This document summarizes a presentation on how physicians can support patients who search for health information online. It discusses how most patients now search the internet for health information. It also explores how cultural factors may influence what types of online health information people prefer. The presentation provides tips for physicians on how to have productive conversations with patients who conduct online research and how to guide them towards credible sources of information. It suggests creating a list of trusted health websites to share with patients.

1. H O W T O O U T S M A RT “ D R . G O O G L E ”
I R I S T H I E L E I S I P TA N M D , M S C
Professor 3, UP College of Medicine
Director, UP Manila Interactive Learning Center
Chief, UP Medical Informatics Unit

2. NOTHING TO DISCLOSE
I give consent for the audience to tweet this talk
and give me feedback (@endocrine_witch).
Feel free take pictures of my slides (though the
deck is at www.slideshare.net/isiptan).

3. D O Y O U H AT E
“ D R . G O O G L E ” ?
H A S G O O G L E A LT E R E D T H E
M D - PAT I E N T R E L AT I O N S H I P ?
H O W C A N W E S U P P O R T
PAT I E N T S W H O G O O G L E ?

4. Pei-Li Teh & Marc Yates (2013)
researchpartnership.com

5. Pei-Li Teh & Marc Yates (2013)
researchpartnership.com
Nine in ten had accessed the internet looking
for healthcare information, with almost 3/4s
having done so in the last month.

6. GENERAL HEALTHCARE WEBSITES
ONLINE HEALTH FORUMS
HEALTH COMMUNITY WEBSITES
DISEASE WEBSITES
CLINICAL WEBSITES
PHARMACEUTICAL WEBSITES
WIKIS
E-NEWSLETTER
FACEBOOK
%
0 25 50 75 100
HEALTH INFORMATION SOURCES EVER USED
Pei-Li Teh & Marc Yates (2013)
researchpartnership.com
(Philippines)

7. Do cultural variations exist in patterns of
online health information seeking?
Song et al. Trusting Social Media as a Source of Health Information: Online Surveys
Comparing the United States, Korea, and Hong Kong. J Med Internet Res 2016;18(3):e25)
US
Hong Kong
Korea

8. HEALTH INFORMATIONSong et al. J Med Internet Res 2016;18(3):e25)
Expertise-based information
produced by medical professionals
Experience-based information
laypersons’ subjective first-hand
experiences of health & illness

9. HEALTH INFORMATIONSong et al. J Med Internet Res 2016;18(3):e25)
Expertise-based information
Americans showed a stronger
preference for WebMD & CDC
Experience-based information
Asians showed more trust in
blogs, online support groups &
social networking sites

10. Internet-hostile
Clearly uncomfortable with, and sometimes seem to feel
offended by patient’s attempts to learn more online
Image by Niklas Hellerstedt
http://www.flickr.com/photos/niklashellerstedt/2414448568/
Tom Ferguson, MD & the e-Patients Scholars Working Group (2007)
“e-patients: how they can help us heal healthcare”

11. “[Most doctors] really
do like to think they
have ALL the answers.
This will never
change, I am afraid.”
Pew Internet Project e-Patient Survey
Image by caricaturas
http://www.flickr.com/photos/caricaturesbynelson/2031107541/

12. WHY DOES SELF-DIAGNOSIS ANNOY DOCTORS?
http://www.endocrine-witch.net/2015/07/05/why-does-self-diagnosis-annoy-doctors/
#Bloggys2015 Blog Post of the Year

14. Online health INFORMATION resources
push information out to the patient
Online health ENGAGEMENT resources promote sharing of
information and support/interaction among patients
Collins S & Lewis DM. Clinical Diabetes 2013

15. Potential to transform the pursuit of health by allowing
people to share what they know
PEER-TO-PEER HEALTHCARE
Fox, S. https://www.pewinternet.org/2011/09/18/medicine-2-0-peer-to-peer-healthcare/

16. Collins S & Lewis DM. Clinical Diabetes 2013

17. … the average person with
diabetes spends no more
than 0.1% of their time in
the course of an entire year
discussing health matters
with a medical professional.
Hernandez M. Diabetes Manage. 2013;3(3):203-205
“

18. D O Y O U H AT E
“ D R . G O O G L E ” ?
H A S G O O G L E A LT E R E D T H E
M D - PAT I E N T R E L AT I O N S H I P ?
H O W C A N W E S U P P O R T
PAT I E N T S W H O G O O G L E ?

19. Crowd-sourcing
Harnessing collective intelligence
Image from antigone78
http://www.flickr.com/photos/antigone/457089364/

20. Image by judepics
http://www.flickr.com/photos/judepics/2059494008/
Physician as INTERMEDIARY:
gatekeeper of health information

21. APOMEDIATION
Less reliance on traditional experts
Image by migclick
http://www.flickr.com/photos/migclick/2535570629/

22. Image by WebWizzard
http://www.flickr.com/photos/webwizzard/3931165028/
The Well
The Acutes
Facing a new
medical challenge
The Chronics
Chronic but
stable illnesses
3 Categories of e-Patients*
from Cain, Sarasohn-Kahn & Wayne (2000)
“Health e-People: The Online Consumer Experience”
* Includes caregivers

23. Internet Access
from Tom Ferguson, MD & the e-Patients Scholars Working Group (2007)
“e-patients: how they can help us heal healthcare”
The
Well
every
few
months
The
Acutes
everyday
The
Chronics
several
times a
month
Image by iwd
http://www.sxc.hu/photo/1129780
60-
65%
5-
6%
30-
35%1 32

