TIM Berners-Lee invented the World Wide Web in 1989 – not so long ago considering the significant impact it has on just about all areas of modern life. It could be argued that no profession has felt this effect more than healthcare, with vast amounts of information and research data now instantly accessible and with the advent of allied technologies such as telemedicine. One of the most notable ways the internet has changed medicine is by encouraging greater health literacy.
Health literacy has been described as the ability to obtain, read, understand and use healthcare information to make appropriate health decisions and follow instructions for treatment. Low health literacy is not just a problem for patients with a limited education or reading ability but can also be found in individuals who are highly literate in other areas but have difficulty understanding medical terminology and jargon.
A recent survey of 2,000 British adults carried out by YouGov suggests that 47 per cent of the public has searched online for their symptoms or possible diagnoses before visiting their GP. While this engagement is a positive sign that patients may be taking a more active role in the management of their own healthcare, it can also present some real challenges for doctors and dentists. Patients having “Googled symptoms” is increasingly common now in consultations so it is vital for healthcare professionals to understand how to properly manage expectations.
In practice this can mean that patients often arrive with a fixed mindset as to their diagnosis and how the condition should be managed. If these expectations are not met, it can lead to disappointment and frustration and can place a strain on the clinician-patient relationship, with a higher risk of a complaint or claim being made.
Any preconceived ideas regarding a patient’s health should never be dismissed out of hand without full discussion, as important details could be missed as well as insights into what the patient may be really worried about. However, it is entirely appropriate to urge patients to be cautious about self-diagnosing via the internet, and this may also offer an opportunity to guide them towards more useful health resources.
Patients should be encouraged and supported in improving their health literacy. They should be provided information on positive life choices and how to manage diagnosed conditions, and encouraged to openly discuss their care and treatment. The GMC makes it clear that doctors have a legal and ethical obligation to involve patients in decisions which affect them. This is vital in obtaining valid consent and ensuring that patients understand the full range of treatment options open to them, as well as known risks and benefits.
Back in 2012 a study by researchers at London South Bank University found that 43 per cent of people in England aged between 16 and 65 were unable to “effectively understand and use” basic health information. The study looked at how patients process content such as health screening posters, medicine labels and letters from GPs. Considering these findings it’s perhaps not surprising that more and more patients turn to Dr Google for assistance.
The internet can be a useful resource but it’s important that patients, particularly vulnerable ones, have the necessary skills and knowledge to use it properly and not to misdiagnose themselves. This is where it is vital that healthcare professionals help ensure patients use the internet to improve health literacy and not as a substitute for a proper consultation.
One particular application is in relation to chronic disease management, where the patient’s enhanced understanding can help improve compliance and reduce reliance on the health service. Providing links to recommended websites with information and guidance sheets can be useful for a wide range of conditions, such as asthma or diabetes or for parents caring for chronically ill children.
Certainly the internet is no substitute for a clear explanation and discussion with your patient, but it can reduce the risks associated with a lack of knowledge and understanding. At best, online content can be critically empowering, increasing individual control and allowing patients to seek out information and take greater responsibility for their own health.
Alan Frame is a risk adviser at MDDUS