The Internet: The Elephant in the Examination Room

October 21, 2014

Damiana Andonova

Peter Conrad, a sociologist at Brandeis University, spoke of the rise and fall of the medical authority in the doctor patient office encounter in his many scholarly articles. With the internet becoming the “elephant in the doctor’s office,” the dynamic of medical authority has certainly changed.

As the internet evolves into a virtual space for communities and patients to disclose personal medical information and seek sustenance and support from one another (preemie parent communities, pregnant mom  communities, Parkinson’s groups, cancer groups, dermatology forums, etc.), how does a clinician negotiate his/her medical expertise and the information available on the internet that their patients have brought to their exam table?

The advantages of the internet are many—its ability to accumulate and disseminate information, its ability to provide a platform to connect and share medical experiences, and of course its potential to store health records, improve accessibility, and improve patient education. But, its use also raises issues of privacy, misuse of medical information to self-diagnose, and misleading medical information.

“Internet-induced hypochondriasis” is not un-heard of. We all know of patients who’ve googled their symptoms and rushed to their health practitioner the following day. We should not hold them in contempt of getting their medical advice from WebMD. Instead, we should applaud them for their initiative to take part of their health care, for their enterprise and interest to learn about their condition, for their correct intuition to follow up with their physicians.

While the internet can raise serious issues that merit attention, the internet has also provided patients a means connect to physicians and to learn more how to care for their condition. Consider the many Google searches for diabetes friendly recipes, how to talk to a sick relative, and how to keep a low FODMAP diet. The internet, in other words, illustrates the demand for patient education and it is up to clinicians to take initiative to offer just that.

Most certainly, the bedside is a great place to start that discussion. Instead of letting the internet become the elephant in the room, the physical exam can allow the clinician to negotiate medical authority. The mother of the pediatric heart patient has no doubt become the leading expert on her child’s heart condition, but, perhaps, it is the pediatrician’s evolving role to not only examine, and coordinate care for her child, but also help the parent navigate through the wealth of information that is literally available with the tap of the index finger


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