doctor study Archives - Lance Silverman, MD - Orthopedic Foot & Ankle Surgeon

How The Internet Is Weakening Doctor-Patient Trust

Lance Silverman, MD — Wed, 03 Dec 2025 20:47:58 +0000

Patient trust in their doctor is eroding, and the internet is to blame, according to a new study.

We all want to be able to have complete trust in the professionals we connect with on a regular basis. We want to believe that our mechanic is performing honest work at a fair price. We want to trust that our accountant is operating in our best interests and keeping legitimate records. We also want to believe that our doctor is putting our health ahead of profits. According to a recent study, that trust between patient and provider is fading, and the Internet and government turmoil may be to blame.

A new report from the University of Florida Health found that distrust of the healthcare system, including government health agencies, is seeping into the doctor-patient relationship. Interestingly, researchers noted that people with low trust in the healthcare system are six times more likely to say their interaction with a doctor worsened after they brought information from the internet to their medical visit. This correlation existed regardless of political leaning.

The internet can be a wonderful source of helpful information, but it can also be a cesspool of misinformation. When patients source information from social media, online forums, basement experts or other less-than-reputable sources and expect that information to be confirmed by a doctor, their trust in the physician can sour if the doctor disagrees with the information they bring in, said Arch Mainous, Ph.D., a professor and vice chair of research in the UF College of Medicine’s Department of Community Health and Family Medicine, and lead author of the study.

“We have treated trust in the health system or in government health agencies and their advice as being a silo different from the patient-doctor relationship,” Mainous said. “What our study shows is that distrust can infect this in-person relationship, too. And when that trust falters, it’s going to affect the delivery of health care.”

The study examined data from more than 2,500 adults who had discussed health information they had found on the internet with a medical provider in the prior year. The study noted that about 1/3 of respondents said they had “a lot” of trust in the healthcare system, and those with low trust were more likely to say their interaction with a doctor worsened after looking up medical information online. Among patients with high trust, only 3% reported that their doctor-patient relationship worsened after discussing online information with their doctor. That number ballooned to 17% for those with low healthcare trust. Low trust individuals were also significantly less likely to report that the doctor was open or respectful during the conversation.

Researchers noted that the study did not attempt to judge the accuracy of the information the patient brought in, but the simple fact is that doctors must improve their ability to have conversations with individuals who bring in outside information to their appointment, regardless of whether that information is helpful or completely false.

“They may have found an article or a testimonial that says a treatment doesn’t work,” said Mainous. “But it’s up to the doctor to say, ‘I hear you. Let’s talk through why the treatment I recommend is the best for you.’”

Dr. Silverman Comments

This truly is a fascinating study, and it’s something I’ve seen play out at times with my patients and with colleagues. Personally, I welcome when patients do some research ahead of time and try to help solve their health issues. If you’ve read this blog much at all, you know that we advocate for the involved patient. We want an involved patient who is going to put forth a strong effort to overcome their health issue, and being involved in your health means educating yourself on your condition and your treatment options. We love it when a patient comes in with information and says “This is what I found, I think it could be helpful to the issue at hand.”

Problems occur when either the patient or the provider “wall off” when information is presented. The patient needs to be open to the idea that the information they found is incorrect, or at a minimum, not the perfect fit for their unique situation. Health issues are highly individualized, and another point we’ve talked about at length is that there is rarely a one-size-fits-all solution for every situation. There may be a standard treatment plan for a specific health condition, but your unique situation may mean that the standard care routine isn’t the best option. The patient needs to be open to this real possibility that the information they bring is not right for their situation.

Similarly, doctors can’t take this early research as a personal insult to their decades of training and education. Again, we want an involved patient, but we can’t pretend that we always have all of the answers on our own. Behind the scenes, doctors are oftentimes looking up information, confirming information with medical texts or discussing patients and protocols with other medical experts to ensure the patient gets the best level of care. We should welcome the patient trying to get involved in the process and not take this research as questioning our capabilities.

