The Doctor as the Second Opinion and the Internet as the First

February 16, 2009 at 1:27 am 15 comments

In “The Doctor as the Second Opinion and the Internet as the First,” I describe the increasing common phenomenon of people using the Internet before seeing their doctor:

People who use the Internet for health information often obtain their first opinion that way, and then, if they go to a doctor, the doctor’s advice is relegated to the second opinion. Using the Internet, or Dr. Google, as a first opinion can be problematic due to misinformation, misinterpretation of valid information, and the fears that can arise due to lack of medical knowledge, inexperience, and limited perspectives. When patients do visit their doctor for a second opinion, some do not disclose the fact they already received their first opinion and often their doctors do not ask. The result is that patients may suffer needlessly if their fears, concerns, misunderstandings, and misinterpretations are not addressed by the healthcare providers with the expertise and skills to assist them. A pernicious disconnect exists between many patients who use the Internet for health information and the medical professionals who care for them. The medical profession can alleviate this disconnect by taking the lead in establishing guidelines for systematically talking to patients about, and guiding, their Internet research. Human-computer interaction professionals can collaborate with the medical community in ensuring credible health Web sites become the gold standard that patients use to achieve better health.

I appreciate any feedback, insights, or experiences.

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15 Comments Add your own

  • 1. Exploring the Usability of e-Health Websites | SURL.org  |  January 16, 2013 at 10:36 am

    […] Gualtieri, L.N. (2009) The Doctor as the Second Opinion and the Internet as the First. In D.R. Olsen Jr., R.B. Arthur, K. Hinckley, M.R. Morris, S.E. Hudson, and S. Greenberg (Eds.). Proceedings of the 27th International Conference on Human Factors in Computing Systems, CHI 2009, Boston, MA. Retrieved from http://lisaneal.wordpress.com/2009/02/16/the-doctor-as-the-second-opinion-and-the-internet-as-the-fi… […]

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  • 2. Internet Marketing  |  November 12, 2011 at 1:01 am

    Sources…

    […]check below, are some totally unrelated websites to ours, however, they are most trustworthy sources that we use[…]……

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  • 3. Dr. Harris Meyer  |  June 30, 2010 at 8:13 am

    Great to have this content. Patients need to advocate for themselves more than ever. When they share with their PCP however, they are often met with resistence, sarcasm, criticism, and worse for believing what they read or hear. There are some of us who are more evolved and open to learning from patients but many are not. We all need to evaluate the openness of our doctors and if they refuse to learn or even hear about info outside their scope of knowledge or study, I recommend not staying with them. Thanks for this post.

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  • 4. mary  |  December 22, 2009 at 7:26 pm

    Education and information should never be used to increase fear but I can understand how one may wrongfuilly interpret information from the internet in regards to their own health.

    I can recall numerous times that I have told a friend that she is a hypochondriac because anything she reads on the internet regarding health and wellness is automatically attributed to a symptom that she “has experienced.” This being said, this kind of behavior goes hand in hand with the old phrase “a doctor is the worst type of patient.” Get a group of medical professionals together and they will agree that doctors do not make good patients–at all!

    The reason–doctors tend to operate similar to the internet–they are a vast library of knowledge in the health field so it’s easy for them to overlook certain things in attribution to the many other (and more in depth) possibilities.

    It should be stated that the internet is not the most reliable source of information out there and patients should only use it as a means of gathering additional information that may–or may not–help in diagnosing their symptoms WITH a DOCTOR! There are millions out there that need to read this!

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  • 5. jack  |  November 5, 2009 at 10:16 am

    Times have changed, we all seem to trust our: doctors, dentist and lawyers less than our parents or grand-parents did. Both patients and doctors have to learn to live with the internet.

    An area that really concerns me is that in-spite of numerous warnings issued by the FDA and other credible sources, some patients are bypassing their doctors and pharmacists to purchase medicines directly off the internet. Taking a big risk of either adverse reactions of getting a counterfeit/diverted pharmaceutical.

    At Checkdrugs.com we have found some website that offer prescriptions online and claim to be based in Canada but are actually based in China.

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  • 6. Denise  |  October 24, 2009 at 6:46 am

    I think the internet is a great resource for finding simple answers to simple ailments or injuries. When it comes to anything more serious, I always consult a physician.

    Reply
  • 7. Allen  |  October 2, 2009 at 11:30 am

    I, too, am guilty of playing doctor through Google and WebMD. I know, though, that the internet is not a diagnostic tool, though. I’m normally pretty honest with my doctors and let them know I’m active in health research and that I know my body really really well, and they’ve been receptive to listening to what I have to say.

    I was surprised to read “frequently the Internet-provided first opinion is not communicated to the doctor” but maybe that’s because I normally mention stuff I find online std clinic london, even if my doc has to tell me “I don’t think that’s quite the case.” I hope Gualtieri responds to Britt’s comment, too. Would love to hear what she has to say!