24. e-patient & Empowerment
From Von Knoop at al of Boston Consulting Group (2003)
“Vital Signs: e-Health in the United States
Accepting
Informed
Involved
In control
Severity of
Condition
Attitude Toward Physician
High
Moderate
Low
Godlike Partner Supplier

25. Accepting Informed Involved In control
Doctor-
dependent &
uninformed
Doctor-
dependent
but informed
Junior
medical
partners
Autonomous
patients
Rarely go
online for
health
information
Go online
before or
after MD visit
Prefer to
make joint
decisions but
defer to MD
Make their
own decision
even if MD
disagrees
From Von Knoop at al of Boston Consulting Group (2003)
“Vital Signs: e-Health in the United States
1 32 4
Image by iwd
http://www.sxc.hu/photo/1129780

26. “Paradoxically, a patient’s interest in knowledge
may not always accompany an interest
in the medical decision making process.”
Gerber & Eiser, Journal of Medical Internet Research 2001
Image by nightRPstar
http://www.flickr.com/photos/ninjanoodles/1586212326/

27. Physician-Patient Encounters
Gerber & Eiser, Journal of Medical Internet Research 2001
Informed
decision-maker
Knowledge-acquirer
Image by Kurhan
http://www.sxc.hu/photo/1314902

28. The Knowledge-Acquirer
Provides some personal values to the physician
Image from carbonNYC
http://www.flickr.com/photos/carbonnyc/3440688097/
Interested in learning
more about the
treatment decided
on by MD
Gerber & Eiser, Journal of Medical Internet Research 2001

29. http://www.flickr.com/photos/72341818@N00/4555752947/
The Informed Decision-Maker
Possesses both preference and knowledge
Extra time to discuss
what patient knows
Avoid frustration of not
being the sole source
of information
Gerber & Eiser, Journal of Medical Internet Research 2001

30. D O Y O U H AT E
“ D R . G O O G L E ” ?
H A S G O O G L E A LT E R E D T H E
M D - PAT I E N T R E L AT I O N S H I P ?
H O W C A N W E S U P P O R T
PAT I E N T S W H O G O O G L E ?

31. WHO runs or
created the site or
app? Can you
trust them?
WHAT is the site or
app promising or
offering?
WHEN was its
information written
or reviewed?
WHERE does
the information
come from?
WHY does the
site or app exist?
http://nccih.nih.gov/health/webresources

32. Unproven Therapies. American Diabetes Association. Diabetes Care 2003; 26(suppl 1):s142.
UNPROVEN THERAPIES
Tend to be developed/promoted
in isolation from established
scientific facilities/associations

33. Unproven Therapies. American Diabetes Association. Diabetes Care 2003; 26(suppl 1):s142.
UNPROVEN THERAPIES
Contain misapplication
of data from scientific
literature
Provide exaggerated
or unrealistic claims

34. Unproven Therapies. American Diabetes Association. Diabetes Care 2003; 26(suppl 1):s142.
UNPROVEN THERAPIES
Often have the potential to be financially
profitable to those who have developed,
promoted or endorsed them

35. Unproven Therapies. American Diabetes Association. Diabetes Care 2003; 26(suppl 1):s142.
UNPROVEN THERAPIES
Generally communicated
outside regular channels of
scientific and clinical
communities
Details of therapies often
secretive

36. Unproven Therapies. American Diabetes Association. Diabetes Care 2003; 26(suppl 1):s142.
UNPROVEN THERAPIES
Their proponents
discourage or refuse
consultation with or
review by reputable
physicians or scientists

37. Unproven Therapies. American Diabetes Association. Diabetes Care 2003; 26(suppl 1):s142.
UNPROVEN THERAPIES
Developers/promoters
often claim a medical/
scientific “conspiracy”
against them

38. http://nccih.nih.gov/health/webresources
Are you
reading news
or advertising?

39. Endorses a product. Only quotes people
who say good things about the product.
Presents research findings
that seem too good to be true.
Contains links to a sales site.
Includes only positive reader comments.
You can’t add a comment of your own.
ADVERTISEMENT NOT NEWS
nccih.nih.gov/health/webresources

40. Collins S & Lewis DM. Clinical Diabetes 2013
Assess patients’ use of online
resources and level of health literacy

41. The Internet Prescription
Recommend websites to the patient
Patients will likely seek
a “second opinion”
on the internet
Gerber & Eiser, Journal of Medical Internet Research 2001
Image by Charles Williams
http://www.flickr.com/photos/charlesonflickr/3926259585/

42. Building the Bridge from Office Visit to Online
Interaction: Time-Saving Approaches
Solicit and review recommendations.
Collins S & Lewis DM. Clinical Diabetes 2013

43. Collins S & Lewis DM. Clinical Diabetes 2013
Create a list of credible
online resources to
proactively share with
patients during office visits.

45. DOK BRU #PARASABAYAN
www.dokbru.endocrine-witch.net

48. D O Y O U H AT E
“ D R . G O O G L E ” ?
H A S G O O G L E A LT E R E D T H E
M D - PAT I E N T R E L AT I O N S H I P ?
H O W C A N W E S U P P O R T
PAT I E N T S W H O G O O G L E ?

49. @ E N D O C R I N E _ W I T C H
I R I S T H I E L E I S I P TA N M D , M S C
Professor 3, UP College of Medicine
Director, UP Manila Interactive Learning Center
Chief, UP Medical Informatics Unit