misinformation

PATIENT EDUCATION

Overcome False Online Information

Follow this step-by-step plan for righting the wrong information patients find on the Web.

JUSTIN BAZAN, O.D., PARK SLOPE, N.Y.

Imagine this: You are in the midst of performing a comprehensive eye exam. You say to the patient, “Now, I’m going to use this device, called a tonometer. It measures your eye’s pressure, which is a risk factor for glaucoma. Glaucoma is a condition that can cause gradual vision loss.” The patient answers in a hushed tone, “You can skip that test. I don’t have glaucoma. I read online that if you smoke marijuana, you don’t get glaucoma. I smoke it almost every day.”

Another scenario: A patient with whom you’ve diagnosed a grade 1 nasal pinguecula frantically calls your office’s emergency line at 2:30 a.m. The patient thinks he/she has a conjunctival melanoma. The reason: He/she came across it during an Internet search. (See “How to React to Misinformation,” page 16.)

We, as doctors, have always fought to overcome myths and misinformation. But this battle has substantially increased since the dawn of the Internet. In the past, a patient had to head to a library to research a condition or explore a topic of concern — an effort that prevented many from doing so. As a result, they took what information their doctor provided without question or follow-up. For those patients who did visit a library, however, the information they uncovered substantiated what their doctor told them, as libraries stock their shelves with accredited resources.

The Internet, due to its ubiquitousness, has facilitated the search of medical conditions. In addition, unlike a library, it is rife with tenable information. Further, many have deemed the World Wide Web as a bible of truth. A recent State Farm commercial illustrates this nicely: www.youtube.com/watch?v=rmx4twCK3_I. French model? I don’t think so.

The verb “Google” certainly hasn’t helped with the Internet-equals-truth belief: “Just Google it to find the information you’re looking for.” Most people don’t say, however, “Google it, but be sure you consider the validity of the sources that come up.”

It’s important we dispel the misinformation patients learn from the Internet. If we don’t listen to and address their comments, concerns and questions, we run the risk of poor compliance to our directions, less-than-stellar outcomes and losing them to a doctor who actively listens to them.

Here is a step-by-step plan for addressing misinformation.

1 Review the source.

When a patient presents with information “found on the Internet,” ask the patient to show you the source, so you can gauge the source’s credibility.

Example conversations:

Doctor: “Thanks for bringing this to my attention. Where did you find this information?”

Marijuana patient: “While browsing Yahoo! Answers. The author was a Yahoo! user who responded to a question about using marijuana to treat glaucoma.” The patient pulls out his smartphone and points: “Here’s the link.”

Pinguecula patient: “I couldn’t remember your diagnosis, but I remembered you described it as a “growth on the eye,” so I searched on the Internet for this phrase, and these gruesome photos appeared. Then, I clicked on one of the images, which led me to this site.”

If you lack expertise in the information the patient shows you, say:

“Thanks for bringing this to my attention. I’m going to do some research on it, and share my findings with you.”

Show you genuinely care about getting the patient the answers he/she is looking for.

Saying this impresses the patient, as it shows you genuinely care about getting the answer(s) he/she is looking for. This makes you the kind of doctor patients want and stick with.

2 Review the content.

Although Yahoo!, among other search engines, has been known to provide credible information and links to accredited sources, this is not always the case. Therefore, you must review the content to ensure its validity.

Example conversations:

Doctor to marijuana patient: “The content, although well-written and complete with a reference, is flawed. It is true that smoking marijuana may reduce the pressure inside your eye temporarily. However, more credible sources than the one supplied on Yahoo! Answers have shown the drug is an ineffective way of doing so. Also, marijuana has other effects that may actually increase the risk of glaucoma and negatively impact your cardiopulmonary and mental health. Yahoo! Answers is a fun site to visit and is a great resource for questions like ‘What’s your favorite Nirvana song?,’ but it’s not a great source for medical information.”

This dialog also serves as an excellent opportunity to further define glaucoma for the patient.

Doctor to pinguecula patient: “The image you found is from a reputable source, but the content is from a journal designed for eyecare practitioners, which can make it confusing for non-medical professionals to understand. It’s actually not about your condition.”

3 Provide an authoritative reference.

Next, give the patient credible sources to aid him/her in learning the specifics of the topic he/she has addressed with you, and briefly explain what makes them credible.

Example conversations:

Doctor to marijuana patient: “Here’s a link about marijuana use and glaucoma from the American Glaucoma Society. This is a credible source, as it bases its statements about the condition on peer-reviewed scientific research. Let’s look at the summary: ‘Although marijuana can lower the intraocular pressure (IOP), its side effects and short duration of action, coupled with a lack of evidence that its use alters the course of glaucoma, preclude recommending this drug in any form for the treatment of glaucoma at the present time.’ I’m glad you brought this up and have learned that smoking marijuana isn’t a viable option for reducing the likelihood of glaucoma. The best way for me to detect glaucoma is for you to keep coming back for your routine comprehensive eye exams.”

Doctor to pinguecula patient: “Here’s a non-medically heavy link about your condition from a site comprised of medical professionals who are experts in the topic. See. You don’t have a conjunctival melanoma. Do you feel better?”

You may also want to include the definitions of common innocuous conditions on your practice website to allay patient fears.

4 Ensure all questions are answered.

Often, by answering all the patient’s questions, he/she no longer feels the need to conduct additional independent research on the Internet. This preserves his/her emotional wellbeing, while making your job a little easier.

In addition, let him/her know the dangers of relying on medical information found on the Internet.

Often, by answering all the patient’s questions, he/she no longer feels the need to conduct an online search.

Wrapping up the conversations:

Doctor to marijuana and pinguecula patient: “Now, that we’ve had some time to discuss this, do you have any other questions about it? Conducting Internet searches is fun, but I don’t recommend doing it for medical conditions. This is because the sources of the information we find aren’t always credible. In addition, what is presented is often medically heavy, making it difficult to understand. Finally, Internet searches are known for presenting the most graphic or worst-case scenarios, and I don’t want you or any of my other patients worrying needlessly. Does this make sense?”

More hurdles to overcome

It’s not possible to prevent all our patients from conducting Internet searches regarding medical conditions, but we can be prepared to handle them when they present. So, the next time a patient brings to your attention medical information he/she found online, keep the aforementioned four steps (and the sidebar) in mind, and use the opportunity to strengthen your relationship with the patient, reinforce your expertise and gain loyalty. OM

Dr. Bazan is in private practice at Vision Source Park Slope Eye. He is a co-founder of Peripheral Vision, a social media group for optometrists. To join, visit www.facebook.com/peripheralvision. Please send comments and questions to dr.bazan@parkslopeeye.com. Or send comments to optometric management@gmail.com.