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Internet Access Produces Misinformed Patients: Managing the Confusion

David S. Hungerford, MD


The Internet has produced a truly phenomenal increase in access to information. This is really only helpful to patients if the information is filtered and appropriate to their specific needs. Too often patients access information about conditions they have self-diagnosed and bring it to the consultation with their physician, who then has to spend time disabusing the patients of the misinformation they have accumulated. Patients also return home from their initial consultation, access the Internet, and come up with all manner of promotional information from companies and even orthopedic practices that they want explained to them by their physician. It is the overwhelming conclusion of orthopedic specialists that this kind of Internet use is actually a burden for them in caring for patients and is not contributing to patient enlightenment. It does not have to be this way, if physicians will do just 2 things: first, create white papers for patients that address common current questions, such as surgical approach or bearing surfaces for implants and why we do what we do. This is a huge time saver and will preempt many questions. Second, develop their own website or select excellent nonprejudicial sites to which they can refer patients. To do less will invite a neverending parade of questions irrelevant to patient welfare.

The Internet is a wonderful thing. Rapid and unlimited access to information is a wonderful thing. Unfortunately, it is creating problems for orthopedic surgeons. I believe a relatively simple solution exists if you are experiencing what I am with my patients.

The quotation, the Internet changes everything, or ICE, is attributed to Bill Gates. I think that is completely true. It is hard to recall the situation 10 or 20 years ago, given the access to information that we have today. Unfortunately, unfettered access to information that patients are unprepared to interpret is producing confusion. Several typical scenarios could occur. Here are some examples: (1) The patient consults a physician, gets a diagnosis, goes home, accesses the Internet, and then returns with several questions that they think have not been answered, or worse, challenges the physician. (2) The patient checks the Internet, makes his or her own diagnosis, comes to the physician’s office armed with all kinds of information that may or may not be appropriate, and requires the physician to spend time correcting the misinformation that the patient has brought to the consultation.

Direct-to-consumer advertising in orthopedics began in 2003 with the Jack Nicklaus ceramic total hip replacement advertising campaign. The Internet advertisement that was posted in October 2003 read, “Jack Nicklaus Tees up Hip Replacement Awareness.” The campaign included print and television advertisements, the result of which led patients to call their doctors and ask, “Do you do the Jack Nicklaus hip?” This typical scenario has since repeated over and over across the country regarding several procedures or products. At first, my secretary was at a loss on how to answer because she first had to “check” with me. Finally, we realized that the patients did not have a clue and the answer to all such questions quickly became “yes.” That may seem somewhat deceptive, but more than 5 years have passed since this has been our routine, and not a single patient has complained! Patients call and ask, “Does Dr Hungerford do minimally invasive total knee replacement?” We reply, “Yes.” Patients call and ask, “Does Dr Hungerford do ceramic total hip replacements?” We reply, “Yes.” Because the patients do not understand what they are asking, the receptionist always answers, “Yes.” In the past, patients came to see us and asked us what they needed.…


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