Doctor as Second Opinion

1. The Doctor as the Second Opinion and the Internet as the First By: Lisa Neal Gualtieri Health Communication Program Tufts University School of Medicine

2. Introduction • The introduction of the Internet to many different domains has dramatically changed how people get the information and services they need. • Finance and Travel • What about Healthcare?

3. Healthcare, and the Internet • Initial use – online support groups • Expansion – used to learn about a disease, to determine whether professional medical care is needed, to diagnose, to learn what treatment options exist, and for peer support

4. Poor Health-Literacy Skills • Health literacy • Problems Searching Online • Results – Patients cannot understand or act on medical information whether it be received online, or by doctor visit

5. Problems, Made Worse • Poor health literacy compounded and made worse • There is reliable health information online, but…

6. Reliable Information • Some people start looking for health information at well-known and established sites • More then half of health-information seekers reported that their most recent online health-info session affected how they care for themselves or someone else • Decisions without the awareness of or feedback from professionals

7. Internet as the First Opinion • Internet – convenient, easy to use, reflexive use to diagnose a problem, look up symptoms, and determine what to do • Professional medical care becomes the second opinion • In some cases, the second opinion, is not even taken into consideration, and many people attempt to solve their health problems on their own • In other cases, the first opinion from the internet leads to seeking the second opinion.

8. Communication • Frequently neither the patient tells the doctor about their internet provided first opinion, nor does the doctor inquire about it, for a multitude of reasons

9. Consequences • Strong Doctor-patient relationship is based on trust, not sharing crucial information about previous research, and concerns, can erode this trust, without the doctor even being aware of it • Third opinion following doctor’s visit – confused, immediately go to Internet, again.

10. True Stories • Whooping Cough – Mary Ann P. • Bat Bite – Diana C. • Uterine Cancer – Julie Z.

11. What Can Patients Do To Use the Internet More Effectively? • Strive to become empowered healthcare consumers • Guidance by their healthcare providers about how to integrate their internet research with their visits

12. What Can Doctors Do? • Doctor’s need to acknowledge their patients concerns • They can give recommendations • Collect information about internet use through surveys and such

13. What Can HCI Professionals Do? • Collaborate with the medical community to develop a gold standard for consumer health web site design • Ultimately, anyone using a health website is trying to feel better or stay well, the design should address that

14. Conclusions • The medical community today fails to acknowledge the extent at which patients do health-related online research. • More information is needed about the reasons patients rely heavily on the Internet. • Why do they use it for their first opinion? Why do they not disclose to physicians any fears or concerns regarding their online diagnoses? • Patients benefit if they are more knowledgeable and have better relationships with their doctors. Doctors benefit if their patients are more knowledgeable and less confrontational or fearful. • With 80% or more of American’s of all ages, to say nothing of Internet users in other countries, using the Internet for health, improving healthcare should be a collaborative priority of the medical and human computer interaction communities!