Internet access has become much more widely available in the last decade. In 2007, 55% of European Union households had internet access; by 2020, this had increased to 91% [1
]. Against this background, the internet has become an indispensable part of people’s lives by providing, amongst other things, greater access to information and knowledge transfer. Veterinary medicine is also affected by these developments, as animal owners have the opportunity to learn more about pet health issues through unlimited access to veterinary medical information based on various internet resources including blogs, social media channels, veterinary associations, or practice websites. As owners become better informed, this will likely impact how they engage in dialogue with their veterinarian and can influence the decision making around diagnostic and therapeutic interventions.
In relation to this, Kogan and colleagues surveyed UK pet owners and found that there had been an increase in owners’ use of internet resources to obtain medical information [2
]. Similarly, a survey among US pet owners conducted by the coalition Partners for Healthy Pets indicated that the percentage of pet owners searching for medical information on the internet due to their animal being sick or injured increased from 39% to 48% between 2010 and 2014 [3
While clients’ interests in seeking medical information can be viewed as a positive development potentially improving their knowledge and understanding of patient care, other studies have shown that veterinarians are also concerned about the potential negative effects [2
]. For example, online resources can distribute incorrect information; conversely, correct information can be misinterpreted by owners. The use of online resources may also inspire clients to try to treat their pets themselves, or to delay taking them to the veterinarian, thereby causing them harm. This has been highlighted in an Austrian focus group study among small animal veterinarians, who were increasingly confronted with clients who had misdiagnosed their pets based on information found online [8
In addition, veterinarians increasingly experience situations where clients challenge their medical advice based on information they have obtained from the internet [3
]. Niedziela published a statement with the title “British Vets Forced to Compete With ‘Dr. Google’” in which he reported that “nearly all British veterinarians say their clients’ behaviour was swayed by what the pet owners found online.” [3
] As a consequence, veterinarians may increasingly have to compete with ‘Dr. Google’ [3
] and hence may feel challenged in their professional authority.
Clients’ use of the internet to obtain medical information as well as information about specific veterinary services will undoubtedly increase [2
]. Previous empirical studies have mainly focused on potential problems in relation to clients’ use of internet resources, and little is currently known about the potential benefits. The possible positive effects of clients becoming better informed include improved dialogue and understanding of their pets’ condition, as well as a greater acceptance of appropriate advanced diagnostic and treatment options.
Although a general increase in the use of internet resources can be seen in all European Union households, national differences exist that might influence the use of the internet in the veterinary context. For instance, in 2020, in the UK and Denmark, 94% of the population used the internet on a daily basis [10
], in contrast to only 75% of the population in Austria [12
]. It is likely that these differences will be reflected in the percentage of clients who use the internet to search for medical information, and the frequency with which clients question veterinarians’ advice. They may also impact veterinarians’ attitudes towards ‘Dr. Google’, both positively and negatively.
Further, it can be assumed that veterinarians’ attitudes will not only be influenced by socio-demographic and practice-specific factors such as age, employment status (self-employed versus employed), or the type of practice (independently owned versus corporate-owned), but potentially also by any previous negative experiences with clients who come to the practice with information they have obtained from the internet.
Therefore, the main aim of this study was to answer the following research questions: (i) What percentage of their clients do veterinarians estimate use internet resources to find medical information prior to consultation? (ii) How often do clients question veterinarians’ professional medical advice based on information obtained from the internet? (iii) What are veterinarians’ attitudes towards their clients’ use of internet resources, and what influences these attitudes? Throughout, we highlight the main similarities and differences between veterinarians in the three countries.
The results of this comparative study show that veterinarians in all three countries gave a similar estimate of the number of clients that consult the internet prior to a consultation with their veterinarian. Approximately half of the Austrian, Danish, and UK respondents estimated that between 40–79% of their clients used the internet. As there is a less frequent use of the internet in Austria in general [10
], we expected that Austrian veterinarians might indicate that a lower percentage of their clients make use of internet resources compared to their Danish and UK colleagues, but this was not the case. A possible explanation for this might be that animal owners are specifically motivated to look for information about their animal’s treatment, irrespective of their general daily use of the internet.
