Feature Essay

E-patients hold key to the future of healthcare

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k846 (Published 26 February 2018) Cite this as: BMJ 2018;360:k846

The downside of being an E-patient: Sometimes ignorance is bliss

Knowledgeable patients who understand the complexities of clinical medicine greatly enhance the quality of their medical management. [1].

But not all patients are able to distinguish sources of reliable information from the ill-informed and sometimes downright fraudulent information on the web. A small minority of patients end up in the hands of charlatans providing so called alternative therapies.[2].

Furthermore , possessing accurate information is not without side effects either. Similar to a placebo/nocebo response, expectations can influence side effects from a treatment.[3]. For example, cancer patients who expect to experience a given side-effect are indeed more likely to experience the side effect. A meta-analysis of the relationship between response expectancies and cancer treatment-related side effects shows the relationship was significantly stronger for pain. [4].

Physicians and E-patients also need to be aware that emotional distress caused by diagnosis of a serious illness such as cancer can influence patient judgement. For instance, men who were more emotionally distressed at diagnosis were found to more likely to choose potentially unnecessary surgery for prostate cancer.[5].

Before triggering the torrent of information at the mere tap of a touch screen, it is worth noting that "sometimes ignorance is bliss".

References
1 Riggare S. E-patients hold key to the future of healthcare. BMJ 2018;360:k846.

2 Murdoch B, Zarzeczny A, Caulfield T. Exploiting science? A systematic analysis of complementary and alternative medicine clinic websites’ marketing of stem cell therapies. BMJ Open 2018;8:e019414. doi:10.1136/bmjopen-2017-019414.

3 Bishop FL, Coghlan B, Geraghty AW, et al. What techniques might be used to harness placebo effects in non-malignant pain? A literature review and survey to develop a taxonomy. BMJ Open 2017;7:e015516. doi:10.1136/bmjopen-2016-015516.

4 Sohl SJ, Schnur JB, Montgomery GH. A meta-analysis of the relationship between response expectancies and cancer treatment-related side effects. J Pain Symptom Manage 2009;38:775–84. doi:10.1016/j.jpainsymman.2009.01.008.

5 Orom H, Underwood W, Biddle C. Emotional Distress Increases the Likelihood of Undergoing Surgery among Men with Localized Prostate Cancer. J Urol 2017;197:350–5. doi:10.1016/j.juro.2016.08.007

Competing interests: No competing interests

04 March 2018
Santhanam Sundar
Consultant Oncologist
Nottingham University Hospitals NHS Trust