    Reply
  • 8. Paul Roemer  |  August 24, 2009 at 3:40 am

    This way I can be certain I have several obscure diseases, recommend my meds and treatment, then learn it’s only a cold.

    Reply
  • 9. Billig a kasse  |  June 22, 2009 at 8:05 pm

    Great post man, keep up the good work ;-)

    Reply
  • 10. David Weight Loss Dotson  |  April 19, 2009 at 1:05 am

    If you look at doctors no days there is a big reason for distrust. The internet does have some sites with wrong information, but it also has a world of good info about all disease and medical problems. Never is the history of man has this kind of information been available to normal people. In the past only doctors had this knowledge and you had to trust what they told you. Now you can and should research you own problems before going to a doctor and after. Doctors in all fields are human and make mistakes. Depending on the issue, they might not be up to date on the latest procedures or they might be looking to make a profit. For example, I went to several ortho doctors for my knees. I had researched and already had a good idea what was wrong. After looking at the MRI’s, two doctors told me there was nothing wrong. Finally one doctor got the diagnosis right, but then suggested an experimental surgery. He tried to play it off as a routine everyday surgery and forgot to mention that it only has a 50% success rate. Thank god for the internet. These kind of things happen all the time. Doctors are not geniuses, they are people who went to school, and like most people that graduate a school, a few are great, and most are decent or poor. Only you know what problems your having and only you are in charge of your health. To blindly trust a person because they have a degree is crazy!

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  • 11. Dave Lee  |  March 26, 2009 at 5:18 pm

    Lisa:

    Very interesting article. I have two reactions – one general and one specific to my health care and use of the internet.

    I think your paper points to the problem with the internet in general that Kate talks about. The incredible volume of information of varying levels of quality. Many people assume too much authority and veracity to the information they find on the internet. As many critics have levied against internet content, there is alot of junk out there. Throw in the complexities of health problems and diagnosis – even for experts – and the data you present doesn’t surprise me.

    As to my personal experience, I recently had a horrible reaction to a anti-nausea pill that a friend gave me. (I know, I shouldn’t take any medicine that hasn’t been prescribed for me by my doctor.) My doctor diagnosed it a Stevens Johnson Syndrome. When I got home, I checked the internet for Stevens Johnson (I checked WebMD and TheBody.com.). It confirmed what had been happening with my body, gave me confidence that my doctor was right, and raised a couple of specific questions. Fortunately, my doctor makes himself accessable by email and I was able to get his feedback to the details I needed clarification about to make me feel total comfort around this new revelation about my health. So in my case, rather than self-diagnosis and distrusting my doctor, I used the information on the internet to gain details and to develop trust in my doctor.

    Now, I have no clue how my positive experience can be shared with others to help them use the internet similarly, but I thought I’d share it with you.

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  • […] admin posted a noteworthy aricle today onHere’s a small snippetBy the very nature of their practice and the fact that patients who see them are already sick, doctors by and large do not focus on preventative or holistic medicine. They only have time to treat the symptoms. … […]

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  • 13. UNRR  |  February 17, 2009 at 5:07 pm

    This post has been linked for the HOT5 Daily 2/17/2009, at The Unreligious Right

    Reply
  • 14. Kate Britt  |  February 16, 2009 at 7:38 am

    As somebody who is a “broker” of her own health, I found your article to be interesting and supportive, yet some of the content surprised me. I’ve been under the apparently incorrect impression that internet literacy and health literacy have increased enormously, exactly because of the vast quantity of online resources available to us. So I was surprised to read that many of the 84% of us (if I were American, that is :) who are using the internet to find health information and guidance are not using the results of our research as well as we might.

    It seems odd to me that people “may be…overwhelmed, frustrated, confused, or frightened by what they find online.” If you’re going to become fearful, don’t read it. If you’re going to read it, remember that learning is a tool that can diminish fear. The more we know, the better armed we are. However, having taught adult students for years, I do know that there is a kind of fear of knowledge that is similar to the fear of the unknown. I also know from personal experience that the more I read online, the better I become at identifying and filtering out the dross.

    I’m absolutely floored to read that “frequently the Internet-provided first opinion is not communicated to the doctor.” My goodness, if you’re going to do the research, why would you not use that education as a framework for the discussion with your medical professional? “Hey Doc, I recently read ___________ and I’m wondering what you think of it?” or “I read this recent report about ______________, and I’m wondering what you know about it and can you tell me more?” I’ve had some very rich discussions with members of my medical team, and at times they’ve even requested links or print-outs of the information I’ve mentioned. As your article points out, doctors don’t always have time to seek out today’s hottest topics in scientific and medical news, so if I read it, I’m surely going to ask them if they have if it’s relevant to my own health situation.

