LAUSR

We were delighted to see Masters’ paper on preparing students for the e-patient (Masters 2017). To date this has been an almost bizarrely neglected part of medical school curricula. Patient-centered medicine and shared decisionmaking simply require the clinician to understand patients’ values, concerns, and understanding. Eliciting information about what patients have learned or sought to learn from the internet is an essential part of this. Masters describes how informed patients may be classified as “problem patients” who cause an unwelcome disruption to the flow of work. In fact, this description covers the two quite specific reasons why doctors respond negatively; shortage of time and defensiveness (Roper and Jorm 2017). The former relates to the time needed to assess the accuracy of patient-sourced information and then provide an alternative authoritative source if necessary. Defensiveness is understandable, any doctor can be “blindsided” by something authoritative published in the last week. Masters provides a list of elements that need to be taught to future doctors, and we propose the use of the theory of planned behavior (Ajzen 2011) to create a comprehensive educational approach that includes such elements (Roper and Jorm 2017). Otherwise, it is hard to make a start or prioritize all the aspects mentioned by Masters. The theory of planned behavior considers three aspects fundamental to behavior change: subjective norms, attitude towards a behavior and perceived power. Surfacing students’ subjective norms involves understanding and addressing the hidden curriculum that exists around the e-patient. Primary care attachments provide the best place to do this. Surveys can uncover student attitudes and roleplay and ethics teaching can encourage reflection. Finally, and most importantly students need greater perceived power in working with the e-patient. If students develop ninja-like health information literacy skills they can quickly and impressively source information in front of the patient. Work flow is then no longer disrupted. Perceived power also requires students to practice the communication skills required to manage challenges to their knowledge base, so that they are not defensive. Educators are well placed to use formative and summative assessment (including OSCEs) to ensure all students graduate with a level of competence in managing e-patients. This tripartite approach offers promise to support the changes needed – so that sarcasm toward patients’ use of Dr. Google ends and the e-patient is welcomed into the consulting room.