Of course, there will always be instances where a patient will be truly convinced that their misinformation is the honest truth. The problem is, medical information isn’t always as easily explained like it could be in other professions. If you walked into a BMW service center driving a Toyota Camry, a mechanic can explain why this isn’t the best place to get work done on your vehicle. When a patient walks into a doctor’s office spouting falsehoods that they read online, it’s typically harder for the doctor to explain why that’s not the best treatment for the patient. Your doctor can try their hardest to explain why they are right and the internet source is wrong, but if the patient isn’t receptive to this possibility, both the patient and provider are going to lose trust in the relationship.

Patient and provider – be open to the possibility that you don’t know everything, and be willing to have a conversation about it. Everyone will be better off because of it.

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Flawed Research Attempts To Create Rift Between Doctors And Patients

Lance Silverman, MD — Fri, 15 Apr 2022 16:24:49 +0000

Recently I came across an article on Doximity, a networking site for healthcare professionals, that suggested a couple of orthopedic surgery operations may be doing patients and their pocketbooks more harm than good. Reading through the article, I was astonished by how much it misled with half-truths, and I bookmarked the piece so that I could come back and pen a blog on the subject when I had some free time.

Today, when I went to find the same article, I noticed it was no longer available on the site. Had it been removed because of professional outcry? Whatever the reason for its disappearance, I found another site that published a similar piece on how spinal fusion and knee/shoulder arthroscopy surgeries may be doing more harm than good. Below, I share my thoughts on those claims.

Spinal Fusion Surgery

While none of these procedures are commonly recommended in my office as I specialize in troubles below the knee, the data cited and recommendations for and against are so poorly presented that they will cause massive confusion for patients. It is almost as if they are claiming that surgeons do things without evidence to support. In the article, they state that surgeons oftentimes move forward with spinal fusion procedures “despite evidence that spinal fusion is not more effective than non-surgical treatments (such as an exercise program) and often results in complications.”

For the treatment of back pain, it is clear that non-surgical management is extraordinarily successful. But when non-surgical management fails and there are distinct painful conditions that correspond to both X-ray, MRI and even discogram, surgery can be highly successful and relieving. Can you imagine showing this article to a patient who has spent the last six months trying physical therapy, has significant signs of lumbar spine instability on flexion and extension radiographs, whose MRI shows significant end plate edema and has a positive discogram which correlates to the site of arthritis in the back?

Surgeons don’t just move forward with a procedure for anyone who walks in their door. Specific conditions need to be met, and months of conservative care will be pursued first because surgeons know if they can fix the problem without an operation, that is what’s best for the patient. To suggest otherwise is a disservice to patients and providers.

Next, they suggest that shoulder arthroscopy to debride inflamed or thickened bone and that knee arthroscopy for knee osteoarthritis is no better than placebo. We know that shoulder arthroscopy is performed to treat rotator cuff tears and shoulder instability, and these clear mechanical conditions can significantly benefit from an arthroscopic procedure. As for knee arthroscopy, it has been shown to successfully treat conditions such as meniscus tears with mechanical symptoms with incredible results. Again, for the right patient who has failed to find relief with conservative care, an arthroscopic procedure can get them back to the activities they love.

To suggest that these operations are harmful to the patient and a money grab by doctors is doing a huge disservice to the industry. Again, we can’t just paint with broad brushstrokes and fit one narrative to every single patient. It’s absolutely true that conservative measures like physical therapy, posture changes, weight loss, dietary changes, controlled exercise, medications and stretching routines can yield great results, but that doesn’t mean everyone will experience this type of recovery, and for these patients and those with a more severe injury, we may need to consider these surgeries that do in fact have a high rate of success for the right type of patient. Not all meniscus tears need surgery, but when specific issues are present, it can be the perfect solution if non-operative treatment fails.

It’s ironic that the article finishes by saying be wary of misinformation, because that’s exactly what they are spreading by grouping all patients with a specific condition into one category. To suggest that the right patient should not consider these procedures is borderline unethical.

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