Examining the Evolution of the Patient-Physician Relationship

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Patients often come to appointments armed with information gleaned from websites, social media, and direct-to-consumer testing.
Patients often come to appointments armed with information gleaned from websites, social media, and direct-to-consumer testing.

The internet has brought a new challenge into the evolving parameters of the patient-physician relationship: patients have begun equipping themselves with knowledge gleaned from websites, social media, and direct-to-consumer testing to diagnose their own ailments.

An article published in JAMA outlined the obstacles and solutions for physicians who must adapt to the era of increasing patient autonomy.

“Today, some patients arrive at the physician's office having thoroughly researched their symptoms and identified possible diagnoses,” wrote Steven Joffe, MD, MPH, of the Department of Medical ethics and Health Policy at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. “It will bring new challenges for physicians who must manage the downstream consequences of tests and screens they did not order.”

Patient autonomy has increased steadily for more than half a century. New models of care lean toward emphasizing patient choice, and shared decision making has been the go-to model since the 1980s.

Direct-to-consumer tests and do-it-yourself kits are the new norm in healthcare. For example, using the US Food and Drug Administration (FDA)-approved 23andMe®, consumers can check their risk for a variety of diseases without setting foot in their physician's office. Do-it-yourself electrocardiograms can be conducted using a $99 device and a patient's smartphone.

“But while patients can research their symptoms and order many laboratory and genetic tests online, they will continue to depend on their physicians for advice, procedural expertise, and access to restricted medical services,” Dr Joffe wrote.

Dr Joffe and the study's co-investigator, Madison K. Kilbride, PhD, also of the Perelman School of Medicine, outlined the 3 main responsibilities of physicians in this new age of patient autonomy. First, physicians must advise and consult patients as they provide thoughts or claims about their diagnoses; second, physicians should continue to provide diagnostic procedures that patients can't access by other means; and finally, physicians must serve as a legitimate source of medical information to clear up any misconceptions and point the patient in the right direction.

“By appreciating how the Internet, social media, and other factors are transforming medical relationships,” the researchers wrote, “physicians will be better able to meet their patients' health care needs in the age of enhanced patient autonomy.”

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Reference

Kilbride MK, Joffe S. The new age of patient autonomy. JAMA. 2013;320(19):1973-1974.

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