Today’s over-informed patient is different. Earlier, such clinical encounters were rare and the information shared by the parent used to be trivial. But now, parents are better educated and have more access to the right information. In a sense, this phenomenon is a new trend, and unless we understand it and learn to deal with it, we will continue to be flummoxed by it.

In a recent article [1], Karnam and Raghavendra provide a matrix of four ‘informed patient’ types: (i) completely informed patient, (ii) misguided patient, (iii) confused patient, and (iv) misinformed patient. The distinction is made on the basis of authenticity and relevance of the patient’s knowledge.

The birth of the present-day over-informed patient is largely due to globalization and digital revolution that swept the world in past decade. In this scenario, there is a tsunami of information from various sources. The internet has made information easily available to all. Advances in mobile technology and tools like WhatsApp have further changed the dynamics of information-sharing. A sense of empowerment can be sensed among the people. Each patient who walks through our door requires and expects information from us in order to understand what has gone wrong with him, how we intend to help, and what can be done to accelerate healing. Many patients, before they consult us, consult ‘Dr. Google’. In February 2017, Google Australia launched a new function in their search results to help people get the ‘right’ information when they are sick [2]. According to Google, one in 20 searches on this platform is health-related. Google’s new health cards include facts vetted by a team of medical doctors, the company says, and adds: "each fact has been checked by a panel of at least ten medical doctors at Google and the Mayo Clinic for accuracy." Under this program, Google search results will show information for over 900 common health conditions. The new health feature includes an outline of the condition, symptoms, diagnosis, and prevalence according to age at the top of search results. Of course, all this comes with a disclaimer: "what we present is intended for informational purposes only – and you should always consult a healthcare professional if you have a medical concern." A survey on more than 3000 adults in US revealed that one in three adults (and almost half of college-educated adults) turn to the internet as a diagnostic tool for themselves or someone else [3].

Now let’s take a converse view and look at things from the standpoint of the genesis of our profession. There was a generation of doctors that were looked upon to be Gods. In those days, doctors even withheld certain information about diagnosis, prognosis or treatment options. The present generation is beginning to realize that doctors are not Gods; rather they are only skilled professionals. So there is a huge paradigm shift for the doctors and the patients alike. The tribe of paternalistic doctors has declined over the years because of legal and cultural changes, but it has not entirely opened the door to the doctor who interacts with the patient.

When presented with a patient who has educated himself about his condition, do we cringe or grin? It may be difficult to work with some (over) informed patients but it would be a mistake to ignore this emerging trend; and if done, we would only end up as the proverbial ostrich with its head buried in the sand to escape attention. It is a wake-up call.

We are now in this thought-provoking transitional phase between a doctor as God, and a doctor as another skilled professional. The doctors are waking up to a rude reality that one needs to be updated or soon one will be outdated. Sustained performance is the buzzwords in any profession, and doctors are no exception to this global trend.

Encountering an over-informed patient is always a challenge to the clinical team. Sometimes it is also tormenting to the clinician. They ask too many questions and second-guess decisions. They want explanations and valid justifications, and not just plain reasons. We see them come armed with papers they have downloaded from the internet. Once you provide some information, they challenge you, and some come looking for an argument. Many entertain false hopes and wrong expectations, some of which we as clinicians are obligated to correct. Fortunately, such extreme instances are uncommon.

On the whole, the educated patients are generally receptive for the efforts made by the clinicians to tell them the right information. Many are quite amenable to learning new things and discarding their misguided ideas as you walk them through current trends and new information. The clinician in particular should encourage the educated patient even in the early vibe-setting days of the therapeutic relationship. If a patient thoroughly understands his/her diagnosis, treatment and prognosis, it becomes easier for the clinician to discuss various viable options with the patient.

Improperly educated patients are a real peril to the doctor, as the doctor might be creating a misinformed patient who does not know that he does not know. A doctor who does not or cannot take the time to correct a patient’s misconceptions about a disease or its treatment options could find that the patient does not trust the doctor’s judgment or skills. The doctor might later find that the patient may have posted negative online reviews based on scattered misinformation. In the extreme, the fall from bad information to mistrust to perceived poor performance could tumble into the abyss of medical malpractice.

The difficulty of the doctors is that they do not actually get trained to educate people. Few do not like to share their level of education, literacy or health literacy. This apart, the biggest factor for the doctor is ‘time’. There is no systematic infrastructure within a practice to make time for patient education. Financial disincentive and a lack of training impair a doctor’s ability to educate. Also my experience is that there are varying degrees of expertise, comfort, interest, passion and personal involvement of the doctors in spending time communicating with patients. Some are naturally good at it and others or not.

Let us also not shy away from the fact that we too are responsible for giving birth to mistrust. Of late, ongoing conflicts and controversies in our professional organizations have spilled out into the media. When the public reads about such issues, they develop a negative view of doctors in general. Furthermore they become suspicious of the entire profession regardless of whether the matters reported in the media are true or not.

As well-informed patients tip the balance of control towards themselves, doctors have found themselves playing a new role – that of a trusted partner. This new kind of relationship is evolving into a symbiotic partnership where patients are educated and get involved in decision-making. Sharing of decisions spreads the responsibility for the outcome, and it is now no more the mundane positive or negative. There are some simple tips to be followed to strike a partnership with the patient.

The advantages are that:

Empower patient in partnership with your whole team – your team colleagues in the specialty, anesthetists, secretary, nursing- and hospital-staff. Everyone needs to speak one lingo and have one focus. Training needs to be inculcated on how to have conversations from the morning weather to the emerging trends in medical practice based on the specific needs and situation.

What makes the entry of social networking into medicine so interesting is that many clinicians are perceived as being resistant to incorporating this tool and altering the status quo. Platforms such as Twitter and Facebook provide a wide medium in which patients can record their immediate symptoms and concerns. Furthermore, some doctors are using these same platforms not only to provide moral support to their patients, but also to educate patients by directing them to valid sources of information on diseases and treatment.

We have now grown global. The way forward in today’s world is through integrating social media and imbibing strategic management practices in our fields of expertise. Clearly, the power of social media as a tool for medical education and communication is only just beginning to show. Using social media to connect with the patients, one can provide practical health information and dispel myths. As Karnam and Raghavendra [1] observed: "there is a need for doctors to help create more informed patients to increase the reach of the doctors in the virtual world and at the same time maintain the sanctity of the medical information available. The doctors will therefore, have to transform themselves into what we call as Hybrid Doctors, where they are available both in physical and virtual world lending their experiences to drive proper decision making."

Doctors these days need to integrate many business skills within their medical practice. The most successful doctors of the future are likely to be those who have effectively mastered social media and integrated this into their medical practice. We are now moving in to process and process controls just as how business managers do it.

So, are we ready to shift gears and switch orbits? It’s time to open our eyes, ears and minds to train ourselves to educate the ever increasing population of ‘information-seeking patients’. My prescription to all professionals is this: Stay informed, Keep abreast and Learn to learn; remembering George Bernard Shaw’s eternal words, "those who cannot change their minds cannot change anything."

1. Karnam S, Raghavendra P. Hybrid doctors: the need risen from informed patients. J Clin Diagn Res. 2017;2:Z101-4.

2. TripleJHack. Dr Google will see you now: Google launches self-diagnosis search. Available from: http://www.abc. net.au/triplej/programs/hack/dr-google-will-see-you-now/8229078#main-content. Accessed April 16, 2018.