Seminar Paper - Exploring the Impact of Patient Internet Research on the Doctor-Patient Relationship

The seminar paper was written during an elective course in the field of politics & health science. The task was to conduct empirical research in the field of digital health care and analyze its effects on society. I chose to focus on the implications of patients bringing self-researched information into medical consultations.

Download the full paper here (German) ⤵️

Sonja Klein_Partizipierende_Patient_innen.pdf

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Introduction

In recent years, the landscape of healthcare information has undergone a significant transformation, especially with the rise of patient-initiated Internet research. The paper delves into the effects of patients in their early twenties engaging in online searches for health-related information on the doctor-patient relationship during consultations. The investigation is grounded in exploring the dynamics between paternalistic, shared decision-making, and informative models of the doctor-patient relationship.

Research Aim

The onset of the COVID-19 pandemic in 2020 brought health-related discussions to the forefront of public discourse. Individuals, especially those in their early twenties, became more proactive in seeking information about vaccinations, COVID-19 symptoms, pharmaceutical players, and broader public health issues. The surge in patient-initiated Internet research is not a new phenomenon, as even before the widespread availability of the Internet, individuals sought health information through family, friends, and personal experiences. However, the ubiquity of internet access has significantly amplified this trend. This paper aims to explore the implications of patients bringing self-researched information into medical consultations.

Research Question & Objectives

The central question guiding this research is to understand how patient-initiated internet research, particularly among individuals aged 20 to 25, influences the doctor-patient relationship during consultations.

Methodology

This seminar paper conducted two open-ended, semi-structured interviews with individuals aged 20 to 25 who actively engage in online health research. The participants, chosen based on their use of online health platforms and self-perceived good health, provided insights into their expectations of doctors in the context of online health research.

The analysis employed qualitative content analysis according to Mayring (2015). The research, rooted in social sciences and complemented by educational, communication, and political science perspectives, aimed to bridge the gap in understanding patient expectations in the era of informed healthcare consumers.

Outcomes

The interviews unveiled a discrepancy in patient participation during different phases of the medical process. Patients actively participate before and after consultations by researching symptoms, attempting to contextualize information, and validating information provided by healthcare professionals. However, during consultations, patients perceive themselves as passive actors, avoiding active participation to prevent influencing healthcare professionals and respecting their time constraints. The study found that patients only introduce their own researched information when substantial discrepancies arise between their findings and information provided by healthcare professionals.

Perceived possibilities for participation

The analysis of the interviews shed light on the positive impact of internet usage, particularly through online health portals, on the perceived participation possibilities for patients.

One interviewee drew a compelling analogy, stating:

"I think if I go to a car mechanic and understand at least a little, then he can't just say: Well, there's some tiny part broken – that'll be 5000€, or else the whole car will break down. If you know a bit, and it's the same in healthcare" (Interview 1, Lines 328-331).

Patients perceive a shift in power dynamics, as they can now critically assess information provided by healthcare professionals rather than accepting it blindly (e.g., Interview 1, Lines 322-325; Lines 328-333). Interestingly, despite this, the study found that patients still place the ultimate decision-making responsibility in the hands of healthcare professionals, emphasizing trust in their expertise (Interview 2, Lines 20-21).

This duality in patient perspectives raises intriguing questions about the doctor-patient relationship. While patients exhibit participatory behaviors, the decision-making responsibility seems to remain largely with healthcare professionals.

This aligns with the paternalistic model or the informative model rather than the shared decision-making model. However, it is noteworthy that the interviewed patients explicitly stated that the final decision "…still lies with the individual…" (Interview 2, Line 17).

Quality Assurance

Patients actively engage in evaluating the competence of healthcare professionals using information obtained from the internet. Post-consultation, patients often seek to verify the information received and obtain a second opinion. This process is perceived as less time-consuming than traditional methods (Interview 2, Lines 256-258).

Patients' use of the internet to cross-check medical information poses potential challenges to the doctor-patient relationship. Healthcare professionals may be aware that patients have conducted online research, and discrepancies between patient findings and professional advice could influence the dynamics between them (Interview 1, Lines 128-130). This dynamic demonstrates a subtle shift in power dynamics, where patients gain influence and the traditionally asymmetrical relationship begins to loosen.

Conclusion

Despite the anticipated trend of increased patient autonomy in decision-making during consultations, the study reveals a discrepancy. Patients, in this age group, still predominantly perceive the responsibility for decision-making to lie with the healthcare professionals during consultations. However, a shift towards more patient autonomy is evident in the pre and post-consultation processes.

As the internet continues to play an indispensable role in health information retrieval, the doctor-patient relationship undergoes nuanced changes.