Background

Background:
Medical providers are facing a new responsibility as the number of patients who consult online resources to obtain medical guidance is expanding. Despite the fact it provides opportunities for patients to become well educated about their conditions and to actively get involved in their own treatment process, it also may leads to many drawbacks.

Design and Methods:
This cross-sectional study was conducted among doctors at King Abdulaziz University Hospital (KAUH) in Jeddah, practicing in various specialties, over a 2-months period (June 2017 to July 2017) using a self-administered questionnaire.

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Results:
Of the 100 doctors who returned the survey, the majority stated that their patients access the internet (70%). Sixty percent revealed that only a few number of patients discuss what they read online during their appointment. We found that 48% of doctors don’t routinely ask their patients to visit medical websites to read about their illness. Many doctors perceived internet-based health information introduced by their patients as problematic 57%. Forty five percent of doctors reported it has a positive impact on their relation with their patients, while 33% thought that it’s actually damaging it.

Conclusions:
It is necessary for all doctors to evaluate information resources to identify the quality of information their patients search for. This allows them to direct their patients to high-quality databases in order to avoid misleading/inadequate information. Generally, our physicians felt uncomfortable with the idea of accessing health-related sites by patients. Further studies regarding this matter to determine patients’ perception is recommended.

Introduction:
Usage of internet as a source of medical information is increasing with an apparent influence on the doctor-patient relationship.1 60-80% of world-wide-web users have used the internet searching for health information. Two-thirds of those patients claim that it had a little impact on their medical decisions. Findings of a systematic review of 79 different studies showed that the quality of online information is usually deficient and sometimes even incorrect.2

In USA, 53.5% of patients search the internet for health guidance. Sixty percent of them thought the information they get from online resources was the “same as” or “better than” the information they get from their own doctors and 59% did not consider reviewing the information with their doctor during hospital visits.3

The quality of online information needs to be examined by the doctors to reduce the spread of poor and inaccurate information. Based on the previous published studies, there’s an obvious effect of using the internet on the relationship between the doctors and their patients. To our knowledge, no studies have been conducted in Saudi Arabia regarding this matter and little is known about our doctors’ opinions.
Our aim is to study the perception of our physicians toward patient’s use of health-related websites.

Objective:
The goal of this study was to determine physician’s perception and attitudes regarding the use of health-related websites.

Design and Methods:
A cross-sectional study was conducted among KAUH doctors. Ethics committee approval was obtained from King Abdulaziz University Hospital (KAUH) on May 9, 2017.

Questionnaire:
The data were collected using structured self-administered questionnaire in English language.
Questionnaires were distributed randomly to doctors practicing in various specialties (Pediatrics, Internal Medicine, Surgical specialties, Dermatology, Obstetrics and Gynecology, Family Medicine and Dentistry) over a two months period (June 2017 – July 2017). The design of the questionnaire was based on a survey used in a previously published study,5 The questionnaire was also enriched with additional questions from another published study 4 Our study assessed the respondent’s perception towards the use of the available online websites and weather they prefer to discuss online medical information with their patients.

Statistical analysis:
Categorical data were described using frequencies and percentages using Excel and IBM SPSS Statistics.

Results:

The questionnaire was completed by 100 of 140 doctors. The majority of the doctors who filled the questionnaire were from the Internal Medicine department (26%), while there were doctors from other various specialties. (Figure 1) Only a small percentage (12%) stated that their patients don’t access the internet for clinical information. (Figure 2)

Additionally, only a few number of doctors (22%) declared that the majority of their patients discuss what they got through the internet with them and ask them for more information at the next visit, while sixty percent expressed that only a few of their patients discuss the online information with them during their appointment. (Figure 3)

Our results indicated that forty eight of physicians from different specialties don’t routinely ask their patients to check medical websites to read about their medical conditions. Statistical analysis also revealed that most of our health providers (70%) preferred and wished that their patients discuss with them the information they get from online databases. Moreover, the majority of medical practitioners perceived internet-based health information introduced by their patients during their medical consultation as problematic (57%) and only forty three percent perceived it as beneficial.

