The Impact of Health Information on the Internet on Health Care and the Physician-Patient Relationship: National U.S. Survey among 1.050 U.S. Physicians

Background Public use of the Internet for health information is increasing but its effect on health care is unclear. We studied physicians' experience of patients looking for health information on the Internet and their perceptions of the impact of this information on the physician-patient relationship, health care, and workload. Methods Cross-sectional survey of a nationally-representative sample of United States physicians (1050 respondents; response rate 53%). Results Eighty-five percent of respondents had experienced a patient bringing Internet information to a visit. The quality of information was important: accurate, relevant information benefited, while inaccurate or irrelevant information harmed health care, health outcomes, and the physician-patient relationship. However, the physician's feeling that the patient was challenging his or her authority was the most consistent predictor of a perceived deterioration in the physician-patient relationship (OR = 14.9; 95% CI, 5.5-40.5), in the quality of health care (OR = 3.4; 95% CI, 1.1-10.9), or health outcomes (OR = 5.6; 95% CI, 1.7-18.7). Thirty-eight percent of physicians believed that the patient bringing in information made the visit less time efficient, particularly if the patient wanted something inappropriate (OR = 2.5; 95% CI, 1.5-4.4), or the physician felt challenged (OR = 3.6; 95% CI, 1.8-7.2). Conclusions The quality of information on the Internet is paramount: accurate relevant information is beneficial, while inaccurate information is harmful. Physicians appear to acquiesce to clinically-inappropriate requests generated by information from the Internet, either for fear of damaging the physician-patient relationship or because of the negative effect on time efficiency of not doing so. A minority of physicians feels challenged by patients bringing health information to the visit; reasons for this require further research.

[1]  Robert P. Spena,et al.  Computer use and needs of internists: a survey of members of the American College of Physicians-American Society of Internal Medicine , 2000, AMIA.

[2]  Petra Wilson,et al.  How to find the good and avoid the bad or ugly: a short guide to tools for rating quality of health information on the internet. , 2002, BMJ : British Medical Journal.

[3]  C. Scott,et al.  Self-reported nutrition proficiency is positively correlated with the perceived quality of nutrition training of family physicians in Washington State. , 2003, The American journal of clinical nutrition.

[4]  S. Khuder,et al.  Survey of physician attitudes toward HIV testing in pregnant women in Ohio. , 2003, AIDS patient care and STDs.

[5]  D. Grzybicki,et al.  Pathology resident attitudes and opinions about pathologists' assistants. , 2003, Archives of pathology & laboratory medicine.

[6]  Marcy M. Allen,et al.  The Ever-Shifting Internet Population: A New Look At Internet Access and the Digital Divide, Amanda Lenhart (Ed.). The Pew Internet & American Life Project, Washington, DC (2003) , 2005, Gov. Inf. Q..

[7]  T. Gallagher,et al.  Patients' attitudes toward cost control bonuses for managed care physicians. , 2001, Health affairs.

[8]  Manish Latthe,et al.  Accuracy of information on apparently credible websites: survey of five common health topics , 2002, BMJ : British Medical Journal.

[9]  M S Wilkes,et al.  Advertisement-induced prescription drug requests: patients' anticipated reactions to a physician who refuses. , 1999, The Journal of family practice.

[10]  G Eysenbach,et al.  Information in practice Towards quality management of medical information on the internet : evaluation , labelling , and filtering of information , 1998 .

[11]  Petra Wilson,et al.  The quality of health information on the internet , 2002, BMJ : British Medical Journal.

[12]  M. Hardey.  Doctor in the house: the Internet as a source of lay health knowledge and the challenge to expertise , 1999 .

[13]  D. Braunholtz,et al.  Quinacrine in possible or probable CJD , 2002, BMJ : British Medical Journal.

[14]  L. Booker,et al.  Internet use among physicians, nurses, and their patients. , 2001, JAMA.

[15]  P. F. Middleton,et al.  General practitioners' use of evidence databases , 1999, The Medical journal of Australia.

[16]  T Delamothe,et al.  Quality of websites: kitemarking the west wind , 2000, BMJ : British Medical Journal.

[17]  Gunther Eysenbach,et al.  Consumer health informatics , 2000, BMJ : British Medical Journal.

[18]  Jeremy C Wyatt,et al.  Survey of Doctors' Experience of Patients Using the Internet , 2002, Journal of medical Internet research.

[19]  Christian Köhler,et al.  Does the internet harm health? Database of adverse events related to the internet has been set up. , 2002, BMJ.

[20]  James Hereford,et al.  Patients, physicians, and the Internet. , 2002, Managed care quarterly.

[21]  E. Murray,et al.  The impact of health information on the internet on the physician-patient relationship: patient perceptions. , 2003, Archives of internal medicine.

[22]  Alejandro R Jadad,et al.  Examination of instruments used to rate quality of health information on the internet: chronicle of a voyage with an unclear destination , 2002, BMJ : British Medical Journal.

[23]  E. Bruera,et al.  Palliative Care on the Net: An Online Survey of Health Care Professionals , 2001, Journal of palliative care.

[24]  W. Levinson,et al.  Resolving disagreements in the patient-physician relationship: tools for improving communication in managed care. , 1999, JAMA.

[25]  Christian Köhler,et al.  How do consumers search for and appraise health information on the world wide web? Qualitative study using focus groups, usability tests, and in-depth interviews , 2002, BMJ : British Medical Journal.