Patient Request for Imaging and the Desire for ‘Proof of Wellness’: The Influence of Online Health Information on Imaging Practices

Abstract

Traditionally, general practitioners (GPs) have served as gatekeepers, determining the clinical necessity of medical tests and procedures and authorising referrals on patients' behalf. However, widespread access to online health information (OHI) has altered this dynamic by enabling patients to access medical knowledge once largely confined to healthcare professionals. As a result, many patients now take a more proactive role in their healthcare, as evidenced by the increasing number of patient-initiated requests for diagnostic imaging in primary care.

Patients who present to primary care facilities with self-diagnoses informed by online searches often seek imaging to confirm or exclude suspected conditions. While this can enhance patient engagement, it may also lead to misconceptions about the diagnostic capabilities and limitations of imaging modalities. Health anxiety further intensifies this trend, with some patients seeking imaging for reassurance or ‘proof of wellness’. This thesis investigates patient-initiated requests for imaging in Australian primary care, examining how patient autonomy, digital literacy, and OHI influence interactions between patients, GPs, and radiologists.

A mixed-methods design was employed, comprising four empirical phases and a systematic scoping review.

Findings highlight a persistent tension between patient-centred care and evidence-based practice. Digitally literate patients report greater confidence in requesting imaging but often lack critical appraisal skills. GPs describe pressure to comply with non-indicated requests due to time constraints, fear of litigation, and concerns about damaging therapeutic relationships. Radiologists report increased workloads from unnecessary imaging.

Overall, this research underscores the need for improved patient education and structured decision-making frameworks to support appropriate imaging use while balancing patient empowerment with clinical responsibility.