Regarding the effect on patient-physician relationship, twenty two percent of physicians thought that using online sites has no impact on the doctor patient relationship, while forty five percent reported it has a positive influence and thirty three percent thought that it’s actually worsening the relation with their patients.

Furthermore, in regards to the reasons health-care professionals think internet-based health information is troublesome, majority answered that it guides to misinformation and misdiagnosis (87%). Forty eight percent of doctors believed accessing the internet produces anxiety and distress. According to some doctor’s point of view, online health information is problematic since it extends the consultation time (27%). Thirty three percent of health care providers agreed that online websites leads to confusion to both the doctor and patient, fifty nine percent stated it’s not beneficial due to the tendency toward self-diagnosis and management, and fourteen percent of doctors believed it makes them feel challenged by their patients.

Discussion:
The use of the Internet to obtain health information has become increasingly popular nowadays.
According to our doctors, a great number of our patients access the internet for medical search (70%). Figure 2

Despite the fact that this will provide new opportunities for patients to become well informed about their disease and to actively get involved in their own treatment process, it also leads to many drawbacks. These drawbacks include the fact that it requires choosing the appropriate websites to obtain medical information and patient characteristics and education level. For these reasons, medical providers are facing new challenges which sheds a light on the importance of assessing the quality of the presented data in online websites.

With the increasing use of the internet, patient-provider relationships might probably change. Forty five percent of our doctors thought that using medical websites has a positive effect on the relationship, while thirty three percent believed it worsens the relation with their patients. A minority (22%) reported it had no impact. The results of an earlier study conducted in US involving 1050 doctors, showed that thirty eight percent of their doctors thought that using online websites has a positive influence on the doctor-patient relationship, fifty four reported no effect, and a small number of doctors (8%) believed that it worsened the relationship as doctors felt “challenged” by patients.4 In another study conducted in Toronto, most of the doctors considered using the internet by their patients as a problem when introduced by their patients. They thought it leads to false information, which results in facing the hazard of self-diagnosis/management. 5 Overall, the majority of our doctors perceived it as problematic (57%). We tried to investigate the reasons behind their opinion and we found that a lot of our medical professionals believed using the internet leads to incorrect information and inaccurate diagnosis (87%). Furthermore, they believed it makes their patients more distressed (48%). While other doctors (59%) stated that it’s not beneficial due to the tendency toward self-diagnosis and self-treatment. Moreover, thirty three of our health providers reported that online websites produce disruption to the doctor and the patient. According to other doctors, it is troublesome since it prolongs clinics hours (27%) and a minority of doctors (14 %) admitted it makes them feel challenged by their own patients.

One of the main disadvantages of internet usage to obtain medical information is that patients might share only some of their knowledge with their doctors. We found that most of our health providers (70%) preferred if their patients discuss what they read with them. However, only a small percentage of doctors (22%) reported that the majority of their patients actually discuss website-information during their appointments. Obviously, a large number of our doctors were in disagreement with using online databases by their patients and they don’t even recommend targeted sources or ask them to read about their conditions (48%). In contrast, a cross-sectional study about the internet by Gastroenterology patients revealed that sixty percent of patients intended to use the internet for health information in the future and that only four percent of 825 patients had ever been referred to a specific Web by a physician.6

In conclusion, Recently the flow of seeking medical guidance through World Wide Websites is increasing and the number is expected to be growing with the easy accessibility. This would probably provide both opportunities and challenges with an apparent impact on the doctor-patient relationship. For that reason, health care providers should be advised to examine patient’s knowledge regularly and to recognize the presented data resources to be prepared to offer high-quality Websites. According to our results, our physicians didn’t welcome the idea of using online sites to gain medical information and don’t favor suggesting it. Further studies regarding this matter to evaluate patients’ perception is highly recommended.

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