Photo Credit: Dzmitry Dzemidovich
Patients have easy access to health information, so doctors must enhance efforts involving helping patients understand their conditions and treatment options.
The art of medicine is partnering with your patient to help use your medical knowledge and experience to apply medical information to their health and circumstances. Patients have easy access to abundant health information, which makes physician communication and patient engagement more critical than ever. This is part of why I don’t believe doctors will ever be replaced with machines; communication and trust are required to provide individualized, evidence-based patient care and engage the patient in their care.
A report issued by Eligility.com in 2019 found that 89% of Americans “Googled” their health information before seeking medical care, with most respondents reporting that they wanted to see how serious their health condition was before going to a doctor. As a result, many patients present to the doctor with a preconceived notion of what they want without context or expertise to know if it’s what they need. I’m happy when patients are engaged and invested in their health, but information needs context. According to the 2024 Commonwealth Fund report, the US ranks last in health quality but first in healthcare expense. As a result, physicians can provide evidence-based, high-quality care while being stewards of limited and expensive healthcare resources. There is robust data that more healthcare is not better and often can lead to wasted resources, cost, patient anxiety, unintended consequences, and even patient harm.
Keeping Patients Happy and Healthy
The confluence of American healthcare consumerism and an overabundance of health information often leaves doctors needing to help patients understand that what they WANT from their doctor or healthcare may differ from what they NEED. So, how do doctors navigate this situation without upsetting patients or simply unintentionally having the patient go down the street to another doctor who will order whatever the patient wants?
The first step is developing rapport with your patient, aligning with their goals, and building trust before a medical request or difficult conversation. This starts with the principles of effective communication: active listening, empathy, mutual respect, clear explanations, and checking for understanding. In the frenetic and dysfunctional healthcare system, doctors can often become overwhelmed or burned out and forgo or forget the critical importance of these foundational communication skills.
When a patient makes a request that may not be medically indicated, the first step is to acknowledge the request. Simply ignoring the request only regrades communication and trust. Secondly, ask the patient why they are requesting this test or study. The answer may surprise you and can guide and individualize the subsequent conversation. Years ago, I had a young, healthy patient who had several visits with different doctors and sent many emails, all insisting on receiving a brain MRI. Finally, I asked him why he wanted this test. It turned out his father died from brain cancer, and he was just worried. No one bothered to ask him; they provided answers and information from their perspective but never addressed his questions and concerns.
Responding to Online Information
If a patient presents with the information they found online, begin by recognizing and appreciating a patient’s effort and active participation in their health, as this can build a therapeutic alliance. Inquire about what they found and how it impacted their decision to visit the doctor or make a medical request. If possible, you can review the information together and educate others on how to evaluate the credibility of medical information online and make recommendations of sources to use in the future. You can use this opportunity to put the information they found into context with your medical expertise and how it may or may not apply to them as an individual.
Once a patient’s medical request is acknowledged and you understand why, the next step is asking permission to share your knowledge and expertise. This small but meaningful request can change the entire dynamic of a difficult conversation. It will build mutual trust and respect, which will help the patient be more open to receiving your education and recommendation. Briefly explaining reasons to forego a test while avoiding medical jargon or getting too detailed may be of benefit. More importantly, explaining medically appropriate treatment options and how a test or study may or may not change management is often the most powerful tool. The next step is to educate the patient regarding the signs or symptoms that might indicate further investigation, a return visit, or when their requested study may be medically indicated. This will empower patients to actively participate in their health, reduce anxiety, and set future expectations.
Lastly, end your conversation by reinforcing patient-physician alignment and the shared goal that you want what is best for their health and well-being. Although some patients may be persistent in their requests, continue acknowledging and reinforcing your recommendations and treatment plan. Be willing to negotiate, but do so while staying consistent.
The most frequent example I encounter in my sports medicine practice is a patient requesting a shoulder or knee MRI. After a comprehensive history and physical exam, I often tell the patient my diagnosis and recommended treatment and that I do not think an MRI is indicated. If they continue to request an MRI, I will often tell them a few things. First, ensure I understand why they want an MRI or what they are worried about. Second, an MRI will often delay treatment as many physical therapists are reluctant to treat a patient if further investigation is ongoing. Thirdly, an MRI often does not change initial management. Fourth, we can consider an MRI in the future if there is no improvement or you develop additional symptoms. Lastly, I address any specific concerns they may have. These simple steps help most patients feel empowered and engaged with the treatment plan without an MRI.
Not all the above strategies will help every patient reach a shared understanding with you, but having multiple options at your disposal can be very beneficial and individualize your approach to each patient. Physicians must practice ethical, evidence-based, high-quality medicine and sleep at night, knowing we did the right thing for our patients. Will we please and help every patient avoid unnecessary tests or studies every time? Of course not, but excellent communication and mutual respect are the most important measures of a successful patient-physician visit, regardless of the treatment.