This would seem to be supported by the results of Kogan and colleagues [2
], who found that 94% of surveyed US animal owners used the internet to find medical information, although at the time of data collection (2009), it was estimated that only 76% of American adults in general used the internet [19
]. Interestingly, even though a study among UK veterinarians indicated that, compared with our study results, more veterinarians (68%) believed that 41–80% of their clients used the internet to look for health information about their animal [5
], veterinarians’ estimates in both studies are clearly lower than the proportion of owners that have been found to use internet resources. For example, in a US study, 94% of the surveyed animal owners indicated that they used the internet to find medical information [2
]. This difference may be explained by the fact that not all clients necessarily tell their veterinarian that they have consulted the internet for information. This would seem to be the case based on Kogan and colleagues [5
], who reported that only 15% of the surveyed UK veterinarians think that the majority (61–100%) of clients discuss the animal health information obtained online with their veterinarian. Therefore, we recommend that future studies attempt to identify the actual number of animal owners who make use of the internet in the veterinary context.
If we now consider why clients might use the internet to seek information on their animals’ care, Kogan and colleagues proposed two main reasons: firstly, animal owners may wish to be more informed or seek clarification following a discussion with the veterinarian [2
]. Second, they may not believe or may disagree with the information provided by the veterinarian [2
]. In the latter case, this can lead to veterinarians being confronted by clients who question their professional advice. Thus, a further aim of our study was to identify how often veterinarians are confronted with clients who question their medical advice based on information they have obtained online. We found that 70–78% of Austrian, Danish, and UK respondents ‘occasionally’ found themselves in such a situation. However, significantly more UK and Danish veterinarians stated that they are ‘frequently’ confronted by clients who question their medical advice compared to their Austrian colleagues. A possible explanation for the observed differences could be that Austrian veterinarians may be underestimating the number of clients who challenge them with information that has been obtained online. However, a more likely explanation is that many more relevant or informative websites were available to clients in the UK and Denmark, which may have led to a higher frequency of UK and Danish clients questioning the veterinarians’ advice. Finally, it may be the case that Austrian animal owners wish to be better informed and prepared for veterinary consultations, but simply choose not to subsequently question their veterinarians’ advice. Although consultations in which clients question veterinarians’ medical advice may be experienced as being rather challenging, it is important that veterinarians do not discourage clients from asking questions, irrespective of the source of the information. Only through such open discussion can clients’ concerns be acknowledged, and a situation of shared-decision making be encouraged, rather than one in which the client feels pressured to accept the veterinarians’ advice.
However, there is no doubt that when clients question their veterinarians’ medical advice, it can affect their relationship. In a survey of 100 veterinarians in the UK, Kogan and colleagues reported that 54% of respondents felt that clients’ use of the internet negatively impacted the relationship, and only 35% said that it had a positive effect [5
]. In addition, 40% of veterinarians thought that clients obtaining medical information from the internet had a negative impact on the health of the patient, 37% thought it had a positive effect, and 23% stated it had no effect [5
]. In this context, a further aim of our study was to gain more detailed insights into veterinarians’ attitudes towards the potential positive and negative effects of clients’ use of internet resources.
If we first consider the possible positive effects, we assumed that the use of internet resources would improve discussions between veterinarians and clients about diagnostic and treatment options, as the clients would be better informed. We found that Austrian veterinarians significantly more often disagreed with this than their Danish or UK colleagues. This might be explained by the findings of Springer and colleagues, who reported that Austrian small animal veterinarians indicated that clients’ ability to understand medical issues during the consultation dialogue varied widely, and that there is a need to deal flexibly with clients [8
]. Yet, we would expect this to apply equally across countries, as the ability of clients to understand medical information varies greatly, irrespective of whether that information is provided by the veterinarian or independently sourced online. In the latter case, client understanding can be complicated if the information obtained online is erroneous, or if valid information is misinterpreted. This is supported by Kogan and colleagues, who identified that 73% of their surveyed veterinarians believed that few (i.e., 0 to 40%) of their clients understood what they read online [5
]. If this concern is shared more widely, it could explain why respondents from all three countries mainly disagreed that clients’ use of the internet leads to the clients being better informed than the veterinarian. Therefore, further work is required to examine the quality of existing online resources, how clients access them, and whether this varies between countries.
