The effect of Dr Google on doctor–patient encounters in primary care: a quantitative, observational, cross-sectional study

Noor Van Riel; Koen Auwerx; Pieterjan Debbaut; Sanne Van Hees; Birgitte Schoenmakers

doi:10.3399/bjgpopen17X100833

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Table 1. Population characteristics

Variable (n = 718)	n			%
Sex Male Female	238 480			33.15 66.85
Age Mean age, years (SD) 18–25 26–35 36–45 46–60 61–75	40	201 123 122 182 90	(15)	27.99 17.13 16.99 25.35 12.53
Education level Primary school Middle school High school College Professional	7 59 203 241 208			0.97 8.22 28.27 33.57 28.97
Frequency of internet use Monthly Weekly Daily More than once a day	1 18 237 462			0.14 2.51 33.01 64.35
Frequency of internet use to gather health information Usually not Usually Always	308 323 87			42.90 44.99 12.12
Frequency of GP consultations Never Less than once a year One to several times a year Monthly More than once a month	15 152 512 36 3			2.09 21.17 71.31 5.01 0.42

Note: Some variables may not add to 100% due to of rounding.

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Table 2. Responders’ answers to the statements: 'After my online search to gather health information …'

Statements	Never	Usually not	Usually	Always
Statements	n (%)	n (%)	n (%)	n (%)
I go to the GP (n = 630)	61 (9.68)	211 (33.49)	288 (45.71)	70 (11.11)
I do not go to the GP although this was the original plan before the search (n = 595)	248 (41.68)	265 (44.54)	78 (13.11)	4 (0.67)
I am more likely to visit the GP than I intended before the search (n = 603)	132 (21.89)	312 (51.74)	144 (23.88)	15 (2.49)
I start medication without consulting a doctor (n = 661)	467 (70.65)	151 (22.84)	40 (6.05)	3 (0.45)
I do not think I need medication although I did think this before the search (n = 546)	204 (37.36)	269 (49.27)	70 (12.82)	3 (0.55)
I am reassured (n = 601)	74 (12.31)	284 (47.25)	226 (37.60)	17 (2.83)
My worries about my symptoms increase (n = 634)	116 (18.30)	329 (51.89)	174 (27.44)	15 (2.37)
I have the feeling my symptoms got worse (n = 630)	254 (40.32)	298 (47.30)	69 (10.95)	9 (1.43)
I have the feeling my symptoms got better (n = 595)	206 (34.62)	314 (52.77)	69 (11.60)	6 (1.01)
I notice additional complaints I did not notice before the search (n = 630)	226 (35.87)	299 (47.46)	98 (15.56)	7 (1.11)
I have more confidence in my GP than before the search (n = 519)	93 (17.92)	131 (25.24)	201 (38.73)	94 (18.11)
I have less confidence in my GP than before the search (n = 596)	329 (55.20)	239 (40.10)	23 (3.86)	5 (0.84)

Note: Some variables may not add to 100% due to rounding.

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Table 3. The correlation between the independent variables and the effects of online searching: multiple regression analysis.

Variable	F	R²	Age category, b	Degree, b	Frequency of internet use, b	Frequency of internet use for health information, b	Frequency of GP visits, b
GP¹	11.42^a	0.08	0.07^b	0.02	0.09	0.01	0.39^a
Not going to the GP anymore²	4.88^b	0.04	0.03	0.01	−0.01	0.18^a	−0.12^c
More likely to go to the GP³	3.42^b	0.03	0.03	−0.05	−0.03	0.10^c	0.11
Self-medication without advice⁴	5.54^a	0.04	−0.01	0.03	0.09	0.12^b	−0.08
No medication anymore⁵	4.72^b	0.04	−0.02	−0.01	0.05	0.19^a	−0.06
Reassurance⁶	4.67^b	0.04	0.03	−0.01	−0.04	0.18^a	−0.09
Increased anxiety⁷	9.50^a	0.07	−0.06^b	0.002	0.04	0.19^a	0.22^a
Increased severity of symptoms	1.60	0.01	−0.02	−0.01	0.09	0.05	0.06
Decreased severity of symptoms⁹	2.76^c	0.02	−0.03	−0.002	−0.03	0.15^b	−0.01
Additional symptoms¹⁰	4.48^b	0.03	−0.04	0.03	0.05	0.12^b	0.15^b
More confidence in the GP¹¹	1.61	0.02	0.04	−0.03	−0.08	−0.05	0.10
Less confidence in the GP¹²	5.31^a	0.04	0.01	−0.03	0.03	0.18^a	−0.02

↵ b = regression coefficient. ^a P<0.0001. ^b P<0.01. ^a P<0.05.
Statements 'After my online search for health information …':
↵ ¹ I go to the GP
↵ ² I do not go to the GP although this was the original plan before the search.
↵ ³ I am more likely to visit the GP than I intended before the search.
↵ ⁴ I start medication without consulting a doctor.
↵ ⁵ I do not think I need medication although I did think this before the search.
↵ ⁶ I am reassured.
↵ ⁷ My worries about my symptoms increase.
⁸ I have the feeling my symptoms got better.
↵ ⁹ I have the feeling my symptoms got worse.
↵ ¹⁰ I notice additional complaints I did not notice before the search.
↵ ¹¹ I have more confidence in my GP than before the search.
↵ ¹² I have less confidence in my GP than before the search.

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Table 4. Statements discussed with the GPs. A: statement based on the descriptive analysis of the survey’s results, B: adjusted statement based on the first four conversations with GPs

Statement 1
A. Most of my patients do not start self-medicating after their online search to gather health information.
B. Most of my patients do not start self-medicating after their online search to gather health information. If they do so, they do it mainly when they have benign symptoms or on the advice of significant others.

Statement 2
A. The online search for health information does not influence the confidence of the patient in their GP.
B. The online search for health information does not influence the confidence of the patient in their GP.

Statement 3
A. The online search for health information does not make my patients experience additional symptoms.
B. The online search for health information does not make my patients experience additional symptoms. Some people will be more likely to do so, such as patients in their 20s and 30s and patients with tendencies toward hypochondria.

Statement 4
A. The online search for health information does not influence the severity of my patient’s symptoms.
B. The online search for health information does not influence the severity of my patient’s symptoms.

Statement 5
A. I do not have the feeling that the online search for health information makes my patients more anxious.
B. I do not have the feeling that the online search for health information makes my patients more anxious, although naturally anxious people often become more anxious after the search. Moreover, this is probably the group of patients that searches the most on the internet for health information.

Statement 6
A. If I know that my patient searched online to gather health information, this will complicate the consultation.
B. If I know that my patient searched online to gather health information, this will not influence the consultation in a negative way. First of all, there is the possibility that we will come together to a broader differential diagnosis. Secondly, I can easily respond to the patient’s ideas, concerns, and expectations and patients will hesitate less to ask for specific diagnostic tests. This can lead to an interesting dialogue.

Statement 7
A. If patients tell me about the information they found on the internet, I can discuss this during the assessment and plan. For example, I can give them websites where they can find health information in the future.
B. If patients tell me about the information they found on the internet, I will put that information in perspective. For example, I can give them websites where they can find health information in the future.