"This must be true—I read about it on the Internet"

Patients get their medical information from many sources—some reliable (like the CDC Web site), some of uncertain dependability (the local TV news), and some probably downright dangerous (a brother-in-law). Given the multiplicity of sources, and especially the explosion of medical information found on the Internet, we cannot be surprised when our patients are confused.

Patient education is a crucial aspect of what PAs provide, and we all should know where our patients are getting their information and should do our own research to determine and recommend the most reliable and appropriate sources. Equally important, we should know what type of information our patients can understand. This helps us to narrow their options for them and prevents us from being confronted with misinformed patients who believe that just because they read something on the Internet, it must be true.

In a survey of patients in a primary care internal medicine private practice, 53.5% (274 of 512 respondents) stated that they used the Internet for medical information on a broad range of topics.¹ Sixty percent felt that the information on the Web was the “same as” or “better than” information from their doctors. Yet, of those using the Internet for health information, 59% did not discuss this information with their doctor.

A survey conducted by the Pew Internet Project in May 2008 confirmed that information gathering has become a habit for many Americans, particularly those in the 55% of households with a high-speed Internet connection.² Referring to Internet users who looked online for health information as e-patients, the report found that those with a chronic condition or disability were more likely than other e-patients to report that their online searches affected treatment decisions, their interactions with doctors, and their ability to cope with their condition. In terms of demographics, the primary care survey found that those using the Internet for medical information were significantly more educated and had higher incomes.¹ The Pew report established that gender, education level, and age younger than 60 years did not affect whether patients shared their Web searches with their physicians.²

One important variable that influences patients' understanding of health information that they find on the Internet is their reading skills. A study of the readability levels of patient education materials on the Web found that, on average, the information was written at approximately a 10th grade reading level, a level too high for the majority of patients to understand.³

As busy practitioners, we may find it difficult in the realtime clinical setting to identify which patient is accessing what information from where and whether the patient understands it and is telling us about it. How should we tackle this problem?

One approach is to start by asking what the patient already knows. This question-and-answer conversation will vary depending on the practice setting and the circumstances of the visit, but you will be better able to assess what information needs to be provided once you know what information the patient already has and where it has been obtained. This process of identifying what the patient knows should be the first step in discarding false or misleading information and reviewing the validity and accuracy of information sources. You and your patient then begin on a level playing field.

Second, determine what the patient needs to know and what education materials you already have available as pamphlets or other preprinted handouts. Are the pamphlets and handouts written at a reading level appropriate for the patient?

JAAPA has its own patient education department, When the Patient Asks, consisting of two pages printed back to back. The first page is for the PA and provides a brief review of the topic in question. The second page is for the patient, provides educational information in a question-and-answer format, and is written at a 5th- to 6th-grade reading level.

Finally, develop a short list of reliable Internet sites, divided into categories based on content and the literacy level of the patient you are seeing. Are there particular diseaserelated sites that have understandable information that can be printed for patient use?

Education materials are not substitutes for our conversations with patients but should, instead, work synergistically. Trust your common sense and your own research to help you sort out the accurate and readable from the erroneous and confusing. The cautionary saying, “If something seems too good to be true, it probably is” is still good advice, for both you and your patients. JAAPA

REFERENCES

1. Diaz JA, Griffith RA, Ng JJ, et al. Patients' use of the internet for medical information. J Gen Intern Med. 2002;17(3):180–185.

2. 61% of American adults look online for health information. Pew Internet and American Life Project. Press release. http://www.pewinternet.org/Press-Releases/2009/The-Social-Life-of-Health-Information.aspx. June 11, 2009. Accessed September 14, 2009.

3. Graber MA, Roller CM, Kaeble B. Readability levels of patient education materials on the world wide web. J Fam Pract. 1999;48(1):58-61.