In addition to improving dialogue, we had also expected that clients’ use of internet resources might increase their acceptance of advanced diagnostic and treatments options. In general, veterinarians from all three countries tended to agree with this positive effect. Interestingly, Austrian and UK veterinarians who indicated that their medical advice is never questioned by clients were more likely to agree with this statement compared to colleagues who are frequently or always questioned by their clients. This is not surprising, as it can be assumed that veterinarians who are often challenged based on online information might feel this outweighs any benefits from clients’ greater acceptance of advanced treatments. Despite the overall agreement, we identified that one quarter of the respondents had a rather neutral stance, indicating neither a clear agreement nor disagreement towards this statement. A possible explanation, based on the work by Kogan and colleagues, is that while some owners might feel eager, confident, or reassured by the information they obtain online, the amount of available information can also be frustrating, confusing, or even overwhelming for others [2
]. This can lead to the uncertainty of the clients, rather than an increased willingness to accept the advanced diagnostics and treatments suggested by their veterinarians. Further, clients need to be able to understand and critically review the information that is available online in order to use it to appropriately inform their decisions, and the ability to do so will vary with their background and educational level. For example, Kogan and colleagues found that clients with at least some college education were more likely to visit recommended websites compared to clients with a high school diploma or general educational development, which might result in a greater acceptance of advanced treatments [6
Further, our study revealed some differences between male and female respondents. For example, female veterinarians from the UK were more likely to agree that clients’ use of internet resources improves discussions about diagnostic and treatment options, as the clients are more knowledgeable. Recent research on the differences between women and men related to the use of internet resources in a veterinary context mainly focusses on the clients’ perspectives [2
]. To the best of the authors’ knowledge, no comparable data exist investigating potential gender differences based on studies of veterinarians. However, in the human medical field, a survey of Dutch rheumatologists and oncologists by Uden-Kraan and colleagues reported that female physicians more often experience patients raising information they have obtained from the internet during a consultation compared to their male colleagues [20
]. Based on that, Uden-Kraan and colleagues concluded that female physicians might be considered more approachable by patients and more open to the use of internet resources [20
], which can improve discussion during a consultation. This might also be the case in the veterinary context, as in general, female veterinarians were more likely to agree that internet knowledge improved discussions with their clients.
However, as previously described, Kogan and colleagues identified that veterinarians thought that the use of the internet also had a negative impact on the relationship between the client and the veterinarian, as well as on the health status of the patient [5
]. In addition, the results of an Austrian focus group study among small animal veterinarians highlighted professionals’ concerns about increasing client expectations in regard to advanced technology in diagnosis and treatment, as well as about the increasing use of social media platforms to exchange with other clients via the internet [8
]. The results of our study support this, with veterinarians from all three countries agreeing that the use of internet resources increased client expectations regarding advanced diagnostics and treatments. While a certain level of expectation on the clients’ side can be beneficial when it comes to dialogue about the use of advanced diagnostic tests or treatments during patient care, it can be challenging when clients’ expectations differ significantly from those of the veterinarian, or from the patients’ best interests [8
]. This was highlighted in our study, where UK veterinarians who thought that internet resources had a strong impact on clients’ desire to pursue treatment against the veterinarians’ advice, or ‘frequently’ or ‘always’ experienced clients questioning their medical advice, were more likely to agree that the internet leads to increased client expectations.
Better-informed clients may also form strong opinions and expect veterinarians to justify their diagnostic and therapeutic steps. Interestingly, we found that in all three countries, younger veterinarians were more likely to view this as a negative effect. This might be explained in two ways: Firstly, clients may behave differently towards younger and less experienced veterinarians compared to older and more experienced professionals, more often challenging the younger veterinarians to justify their treatments. Alternatively, younger and less experienced veterinarians may feel more insecure when facing owners with strong opinions, feeling that they have to justify themselves, whereas older and more experienced colleagues might feel less stressed and more secure in dealing with such clients.
