Please leave your phone outside: policymakers and medical app providers are encouraging patient participation, but doctors in the consult room are not

• Published in: BMJ innovations Vol. 3; no. 2; pp. 65 - 70
• Main Authors: Roper, Lucinda, Jorm, Christine
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.04.2017
• Subjects: Behavior; Communication; Curricula; Family physicians; Information literacy; Internet; Interviews; Literature reviews; Medical students; Patient satisfaction; Physicians; Prescriptions; Professional relationships; Professionals; Qualitative research; Researchers; Self evaluation; Students; Web 2.0
• ISSN: 2055-8074; 2055-642X
• DOI: 10.1136/bmjinnov-2016-000134

[...]we propose a set of practical, implementable teaching activities, using a theoretically grounded approach and informed by exploratory research. patients' use of the internet for health information AND the patient–doctor relationship A search was undertaken using a snowballing strategy (appropriate in this field, which has a large variation in the nomenclature and field of publication) and continued until saturation was reached. Method Literature Primary research  Survey or semistructured interview of patients 178–24  Survey or semistructured interview of doctors 1325–37  Survey or semistructured interview of doctors and patients 338–40 Observational study (plus interviews) 26 41 Novel methodology 242 43 Literature review 729 44–49 Opinion piece 550–54 Researchers took a comprehensive observational approach in just two studies, interviewing patients preappointment and postappointment and also audio recording or observing the consultation.6 41 Most research was attitudinal and two prominent themes emerged from the attitudinal literature: the negative reactions reported by patients and doctors' justifications for such reactions. Patients report negative interactions Surveys and interviews consistently find that some patients feel that their doctor responds coldly or defensively when internet-sourced information is mentioned.8 11 16 27 32 This frustrates and humiliates patients, negatively impacts their relationship with their doctor and increases the chance that they will not share internet-sourced information in the future.16 18 27 38 55 Reasons why doctors respond negatively The two major reasons why doctors respond negatively are shortage of time16 25 26 30 34 38 56 and a sense of embarrassment and anxiety when patients bring accurate, highly specialised information outside of their area of expertise.25 28 Changing the negative response Informed by these data on why doctors may respond negatively, we used a theoretically grounded approach to formulate a plan for an educational intervention for medical students, to help them welcome the patient's digital self into the consultation room. Over 50% of Australian general practitioners claim to use a trusted website as an ‘ally’ when managing IIP.60 This may be referred to as an ‘internet prescription’ and can be associated with a high level of patient satisfaction.61 62 Internet prescriptions only facilitate one-way communication between doctors and patients about health information on the internet, and do not challenge the historical patient–doctor power relationship.