A sharing by Cheong Pak Yean
Once, a patient consulted because he feared he had leukaemia. In truth, his weight loss was because he had not taken his diabetes medication as prescribed. Both his fear and non-adherence resulted from misconceptions gleaned from surfing the internet. After a dialogue during which his ideas and fears were voiced and addressed, he agreed to start taking his medications again.
A second patient had high LDL-cholesterol, unresponsive to lifestyle and dietary changes. He steadfastly declined statin therapy because of fear of potential side effects, again resulting from online research. When the doctor explored his ideas, he turned combative and declared, I am the expert!
Commentary
The doctor-patient relationship is built upon a traditional information asymmetry. The doctor has relevant information that the patient lacks. Out of this asymmetry, professional and governance ethics dictate that the doctor makes decisions in his patient’s best interests.
The internet has changed this. The World Wide Web, freely accessible, can dramatically increase the amount of health information the patient is exposed to. At the same time, if the information that is trawled is not relevant or contextualised, the therapeutic relationship can be disrupted.
Knowledge is power. Does more information equal more power? Unbridled information from the internet has given some patients a false sense that the information asymmetry has now shifted in their favour. A faux literacy is born, untempered by professional discernment or emotional detachment.
The drawings tell us that to some patients, their doctor takes third place to Google and their friends. To remain therapeutic in such consultations, doctors need skills to handle this new ‘information symmetry’.
———A/Prof Cheong Pak Yean
Dr Cheong Pak Yean is a family and internal medicine physician who is also a psychotherapist in private practice. He teaches undergraduates and has an interest in medical humanism and communication, and is a past president of the College of Family Physicians as well as the Singapore Medical Association.
The commentary and vignette were reproduced with permission from the book ‘Being Human, Stories from Family Medicine’ edited by Cheong Pak Yean and Ong Chooi Peng and published in 2021 by the College of Family Physicians Singapore.
Pictures of illness experiences were drawn by NUS medical students in workshops conducted from 2012-2017 by A/Prof Cheong Pak Yean. Senior family physicians subsequently shared vignettes and commentaries based on the pictures.
