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The Delicate Balance Treating the Internet-Informed Patient

If it seems that every patient today has his or her own opinion of what ails them and the care they need, that's probably more fact than fiction. Technology has put information at patients' fingertips. What they do with it, and how they interpret it, is another story-one that dentists need to handle in a delicate but informed manner.
Ed Rabinowitz
PUBLISHED: Sunday, February 25, 2018
Internet, informed patient, information, overload, mobile health app, self-diagnoses, scientific literature, abstracts
There’s a huge push today for evidence-based dentistry and clinical practice guidelines that are based on a systemic approach to obtain and assess scientific evidence.
We’re living in the information age. But perhaps that's a misnomer. With literally millions of sources of digestible information, are we suffering from a bit in indigestion? Are we actually in an information overload age?
Michael Glick, DMD, is a professor at the School of Dental Medicine at the University of Buffalo, State University of New York. Four years ago he published an article in The Journal of the American Dental Association (2013 Mar;144(3):239-40) pointing out that, at the time, there were 17,000 mobile health-related apps.
Three years later the number was up to 259,000.
“That’s from 59,000 different publishers,” Glick adds. “I think there’s enough information out there for people, but what the heck are they going to do with it? And how do you figure out whether it’s right or wrong.”
And therein lies the challenge facing dentists as they service the oral health needs of today’s internet-informed patient.
It’s well documented that healthcare professionals encourage patients to become more engaged where their personal health is concerned. But as Glick explains, there are two sides to every story.
“Having a more informed patient, we can address the patient’s concerns much better because they know much more,” he says. “On the other hand, we have all these self-diagnosers today, and they challenge the dentist whose diagnosis is not the same as they found on the Internet.”
And the challenge is even more complicated than that. For example, patients may tell their dentist that they read on the Internet how cell phone use could cause tooth decay. As such, they want the dentist to treat their oral health issues that were caused by cellphone use.
How is a dentist supposed to react to that?
“The best way to react is to be scientific and say, ‘Okay, what study did you read, or did you hear it on the news, or was it a Tweet, or was it on social media?’” Glick recommends. “And until I know the source of your information that can be scientifically validated, it’s very hard to make an intervention based on what you are telling me.”
But validating scientific literature presents its own set of challenges.
Glick says doing a single-word search on “dentistry” will reveal one article published every 22 minutes. That’s a lot of information to comb through.
“I know this stuff pretty well,” Glick says. “I teach this stuff, but I have to use experts to help me understand some of this literature.”
Simply knowing the source of the information is insufficient. Glick explains that it’s also a question of how the information was obtained. Consider that the source of patient information could be a study published in the New England Journal of Medicine. But was the study done correctly? Are the conclusions accurate?
And then there’s spin, defined as “reporting practices that distort the interpretation of results and mislead readers so that results are viewed in a more favorable light”.
“More than 50 percent of abstracts of articles published in journals today have spin in them,” Glick says.
So is the problem that patients are only reading abstracts? Glick says that’s giving patients too much credit. More likely, they’ve obtained their information through some form of social media.
“They Google something, and find someone saying X, Y and Z,” Glick says. “There may be no scientific value there.”
Help may be on the way, at least from the dentist’s perspective. Glick, who is also an editor of the Journal of The American Dental Association, says there’s a huge push today for evidence-based dentistry and clinical practice guidelines that are based on a systemic approach to obtain and assess scientific evidence.
“In JADA we have a feature called clinical scans, where every month we publish 10 to 200, 500-word evidence summaries of articles published in literature,” Glick says. “There the dentist can actually get evidence without having to know how to actually gain that evidence by themselves by reading. It’s a tremendous resource that is available for dentists. So, the resources are coming.”
In the interim, Glick stresses the importance of maintaining a delicate balance when engaging patients in conversations regarding information they may have researched.
“Patients need to trust you trust their healthcare professional,” he says. “And if they lose that trust would they return to the dentist as a patient? So if I lose that trust, I may lose the patient.”

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