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It’s a no-brainer that patients are on the internet, and it’s not all funny cat videos, restaurant recommendations, and career-related searches. Nearly 6 in 10 use the internet to search for medical and health information , according to the CDC. That includes the majority of your patients.
“Patients often arrive having researched symptoms online or even self-diagnosed. They may cite TikTok, something they read on Facebook, or medical websites,” said Victor Ajluni, MD, assistant professor of psychiatry at Wayne State University and emergency psychiatrist at Detroit Receiving Hospital, both in Detroit, Michigan. “It’s a shift from passive reception of care to active engagement. That’s a good thing — but it requires a lot more skill and nuance on the clinician’s end.”
In fact, patients have never been as informed as they are today. But are they well informed? Or misinformed? The preponderance and availability of medical and health information is one reason patients are more vocal and more involved in their care decisions. Patients know more and, in turn, expect more from their care providers — and they’re more empowered than ever before.
However, accompanying that autonomy can be patient anxiety and uncertainty.
About Medscape Data
Medscape continually surveys physicians and other medical professionals about key practice challenges and current issues, creating high-impact analyses. For example, the Female Physician Career Tracks Report 2024 found that
- 51% of female physicians value treatment autonomy in their practice.
- 43% think a practice with a positive atmosphere is important for their patients.
Gaining Patient Autonomy on the Internet
“Patient autonomy is the principle that patients have the right to make informed choices about their own healthcare,” Ajluni told Medscape Medical News. “It’s not simply about saying ‘yes’ or ‘no’ to treatment — it’s about understanding their values, goals, and fears and empowering them to participate meaningfully in decisions about their care. True autonomy is informed, supported, and situated in a relationship of trust.”
“The historical way of practicing medicine in the 50s, 60s, and 70s was very authoritarian…but the medical establishment realized that patients do better and are more compliant when they’re involved in their medical decision-making,” said Brandon Hirsch, MD , a board-certified, dual fellowship-trained orthopedic surgeon at Disc Sports and Spine Center in Newport Beach, California, who started his practice in 2019.
“I’ve practiced this way the entire time…,” Hirsch said, adding that the psychological aspects of the patient-surgeon relationship is very important.
“My time is really spent educating the patient about what the problem is and what the options are,” said Hirsch. “I want patients to be invested in the decision because I think it leads to more satisfied patients and better outcomes. It’s something I’ve always done.”
There may also be aspects of correcting misinformation, easing anxiety, talking patients down, or convincing them they don’t have or need something that their online information has convinced them they do.
Creating More Patient Autonomy
Patient autonomy starts with building rapport. Asking open-ended questions and listening to the answers can provide insight into your patient. “For example, if the patient asks, ‘what is recovery like after surgery?’ that’s kind of vague. I’ll say, ‘tell me specifically what you mean by that,’” said Hirsch. “You really want to individualize the concepts and the answers. That goes a long way to developing shared decision-making because people like to get what they’re looking for.”
“There is an acquired skill to building rapport and getting them [patients] to trust you,” said Brian T. Garibaldi , MD, MEHP, director, Center for Bedside Medicine, and a professor of medicine at Northwestern University Feinberg School of Medicine in Chicago. “There’s no substitute to sitting down and saying, ‘tell me what’s important to you…’ or ‘what are you most concerned with?’”
While medicine has made huge advancements in diagnostic tools and treatment options, “when it comes down to navigating underneath and making decisions and helping someone navigate their health journey, the only way to help them meaningfully is to get to know them, and know where their values, goals, and preferences are,” added Hirsch. “It really does come down to making the most of your time and directing attention to who is this person as an individual, not only what is the disease and what is the disease process.”
Addressing Patient Anxiety
There can also be a downside to being well informed. “Many patients feel overwhelmed, not reassured, by what they find online. There is a lot of misinformation,” said Ajluni. “A common theme is catastrophizing — believing the worst-case scenario is the most likely…. Transparency and structure can calm that anxiety. I also name the dynamic — telling patients that anxiety tends to escalate when we try to self-diagnose from fragmented or extreme online content. A little reassurance can go a long way.
“Being dismissive is the worst thing you can do,” agreed Hirsch. “You need to validate their concerns and address them.”
Uncertainty in Medicine
Patient autonomy doesn’t mean acquiescing when a patient demands a treatment that you know to be harmful or that is against the standard of care. But in many cases, there is not one “right” option. “Even as far as we’ve advanced in the last 100 years in terms of diagnostics and treatment, there is a still a lot of uncertainty when it comes to complex medical decision-making,” said Garibaldi.
“We’ve started to talk openly about that with trainees and with patients…the only way to make a decision is to engage the patient, understand their goals and values, understand how they weigh the risks and benefits....”
“I’ve been in clinical practice, since 2000, and the more I’ve done this, the more I’ve realized there really is no best solution to a particular problem,” Garibaldi said. “There isn’t always a right answer. Make sure that when you’re making diagnoses and choosing treatment options, you remember that the ‘right’ answer depends on who the person is. And the only way to get there is by partnering with the patient.”
More and more doctors are embracing the idea that a partnership that supports patient autonomy leads to better outcomes. “Early in training, I thought clinical authority meant always having the right answer and steering patients firmly. But I’ve learned that real authority comes from humility and dialogue,” said Ajluni.
“I’d advise younger physicians to practice curiosity as much as clarity. We don’t know everything, and we certainly can’t without asking questions. Ask patients what they’ve read, what they’re worried about, what outcomes matter most to them,” he added.
“Autonomy isn’t about letting patients ‘do whatever they want’ — it’s about making decisions together in a context of respect. People are more likely to listen to medical advice if they are part of the process.”
Kelly K. James is a freelancer, content manager, and author of The Book That (Almost) Got Me Fired: How I (Barely) Survived a Year in Corporate America. She covers health/wellness, business/career, and psychology topics from her home in the Chicago suburbs.
