A guest column by the American College of Physicians, exclusive to KevinMD.com.

It made the rounds on social media this winter: a photo of a coffee mug with the words “Please Do Not Confuse Your Google Search With My Medical Degree.” Colleagues shared and retweeted it, feeling a sense of vindication. I have to admit that I had a chuckle over it as well. It was the focus of a post on KevinMD.com by patient advocate Dave deBronkart, a.k.a. “e-Patient Dave.”

The response from the physician community reflected the widespread feeling that the Internet introduces another barrier to physicians doing their jobs: patients who don’t know what they don’t know thinking that they know it, adding to the growing list of challenges to physicians’ standing, the demands on their time, and the frustrations of practice. What made the photo resonate was the sense that our jobs are hard enough without having to respond to stuff that patients download from the Internet, much of which is wrong or not applicable to the person who brings in the printouts.

As amusing as I found the photo, as I thought more about it, I realized that of my many positive and rewarding patient interactions, a significant number are with patients who take the time to learn about their conditions, come to their visits with challenging questions, and want to know what I think.

Several times a week, I receive secure messages via my electronic health record (EHR) patient portal where patients ask questions about something they read or that a friend told them, asking for my opinion and grateful that I took the time to reply. Or they come to their visit with printouts and questions that are opportunities to educate and motivate.

It’s not like physicians aren’t guilty of doing the same sort of “do it yourself” work outside their area of expertise. How many of us Google “squeaking when the brakes are applied” or “hesitates when the engine is cold” before going to the mechanic? How about “takes long to start up computer” or “crashes when I try to save file” before calling IT?

That is not to say that when we drive our car to the mechanic or the IT person stops by our desk that we tell them how to do their work, but we feel better knowing something about what may be going on so that we can judge the advice that we receive. Why shouldn’t our patients be able to do the same?

For that matter, isn’t a patient who is interested enough in their well-being to research their conditions and come to their visit prepared to discuss their treatment more likely to be an active participant in their care, which should make our lives easier, not more difficult?

Some patients have taken to heart the message conveyed on the coffee mug. They’ll come with their online research-generated questions but ask them apologetically, often starting with “I know you won’t like this, but…” I suspect many are afraid to ask at all. Is that what we want?

Why not instead refer patients to websites that we know to be good sources of reliable information (rather than fronts for modern-day snake oil salespersons or soapboxes for the misinformed)? For example, the American College of Physicians (ACP) has a library of patient education resources for specific conditions as well as high value care. The National Library of Medicine’s Medline Plus is a searchable site with vetted information for patients.

If you’re worried about all of that taking more time, consider that it may, but there are ways to manage that time more effectively. If your patients are online doing research, they can also be online using your EHR patient portal’s secure messaging to discuss their findings, or even send you their questions in advance of the visit so you can plan ahead. When you start your visits, make sure you solicit questions generated by online research when you set the agenda for the visit with your patient.

If the extra work results in a more engaged patient who has better outcomes, why would we resist? Plus, as future payment models value outcomes over volume, welcoming this type of patient participation can help the bottom line.

It’s not like we’ll be replaced by Dr. Google. As much as patients can get to just about all the medical knowledge that we can access, what we bring to the relationship are the ability to interpret that information, to filter the garbage from the valuable, and to put some pretty scary stuff into the proper perspective. Our years of training go beyond book knowledge. Our patients know that and appreciate it.

Yul Ejnes is an internal medicine physician and a past chair, board of regents, American College of Physicians. His statements do not necessarily reflect official policies of ACP.

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