1.
Physician – Patient
Interaction and the Internet:
The Canadian Experience
Pat Rich – Director, CMA Online Content

2.
The problem?
“A disconnect currently exists between patients' use
of the Internet and their consultations with their
physicians. Too often, patients don't tell their
physicians about their Internet use and physicians
don't ask; both suffer due to the erosion of trust and
missed educational opportunities.”
 From: Improving Patient-Physician Communication about Internet Use: Why “Don’t
Ask, Don’t Tell” Doesn’t Work Lisa N Gualtieri, Tufts University School of Medicine,
Boston, U.S.; Medicine 2.0, Toronto, 2009

3.
How doctors and patients use the
Internet for health
Patients
 search for health
information
 maintain Patient Health
Record
 write a blog
 monitor and/or participate
in online discussion fora
 interact with physician on
patient portal
Physicians
 search for health
information
 maintain practice website
 write a blog
 participate in online
discussion fora
 interact with patients on
patient portal

4.
CMA e-Panel
 “Help us represent the views of Canada's
physicians by joining a panel of doctors who have
agreed to be contacted by email four to six times
per year for their input on matters of importance to
the profession”
 started in 2007
 currently 3,258 participants (practising physicians,
medical students, residents, retired physicians)

5.
Physician-patient interaction
1) Do you use the Internet for personal or professional
searches about health information?
2) Do you suspect ― or know ― if patients are
bringing information they have gathered from the
Internet to their medical appointment?
3) Has greater access to medical information on the
Internet improved the interactions you have with
your patients?
4) Do you provide recommendations for disease
and/or treatment- specific websites to your
patients?

6.
Response rate
 687 responses from 2688 e-Panellists (26%)
 37% family physician or general practitioner
 52% other specialist
 4% medical resident (trainee)
 4% student

7.
Main survey findings
 98% use the Internet to search for health
information (87% for both personal and
professional reasons)
 94% know or suspect patients are bringing
information from the Internet to their appointment
 51% feel greater access to medical information on
the Internet has improved interactions with patients;
21% feel it has not
 75% recommend websites to patients (57%
unprompted)

8.
Patients and the Internet
MD survey comments
Positive physician comments:
* patients more informed
* patients more compliant
* patients more willing to share decision-making
about their own care
* many patients able to accurately rate the value of
information gained from the Internet

9.
Patients and the Internet
MD survey comments
“Internet access enables patients to have a greater
understanding of their conditions and prognosis, all of which
can mean greater compliance with treatment plans.”
“Patients are more informed and feel that they can corroborate
what I am telling them. Also, they feel more in control in terms
of making informed decisions. I have found that patients are
at times overwhelmed with the information and are very
appreciative of my comments and interpretation, as a trusted
medical advisor. Patients often appreciate a little help in
sorting out websites that are likely to be evidence-based vs.
those that are not.”

10.
Patients and the Internet
MD Survey comments
Negative physician comments:
* lots of inaccurate information on the Internet
* patients unable to assess value of information
* information overload
* time-consuming to correct patients if information
is incorrect

11.
Patients and the Internet
MD survey comments
“Almost all patients (save for patients that are
physicians) do not have the necessary critical
appraisal skills required to analyze the information
they obtain from the Web. Being able to read an
article capably these days essentially is like
‘decoding’ a message which involves its own set of
algorithms and ciphers.”
“Ill-informed, opinionated patients can always find
something to buttress a poor argument and (this)
often interferes with their understanding of the
disease or how disease management might work.”

12.
Survey strengths/weaknesses
Strengths
 representative of
Canadian physician
population
 asked questions for
which little data exists
 relatively good
response rate
Weaknesses
 not randomized
 voluntary; self-selected
responders
 generalized questions
 relatively poor response
rate

13.
Canadian physician use of the
Internet II
Unpublished survey of 300 primary care physicians in
Canada
 60% consult the Internet for medical information
 77% consult the Internet between patients
 61% access the Internet during patient visits
Source: Personal correspondence with Pfizer Canada

14.
The times they have a-changed
Then:
Physicians were fearful of patients coming to their
appointment with reams of unverified health
information taken from the Internet, demanding
explanations or, worse yet, treatment based on that
information.
Now:
The Internet is accepted by both health consumers
and physicians as a potential valuable source of
health information.

15.
But ….
 Many Canadian physicians still do not use
electronic medical records or have computers in
their examining rooms.
 A shortage of physicians means physicians often
don’t have time to discuss health issues in-depth
with patients.
 The remuneration system does not reward
physicians for working with patients online.
 The quality of health information on the Internet is
still hugely variable, and the level of health literacy
means health consumers are often unable to make
a good assessment of that quality.

16.
Physician practice website

17.
Physician blog 1

18.
Physician Blog 2

19.
To infinity …. and beyond
Both physicians and patients are learning how to use
social media to expand the connectivity and
conversations regarding health

20.
CMA Perspective
“Patients and health care consumers want to use IT to
manage their health more conveniently. Physicians
can strengthen their relationship with their patients
by encouraging them to participate more fully in
their care. At the same time we can foster our
growing role as health advisors and knowledge
navigators, and ensure patients continue to get the
best health advice from the most trusted advisor”
Dr. Brian Day, then-CMA President, June 2007

21.
Acknowledgements
 Carole Deburggraeve and Angela Moffatt for e-
Panel management
 Marla Fletcher for review and editing of content
 Bill Pascal and Maryan McCarrey for ehealth
insights
 MDs too numerous to mention for sharing their
perspectives on this issue