    At the root of the problem, possibly, is that many of us were raised with the idea that Doctor Knows Best. (I’ve seen it also as Teacher Knows Best, a myth I work hard to destroy for my students.) You say that patients don’t mention their research to a doctor out of feeling disrespectful, or of appearing stupid, or of being perceived as a cyberchondriac. (Hey, good word; I haven’t seen that one.) I’d say to them, be proud that you’ve sought out knowledge, that you know some new words, that you have new things to ask about, and that you’ll now understand better what the doctor says. Speak your fears if you trust the doctor’s opinion; give him or her a chance to explain what you’ve been reading. Guaranteed – you’ll feel better for having voiced the fears.

    You wrote, “Because the lack of health-literacy skills can lead to poor comprehension and retention of information during a doctor’s visit, many patients leave a doctor’s visit confused and ill-informed.” Well, that has been true through the decades and has little to do with the availability of internet information. I remember that my mother really thought doctors’ law was THE law, was frequently confused about what was said but ALWAYS followed their advice and “rules”, always felt that she hadn’t been heard properly or given enough time for her visits. If only she’d had the internet so she could find out more about the topics of her concern. Surely a patient who has read a range of material online stands a much better chance of being less confused and ill-informed, and more capable of focussing their discussion with the doctor?

    I use my internet research as a first window to information, and carefully consider each source, each author’s qualifications, and how much the information agrees with other medical opinions I’ve read on the same topic. That is, I won’t find just one bit of information and stop; I’ll seek out a dozen and compare what they have to say. I suppose I seek a consensus of opinions, which collectively becomes my “first opinion.” Then I don’t ‘test’ my doctor by staying silent about what I’ve learned to see if she comes up with the same ideas; I tell her what I’ve learned up front so that we both start from the same place in the discussion. It saves us time, rather than taking more time.

    It’s ultimately up to us to take care of our own health. Our society doesn’t seem to be so good at that in general, given the continual rise in the incidence of dis-ease. But running to the doctor and trusting just that one opinion isn’t the way to make sure we have the best knowledge available about our own bodies, any more than is doing our internet research and then running to the doctor for a “second opinion.” Instead, we must use all resources available to us. As I’ve mentioned already, I have my own “medical team” – my GP; specialists from time to time (I always research those ahead of time so that I can request a referral rather than just being given one); alternative health care professionals (naturopathy, chiropractic, acupuncture, massage, yoga, nutrition advisors, and others). As I said, I’m my own health broker and I seek out the professionals I need, but I always do my own research first.

    One thing you mentioned but didn’t emphasize in your article was that, “ultimately, anyone using a health Web site is trying to feel better or stay well.” That’s the key here. If we know more, if we seek health information even more than illness information, we’ll succeed in that goal. By the very nature of their practice and the fact that patients who see them are already sick, doctors by and large do not focus on preventative or holistic medicine. They only have time to treat the symptoms. In fact, my personal experience is that many of them tend to reject more holistic approaches, having had no training in herbal remedies, homeopathy, or a huge list of other alternatives. I don’t criticize doctors for this because I do see them as trained professionals with a focussed set of skills and knowledge. But I know that training is by necessity limited. I believe it’s up to me to complement what they know and do for me by adding to the mix my own willingness to research information from credible sources.

    I couldn’t do without my GP, but my GP has been carefully chosen, after interviews of several. I make sure any new GP I “hire” knows about and is open to my holistic approach and understands that I also work with alternative practitioners. I make sure that every medical professional I see understands that my goals are continued good health and finding/treating the cause of a health issue rather than just treating current or acute symptoms.

    As you say, we all have to recognize that personal health is a “shared goal” between us and our medical professionals. In our own self-interest, though, we must take on the majority role and do what it takes. This includes sifting through the results of our internet research with an eye to determining what’s reliable, what’s helpful, what’s not, what makes us afraid, and then discussing it all intelligently with our carefully selected medical resource people.

    (Sorry for the length. I should have started with “don’t get me started!” Clearly your article hit home with me, Lisa. Thanks for providing your thoughts and research here.)

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  • […] Lisa Neal Gualtieri added an interesting post today on The Doctor as the Second Opinion and the Internet as the FirstHere’s a small readingIn “The Doctor as the Second Opinion and the Internet as the First,” I describe the increasing common phenomonon of people using the Internet before seeing their doctor: People who use the Internet for health information often obtain their first opinion that way, and then, if they go to a doctor, the doctor’s advice is relegated to the second opinion. Using the Internet, or Dr. Google, as a first opinion can be problematic due to misinformation, misinterpretation of valid information, and t […]

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Lisa Gualtieri, PhD, ScM

Lisa GualtieriLisa Gualtieri is Assistant Professor at Tufts University School of Medicine in the Department of Public Health and Community Medicine. She is Director of the Certificate Program in Digital Health Communication. Lisa teaches Online Consumer Health, Social Media and Health, Mobile Health Design (online), and Digital Strategies for Health Communication (1 week summer institute). Contact Lisa: lisa.gualtieri@tufts.edu

@lisagualtieri


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