How well do you trust your doctor?
Is seems that, at least for parents, a level of trust might be impacted by exposure to on-line medical information. A study presented at the 2017 Pediatric Academic Societies suggests that doctor / patient trust and the drive to a second opinion–in a digital age–might be more fragile than we thought. In this study, 1,374 parent participants were presented with a vignette of a child who ‘has had a rash and worsening fever for 3 days.’ The participants were divided into three groups and the first two were presented with information related to the symptoms as computer screen shots.
- Group one was presented with screen shots of clinical information on scarlet fever.
- Group two was presented with screen shots of clinical information on Kawasaki Disease (a condition that causes inflammation in the walls of blood vessels).
- Group three received no internet screenshots.
After which, all three groups were informed that that physician had diagnosed the child with scarlet fever and then asked to rate their level of trust in the diagnosis from 1 (Not at all) to 7 (Completely). Parents were also asked to rate their likelihood of seeking a second opinion regarding the diagnosis, from 1 (Extremely Unlikely) to 7 (Extremely Likely).
The results suggest that prior exposure to information can ‘prime’ a parent to have a unique bias. This bias can impact the trust that has been established with a physician and even change the care pathway. And this result was supported statistically–the three cohorts significantly differed in reported trust in the doctors’ diagnosis (p < .001) and reported likelihood of seeking a second opinion. The authors concluded:
After reading online search results, parents were more inclined to trust their doctor’s Dx (diagnosis) when online information supported their doctor Dx and less inclined when information contradicted the doctor. Parents were also more likely to seek a SO (second opinion) if internet results contradicted the doctor Dx. Although it is imperative that parents participate in the medical decision-making process, conflicting online information could in some cases delay necessary medical treatment. Physicians must be aware of the influence the internet may have on parents and ensure adequate parental education to address any possible concerns.
While this ‘artificial’ scenario may not accurately reflect everyday life or clinical practice, the results seem to indicate that exposure to clinical information on-line may ‘prime’ parents to particular point of view and predisposition to action. I’m reminded of work done by John Bargh, a social psychologist who studied how people, given prior exposure to information, can have that point of view reflected in their subsequent opinion or actions. This concept was popularized by Malcolm Gladwell in his best selling book Blink.
In this study, we can see how information obtained on-line can directly impact the caregivers’ perceptions of decisions and recommendations of a physician. Dr. Ruth Milaniak MD, the lead investigator of this study, supports this observation and offers some important advice.
Every time I speak with my patients, I always have in the back of my mind what on-line influence may have already impacted our dialogue. The internet is emerging as ‘the elephant exam room’ and we as clinicians need to understand this and communicate with patients and caregivers accordingly.
In an era where doctor / patient communication can be time-limited, the role of on-line support may play and increasing role. And as more and more, patients look to Dr. Google as a primary source of medical information, the key question that emerges is if that ‘digital information’ helps or hurts clinical care.
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