Finally, the volume and nature of information on the internet can sometimes give clients an unrealistic impression of modern small animal practices. UK veterinarians were more likely to agree with this compared to Austrian and Danish veterinarians, perhaps because of the high media presence of cutting-edge veterinary medicine within the UK [21
]. For example, Noel Fitzpatrick is a well-known veterinary surgeon who has a very popular television series (‘Supervet’) featuring challenging cases receiving advanced treatments [21
]. He also has a very visible presence on various internet channels such as YouTube and other social media platforms, and this may indirectly influence the information about possible therapeutic options on other websites. Clients can be highly influenced by exposure to such information and gain a false impression of the types of services available in most veterinary practices. UK veterinarians in particular believe that internet resources have a strong impact on clients’ desire to pursue treatment and are more likely to agree that it creates a false impression of modern small animal practice than vets in Austria and Denmark. Therefore, we recommend that veterinarians should proactively direct clients towards appropriate and factually accurate online resources where they can seek further information if desired. In this context, Kogan and colleagues found that of the 94 veterinarians they surveyed who suggested websites to clients, 32% verbally recommended particular websites, 21% gave written recommendations, and 17% gave both written and verbal recommendations [5
]. By providing both verbal and written information, as well as recommending reliable websites, veterinarians should be able to manage clients’ unrealistic impressions of modern small animal practices.
Although this study involves three countries to enable a comprehensive investigation of our research questions, the study is subject to limitations:
First, since not all small animal veterinarians are members of a small animal association, the study is subject to a selection bias, especially in Austria and the UK, with a coverage error of around 30%. In addition, even though there was a very good socio-demographic coverage by the three samples, the rather low response rates may lead to potential non-response bias, where participants deviate systematically from those invited respondents who did not reply. Further, the number of participants from the three countries varied, with a higher number of UK veterinarians and much smaller numbers from Denmark and Austria. This may have influenced the identification of significant differences in our regression analyses. In Austria, the higher proportion of older (50–59 years) and self-employed veterinarians and the lower proportion of veterinarians with 0.5–5 years of work experience compared to Denmark and UK could have influenced the differences we identified. Further, of the 21 veterinarians who were categorized as “Other” in relation to business type, only three indicated that they were retired (one from each country). Due to the small number and mostly short duration of retirement (<0.5, 1 and 7 years), we did not consider this aspect in our analyses in the context of their ability to recall information relating to their clients and clients’ use of internet resources.
Second, to generate an overview of the different aspects that are of relevance in relation to clients’ use of internet resources, we formulated six statements to identify veterinarians’ attitudes toward this issue based on the results of an Austrian focus group study [8
] as well as the existing literature including empirical studies and anecdotal knowledge [2
]. However, it was not specified whether veterinarians should answer the statements by referring to their own personal experiences, or in relation to the profession in general. These aspects should be explored independently in future research.
Third, the use of answer options such as “occasionally” or “frequently” is more subjective compared to, for example, a specific percentage. Thus, the respondents may have interpreted these terms differently, introducing variability into the reported occurrence rates.
Fourth, veterinarians were asked how many of their clients they thought used internet resources prior to a consultation, which may not reflect the actual number who do so, as not all clients will explicitly share that information with their veterinarians. Future work should collect that information directly from clients for a comparison.
Fifth, when we asked veterinarians about their perceptions of clients’ acceptance or otherwise of ‘advanced’ diagnostics and treatments, we did not provide a detailed description of the term “advanced”. Although a generally understood and commonly used term within the profession, it may have been interpreted in different ways by the respondents, perhaps depending on their working background and/or level of specialization.
Although our results indicate how often veterinarians are challenged by clients questioning their professional advice based on information obtained from the internet, we did not specify the context, e.g., clients questioning veterinarians on diagnostic or treatment recommendations, costs, vaccination policies, behavioral issues, etc. Further, we did not ask how often veterinarians showed interest in what kinds of information clients have found on the internet. Hence, we recommend that these aspects should be explored in future studies.