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more often than not I have to refute what their neighbor thinks is going on or someone else thinks is going on and explain why that is not the correct diagnosis. In many cases it makes the visit longer and more cumbersome.
Other physicians just seemed to accept patient-introduced eHealth information as part of their normal routine and fit it into their examination workflow.
Family Physician Five: …they all come across things on the internet. A lot of times they will like put in a symptom online and then they will come up with a gazillion kind of differentials that it could be, so sometimes they get the target and sometimes it is so way off…I will kind of push them toward what we see most prominently as far as what their symptom is and then let them know why it is probably unlikely that it is something in the “zebra” category.
Evaluation of the task structure charts, using Hierarchical Task Analysis
techniques, demonstrated that all physicians reported that they performed the same set of six subtasks during the patient examination. The subtasks performed by all physicians were (1) Enters examination room, (2) Communicates with patient, (3) References medical record, (4) Examines patient, (5) Communicates with patient and (6) Leaves examination room. (see Appendix E) The introduction of eHealth information by the patient occurred during one of the “Communicates with patient” subtasks, either at the
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beginning or the end of the examination depending upon when it was introduced by the patient.
Family Physician One: …I will acknowledge it [patient- introduced eHealth information] before I begin, I will sort of glance at it and sort of set it aside until I evaluate them and make a decision or have an idea of what I think is going on and then I will look at it more closely to see whether it coincides or whether it is different. It is generally in the discussion basically where we are reviewing findings or lab results and we will incorporate that information they brought into the equation. Sometimes it may be very useful, such as great information, in a lot of cases they bring in information that is not as useful or pertinent and we discuss that.
Family Physician Two: I think usually when people bring things in, they have got that on the forefront of their mind so I would just try to address those questions or kind of any questions towards the beginning of the exam. So I try to answer questions like any questions or key questions they come in with or any internet type questions at the
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Family Physician Five: Usually it comes at the beginning when they are kind of talking, you know about what they are coming in with, and we kind of go over what they printed out or what they found and then I say let me do your exam first and what not, but this is what I am thinking as far as what they have printed out.
Family Physician Ten: Usually toward the end of the visit, that is usually when they pull out their stuff from the internet toward the end of the visit.
The physicians who were utilizing electronic medical records systems, that included patient educational material often, printed out health information for their patients.
Family Physician Two: It is all very problem specific so I do a lot of sports medicine and orthopedics so there are hundreds of handouts for different conditions and rehab programs and that comes from a variety of settings from things that I have found from large teaching programs in the country. For basic conditions the handouts in our EMR are pretty good for a few things like diabetes, high blood pressure, cholesterol things like that. I will point them to
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specific web sites and they have many things that are on there that they can read….
Family Physician Five: …So it’s usually I like have my certain web sites that I go to so I will show the patients where to go if they have access to a computer or I will print off some stuff…I usually print it out, like as a Word
document or I will write it down for them in addition to the Word document…I have handouts that you can get to electronically on our EMR and I will print them out.
Family Physician Seven: …For me I will print out
something from familydoctor.org. For example, I will print out something on shingles and give them a printout.
Family Physician Ten: …we have a lot of stuff that we print off the internet but it is hard copy so we do not refer them to internet sites. We give them paper, no internet sites.
Other physicians referred their patients to web sites or provided brochures with links to web sites. One physician recommended web sites when they needed to counteract bad information their patients had found online.
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Family Physician One: …if they have brought in some