There is no doubt the internet is one of the most powerful methods to gain information. For the surgeon or the patient, the available information is completely overwhelming and makes sensible interpretation difficult, if not impossible.
The credibility of the sites and the information is not always clear. Patients are often desperate to find the cure or unorthodox approach and travel through endless documents until they find someone in cyber space who tells them what they want to hear.
It is not surprising, therefore, that patients frequently come to see surgeons with hundreds of pages of useless, poorly researched information, even advertising downloads, wanting the surgeon to spend hours explaining to them the pros, cons and deceptions they have read. If this was done for all patients, only a handful of new cases could ever be seen in a day and a great deal of time would be wasted.
There is a clear obligation and expectation that the surgeon will explain the options available, respond to appropriate enquiries and tailor the advice to the patient. Alternative, untested, unproven options are not part of modern surgical practice.
Surgeons in Australian public hospitals are usually overwhelmed by waiting lists of patients needing to be seen and treated. They spend much of their time trying to stay up-to-date with the latest literature, attend meetings, discuss concepts, ideas and views with colleagues. If there was a new treatment that needed assessment, then they mount a study to ethically inform patients and report the results, good or bad.
Having expressed my concern for unassessed internet information, I am not suggesting that patients should not question and challenge their surgeons: Why this approach? Are there other legitimate options? Could it be treated differently? Why doesn’t the new provide better outcomes?
These questions should and must be addressed in advising the patient in the surgical consultation. Indeed, on occasions such a probing set of questions raises another series of options that can be considered, discussed and sometimes adopted. If the best outcome is to be achieved, the patient with the surgeon should have a shared understanding of the risks, benefits and options of any surgical intervention and, indeed, non-surgical intervention. While surgery has risks so, too, does failing to intervene.
“Alternative, untested, unproven options are not part of modern surgical practice.”
Except in spinal surgery. And orthopaedics. In fact, pretty much every area of medicine and surgery has their collection of treatments that are unproven, or at very least, inadequately proven. The statement above is a nice claim, but doesn’t actually match what happens in practice. For conventional medicine to take the high moral ground we need to demand a higher standard of evidence and remove some of the blatant conflicts of interest.
“If the best outcome is to be achieved, the patient with the surgeon should have a shared understanding of the risks, benefits and options of any surgical intervention and, indeed, non-surgical intervention.”
I totally agree. Unfortunately it’s almost unheard of for patients to be consented by the surgeon performing the operation, and in fact most patients in most hospitals I have worked have the consent done by a junior member of staff on the day of surgery, if not while they’re in the theatre waiting bay. It’s one thing to have to deal with a deluge of information and misinformation from the internet. It’s another thing entirely to fail to provide basic information to patients to enable any kind of informed choice.
I have to concur with the comment above. In the doctor patient relationship traditionally all the power has been in the doctors’ hands. The doctor has all the knowledge about the illness, the possible treatments and the likely outcome. The patient’s understanding of their illness has come almost completely from this source.
At long last the internet is beginning to address this problem and doctors do not like it. Professor Maddern’s complaints about the amount of mumbo jumbo on the net is justified but at least it gives the patient a starting point to challenge the doctor’s advice. For any doctor to claim that this is unwarranted flies in the face of the number of unnecessary deaths in hospital.
As an ICU nurse for 20 years I have been involved in caring for patients whose lives were on the line because of some surgeon’s stuff up or pushing their luck with someone else’s life. Doctors and surgeons need to be challenged far more than they presently are and if the internet is encouraging patients to do this then thank god because it is about time.
The real issue I see here is that patients are often being duped by Internet searches into believing what they read is fact and not an advertisement for a drug company or a device or a particular technique.
Try an Internet search for the Da Vinci Robot and all you see are the wonders of this technique, flashy websites and outrageous claims of superiority of this technique, with unsubstantiated claims about the inferiority of the other treatments of prostate cancer. The Mayo Clinic has produced papers stating the gold standard remains the open technique. No where is there any real ability for the average Joe to find out the facts. It is up to the doctors to listen and reason with patients, explain the pros and cons of different techniques for each individual.
I must admit in spite of that people do believe it if it’s on the ‘net.
My favorite line..”If i put myself on the Internet as the best doctor ever, would you believe that?”