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Practice comment

'Too much information can be dangerous, not empowering'

Patients now self-diagnose at the click of a mouse.

I’m sure if I were to cobble together enough symptoms, start my search engine and wait breathlessly – oh, that could be another symptom – I’d probably be reassured, but still have a nagging worry that something clinically significant may have been missed.

The extent of online medical resources available to the public is vast, but the quality of the information provided varies from the potentially lifesaving to websites serving as mouthpieces for their own agendas and commercial interests. Sadly, the latter may have very little to do with robust clinical evidence, so how can we help patients to evaluate these sources?

Our consultation models rightly encourage us to explore each patient’s ideas, concerns and expectations. But I sometimes long for the old days, when patients would say “I brought you this,” meaning something as easily dealt with as a urine sample. Now, the very same phrase is usually accompanied by a flourish of two dozen pages of closely typed A4, for which I thank my patients through gritted teeth. Worse still, some have been known to ask me innumerable questions, adding their parting shot: “Thanks. That’s exactly what NHS Direct said.”

One galling issue with even the most informative, evidence-based site is that it can hypothetically wash its hands of accountability in a “this site does not claim to be a substitute for clinical judgement” sort of way. Naturally, if things should go wrong, it is hoped patients will politely refrain from suing – which is also why symptom-checking sites often suggest patients make an appointment with a clinician instead of offering blanket reassurance. This, in itself, generates the rabbit-in-headlights factor: “There must be something seriously wrong if the website has told me I need an appointment.” Many of my consultations begin with the patient’s opening gambit of “I hope you don’t mind, but I have looked this up and I probably need a blood test for…”

Of course, patients should not feel sheepish about having consulted reputable websites – that is what empowerment and autonomy are all about. And, thankfully, we are able to direct patients to some useful ones that offer up-to-date patient information leaflets. These are particularly beneficial now we are seeing more patients with long-term conditions.

However, there is a danger that when the public is bombarded with medical advice, the concept of the well-informed patient often becomes the first casualty of the very sources that are supposed to promote empowerment and the ability to self-care. Too much information can cause confusion. How many times, for instance, have patients told us that having some cholesterol in their bloodstream is very bad or that statins are dangerous? It could be that we are setting ourselves up for a climate of learnt helplessness, in which patients “know” everything but understand next to nothing. NT

Jane Warner is locum practice nurse in Somerset; and associate lecturer, general practice nursing foundation programme, University of Plymouth

Readers' comments (5)

  • I have said for a long time that the patient - care 'partnership' has gone too far. The paradigm of patient empowerment can be very dangerous, and I think it has reached the tipping point. It is important to include patients in care decisions, yes, and the RIGHT information from the RIGHT source (the emphasis on these words is very specific) can be very helpful to patients; but at the end of the day it is WE who are the professionals. I do not take my car to the garage and tell the mechanic how to do his job, or call in a plumber and proceed to fix the leaky pipe for him, telling him all the ways he is doing his job wrong in the process.

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  • Patients may be getting mixed messages. 'Take more control over your own health' versus 'leave it to the professionals'. Lets face it, we all do a bit of DIY, now and again.

    I don't think there is enough emphasis on polypharmacy these days.

    Personally, I have had to check my GP a couple of times, on a medication I have been prescibed, due to contra-indications. It was not that I am a healthcare professional, but that I read the enclosed leaflet available to all. When my mother, God rest her soul, was in hospital 10 years ago, she wouldn't have survived a further 7 years without my intervention, from a daughters point of view as well as being a nurse. None of us are infalliable, none of us know everything, and as professionals, we should be prepared for the questioning of our decisions and in some cases, they may be wrong. It is a learning curve and we shouldn't feel threatened by it.

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  • my G.P told me to go and gather information form the internet and forward it to her !

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  • Anonymous | 7-Sep-2011 9:59 am

    hopefully you also billed this to her!

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  • Anonymous | 7-Sep-2011 10:10 am HAHAHA! At bloody extortionate prices too I hope?

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