Risk Management



Medical Information and the Internet

 By Byron H. Demorest, MD

Digest, Winter 1997

Patients now have a convenient and complete bibliography at their fingertips with access to a remarkable medical library on the Internet. Software stores sell directories of web sites featuring information on specific medical problems. Because of this, patients may ask us more educated questions and have a better knowledge of their diagnosis or treatment. Conversely, they may misinterpret or misunderstand some of the medical literature they read on the Internet, leading to doubts or confusion.

Since Cobbs v. Grant, 8 Cal. 3d 229 (1972), it has been a legal requirement that physicians provide sufficient information to their patients to allow them to give consent for surgery or medical therapy. This education of the patient is essential and should be as complete as possible. Physicians use a vast array of patient information materials, including brochures, videotapes, and personal conversation. For some patients, physicians may suggest that additional information is available on the Internet. 

Patients Cruise Internet for Medical Information

The development of the Internet allows patients who used to rely solely on physicians for information about their illness or treatment to turn on their computer and dial into a vast collection of knowledge – some of which may be reassuring and some of which may be worrisome to them. Without the benefit of a physician to translate the medical language, patients who cruise the Internet to verify information their doctor has given them may find it to be a frustrating or negative exercise. It has been said that seeking reliable information from the Internet is akin to sitting between two informants. The Nobel prize winner on your right may give an opposite opinion to the huckster on your left. If you are a naive inquisitor, you won’t know which person to believe.

Consider this case history. A 45-year-old female schoolteacher sought correction of 40 prism diopters of left extropia due to the fact that her students often made fun of her appearance and complained that they could not tell when she was looking at them. A recess-resect operation on the deviating eye was recommended, and a careful discussion followed of the risks of both local and general anesthesia as well as the risks of surgery. Corrective surgery was approved by the patient’s medical insurance company in spite of her age, and surgery was scheduled.

One week before the scheduled operation, the patient called the ophthalmologist with “some questions.” A lengthy phone call resulted, as the patient outlined in detail the major complications of retrobulbar anesthesia as well as the number of deaths and near deaths following general anesthesia. She quoted several journal articles she had read on the Internet that local anesthesia may cause ocular muscle fibrosis. Aware that retrobulbar anesthetic needles sometimes perforate the eye, the patient was now convinced that both types of anesthetic would be unacceptable to her. Although she still wanted to have her eye straightened, she no longer was willing to face the risks of surgery. The surgeon reminded her that the operation was elective and that the risks had been mentioned to her prior to her Internet exposure. He wondered if there was anything that could be done to relieve her anxiety.

Internet Phenomenon May Fuel Patients’ Fears

All physicians have had patients who were fearful of surgery, but now some of these patients have access to a technical Internet library that may confuse them and increase their fears by providing them with an incomplete education regarding their risks. It may come down to whether patients are going to trust their doctor’s expertise or a negative article they’ve read. In the new medical practice climate, physicians often don’t have as much time for lengthy conversations with their patients and it may be that patients will trust what they read rather than what they hear from their ophthalmologist.

There is no easy answer to helping patients with exaggerated fears about surgery; elective surgery on such patients probably should be deferred. However, physicians should be aware of the “Internet phenomenon.” Depending upon their perceptions, exposure to the medical literature may confuse patients rather than enlighten them. Physicians should provide complete and accurate information to all patients. Additionally, physicians need to understand their patients’ concerns and accept the challenge to counsel better informed patients, some of whom may be receiving outside input through medical libraries on their Internet connection.

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