: "Most of us look up questions about our health online prior to visiting our doctors. Did you come across anything you’d like to discuss?” After demonstrating interest in this way, they suggest waiting to render judgment, instead responding with statements demonstrating empathy, support, validation, and naming of the underlying emotion that may have resulted from the search. Rather than pushing back or doing your own search in the moment, the authors suggest asking questions to clarify the information, determine its source, and find out what the patient thinks about it. The last step is to perhaps offer an anecdote based on your own experience and then negotiate a way forward. If the patient's found approach does not appear to be harmful, suggest "giving it a shot." If you perceive a risk, express your own worries about the approach. Although this approach to sharing space with Dr. Google has not been studied, it seems like a reasonable framework for aligning with your patients.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
SO unrealistic ........
when you work in the community, which I suspect this author doesn't, and you are seeing 4-6 patients an hour and they are constantly telling you what "Google" says, this approach does not work
This is a classic Ivory Tower, Academic approach
Dr Google
The TIMING of exploring Dr Google (up front, first thing, right off the bat) is problematic in my opinion; I think it's always better to listen first; bringing it up later, even at the end, is better since it does not "contaminate" or usurp the history, and does not risk annoying / distracting / embarrassing the patient; you may even find in the end that Dr Google was irrelevant, or the patient volunteered the information.
A stepwise framework for discussing information your patient
While I agree with listening and being empathetic, I strongly disagree with some of the other recommendations. While I realize that an anecdote can be persuasive, it is the exact opposite of what physicians should be trying to promote. Our role and duty is to explain in lay terms why anecdotes are not evidence. After all, "The plural of anecdote is not evidence." I found the suggestion that "if it does not appear harmful, suggest "giving it a shot." very disturbing. This most definitely should not be the role of a science and evidence-based physician, and will only undermine our role as an honest and trusted advisor. Not "appearing" harmful is far different than being a safe option and should most definitely not be our standard when endorsing a treatment option.
shared care
patient wellfare
Discussing medical information that patients acquired from t
I have had patients or their family search while they were in the consult or follow up visit. Usually, I try to direct patients to legitimate sources and often there are very helpful images of anatomy and procedures to aid in their understanding.
Unfortunately, physicians do not have the time to engage in debunking an ever evolving menagerie of misinformation that is available to the masses.
COVID has certainly demonstrated just how big a problem this has become.