The directness of my patient's question gave me a moment of pause. Did you just look up which medication I should take on Google?
I quickly put down my phone and told my patient, “I was looking up the appropriate dosage.” This patient then questioned whether I knew what I was doing, and why I needed to look things up on my phone if I went to medical school.
This was not the first nor the last patient who would question me when looking up medical content on my phone. I always encourage patients to look up their symptoms, diagnosis, and treatment on reputable sites online, and I try to explain to them that physicians often do the same.
Why we look things up
Medicine is a lifelong learning process. Doctors often need a quick refresher when it comes time to make certain diagnoses or develop treatment plans, as they do not want to make a mistake. Medical knowledge is constantly changing and growing.
"A doctor practicing in 1950 would have seen a doubling of medical knowledge every 50 years. In 2020 this rate increased to 73 days."
— Tranter I, et al., BMJ Open
An article in BMJ Open states that a general practitioner will need to look up information for 0.57 clinical questions per patient visit, or about 58 questions per week. Before smartphones and medical apps, doctors would have shelves of medical books in their office that they would use to look up specific medical cases.
However, in the world of technology at our fingertips, we can access information in real time in front of our patients, to make our office visits more productive and efficient.
But do all patients agree with this mentality?
A question of trust
Considering the rapid increase in medical information, the time constraints for in-office visits, and having the patient, physician, and information source in the same time and space, it makes logical sense for physicians to quickly look up evidence-based information related to their patient’s condition.
According to the BMJ Open article, studies have shown that online evidence-based resources are known to improve the accuracy of clinical questions and to increase physicians’ confidence in their clinical decision-making skills—two critical aspects of successful treatment outcomes in patients. But despite the benefits to the physician of accessing medical information during the patient encounter, not all patients may regard this practice as beneficial to their visit or the overall clinical outcome.
The BMJ Open authors cited a study that was conducted to find out how looking things up digitally might affect the patient’s confidence in the physician.
"While most patients responded positively, a substantial proportion of younger patients reported decreased confidence."
— Tranter I, et al., BMJ Open
A similar study found that a GP’s use of digital technologies to access information during consultations can have a deleterious effect on the patient’s perception of the doctor’s competence and their interpersonal skills.
This is vital information, because how patients view and trust their physician, and their confidence in their physician’s decision-making skills, is a significant aspect of patient compliance, satisfaction, and a positive therapeutic alliance between the physician and patient. When patients trust their physician, they are more likely to follow the treatment plan and have better outcomes.
How you look up information matters
The BMJ Open article presents the results of the authors’ own research study, exploring patients’ perceptions of doctors who look up clinical knowledge on their phones or computers during the office visit. Based on patient interviews, this is the first qualitative study of its kind. It provides valuable insights into how information-seeking impacts the patient’s impressions of a doctor’s competence and trust.
Several takeaways emerged that we, as physicians, can implement in our clinical practice.
Factors that affect the patient’s impression of the doctor include:
The baseline level of trust between the patient and the physician
When, during the visit, the information-seeking occurs
The importance of engaging with the patient, and making the information search a teachable moment.
Understand the patient’s baseline trust
The patient’s baseline trust in their physician depends on multiple factors, including the patient’s perspective on the medical system, emotional state, rapport with their physician, and sense of cultural safety.
Know when in the visit to begin looking up medical knowledge
In general, patients expect us to have a strong foundation of general medical knowledge, so if we immediately start looking information up without asking the patient questions or finishing our physical examination, it can easily be perceived as if we do not know what we are doing. It is best to complete a thorough clinical examination, listen to the patient’s entire presentation, ask questions, give your best clinical explanation, and then explain to your patient that you would like to take a quick second to confirm or double-check something on your phone or computer, from a trusted medical journal.
"How a doctor phrased their need to access information was recognized as a key component in protecting patient trust. Using phrases such as ‘double checking’ or ‘confirming’ were considered best practice."
— Tranter I, et al., BMJ Open
It’s a good idea to share your hypothesis prior to initiating your search. In the study, patients said that when this was done, they felt reassured that the doctor was refreshing previously acquired knowledge and not learning something new.
Patients also felt reassured when the doctor explained that they were consulting a reputable source of information, using terms like “guidelines,” “medical journals,” or “research institute.”
Engage with your patient while accessing medical information
Patients expect that our access to medical information is better than that of the general population, and this is often true. We have access to paid and free subscriptions to medical journals and evidence-based medical apps. When looking up clinical information, explain to your patient the source you are using, and what you are looking up, and share the information you're reading and how you are interpreting it.
When explaining the information to your patient, it is essential to translate complicated medical terms into language and syntax that a lay person can understand. Using lofty language can cause mistrust, so it is essential to communicate with your patient using appropriate patient-centered language.
Participants in the BMJ Open study expressed the idea that a trained doctor would be able to add value in their consultations through an ability to search reputable sources efficiently and effectively. When a doctor accesses the information at the point-of-care, patients expect an “individualized interpretation and explanation.”
Be confident; use looking up information as a teachable moment
Patients appreciate a competent doctor who is confident in what they know, but able to be honest and transparent about their limitations of knowledge. Therefore, it is vital to be confident in what you are looking up.
Use this information to teach your patient how and where to access high-quality information, and explain that looking information up is a sign of high-quality care. Patients should be happy when a doctor takes the time to look information up in an appropriate, empathetic, and constructive manner.