Communicating Risk to Patients Who Get Their Information from the Internet
Am Fam Physician. 2019 Sep 1;100(5):306-308.
A 67-year-old woman came to my clinic with uncontrolled hypertension and stage 3 chronic kidney disease. She told me she had not taken her lisinopril because she read on the internet that taking lisinopril causes lung cancer. I searched online and found the population-based cohort study that appeared to be the source of my patient's concerns. What can physicians do when our patients act on findings from the internet? How do physicians address information that tells us that additional studies and more long-term follow-up are needed when our patients have already decided that the alleged risk outweighs the benefits?
This case raises important issues related to communicating with patients, including where and how patients get health information, how reliable the information is, and, above all, how well patients understand risk relating to the information. Regarding these issues, physicians need to know the best way to provide patients with convincing, reliable, and accurate information about risk.
WHERE DO PATIENTS GET HEALTH INFORMATION?
Some studies show high percentages of patients getting information from health professionals1; however, national data show otherwise. The annual Health Information National Trends Survey reports that nearly one-half of U.S. adults use the internet as their first source of medical information, whereas only 10% to 15% rely on health care professionals.2 Perhaps not surprisingly, younger adults are more likely than older adults to seek health information on the internet.3 Many individuals, particularly the one-third of U.S. adults with limited literacy,4 are likely to get health information primarily from television, social media, and celebrity webpages,1 and they are less likely to trust information on government websites.5,6
HOW RELIABLE IS THAT INFORMATION?
The internet provides many excellent sources of health information. Physicians regularly use online resources to guide them in the care of patients. However, studies and media reports indicate that members of the public are not always able to distinguish reliable and authoritative health information from unreliable and incorrect information. Individuals tend to believe things that match their own preexisting biases.7 Fake medical news is common, ranging from the well-known false reports of childhood vaccines causing autism or seizures to reports
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8. Warraich H. Dr. Google is a liar. December 16, 2018. The New York Times. Accessed June 27, 2019. https://www.nytimes.com/2018/12/16/opinion/statin-side-effects-cancer.html
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13. Agency for Healthcare Research and Quality. The SHARE approach —communicating numbers to your patients: a reference guide for health providers. Updated August 2018. Accessed June 27, 2019. https://www.ahrq.gov/professionals/education/curriculum-tools/shareddecisionmaking/tools/tool-5/index.html
14. Icon array Risk Science Center and Center for Bioethics and Social Sciences in Medicine, University of Michigan. Accessed July 2, 2019. http://www.iconarray.com/
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16. Zhou D, Xi B, Zhao M, et al. Uncontrolled hypertension increases risk of all-cause and cardiovascular disease mortality in US adults: the NHANES III linked mortality study. Sci Rep. 2018;8(1):9418.
17. Agency for Healthcare Research and Quality. Health literacy universal precautions toolkit, 2nd edition: use the teach-back method: tool #5. February 2015. Accessed July 2, 2019. https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/healthlittoolkit2-tool5.html
Case scenarios are written to express typical situations that family physicians may encounter; authors remain anonymous. Send scenarios to email@example.com. Materials are edited to retain confidentiality.
This series is coordinated by Caroline Wellbery, MD, Associate Deputy Editor.
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