Digital Distrust: Patient-Centred Communication and the Calibration of Epistemic Reliance in the Era of Online Self-Diagnosis and AI Symptom Checkers

Vollständiger Abstract

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Background: Patients are coming to consultations informed by search engines, social media and generative AI. Clinicians may characterize this as distrust of clinicians. Actualities are messier, and our language for talking about how communication breaks down is limited. Purpose: Operationalize the concept of digital distrust, disambiguate it from related concepts with which it is often confused, and report a communication framework grounded in theory for clinical practice. Methods: Methodology is an interpretive conceptual integration, described per guidelines for conceptual articles and interpretive description. We performed an iterative, theory-driven integration of peer-reviewed scholarly literature from digital health, health communication, judgement and decision-making, and bioethics scholarship, interpreted by the first author’s practice-grounded understanding developed across over thirty years of clinical nursing practice. No primary data were generated or analyzed. Findings: Five themes emerged from our analysis. Pre-informed consultations are normalized. Conversational fluency is becoming dissociated from clinical credibility. Checking behavior is varied depending on information source, with conversational artificial intelligence (AI) less often double-checked than search engines. Rather than merely possessing divergent epistemic authorities, patients navigate them. Patients also hold back information to preserve the relationship. The interpersonal exchange is where trust is appraised or misappraised. Implications: We reconceptualize patients' digital distrust as an epistemic recalibration gone awry at the margins of an otherwise benign revolution in information access, rather than a generalized loss of faith in clinicians. We propose five working categories of digitally mediated stance that patients take during consultations, as well as the Digital Calibration Protocol (DCP), a four-step communication maneuver (Acknowledge – Clarify – Educate – Reframe). Conclusion: Blanket acceptance or rejection of patients' digital content is indefensible. Patient-centered communication provides a mechanism for recalibrating patients' reliance. Here, we introduce the DCP as a hypothesis-generating framework in need of empirical testing.