Negative Outcomes

Twenty-one articles reported impacts or adverse outcomes of challenging encounters. The study explains continued use as more likely when consequences do not outweigh immediate gratification. Students reported sleep, mood, health, relationship, role, and academic harms from excessive internet use. Patient dissatisfaction was the strongest identified patient outcome. Most students treated these harms as tolerable or insignificant. Students described concrete harms including tiredness, worse grades, worsening eyesight, anger, weight gain, and neglect of eating, sleeping, or responsibilities. Challenging encounters were linked to greater use of diagnostic testing. Patients in challenging encounters had higher six-month healthcare utilisation in one study. Challenging encounters were associated with diagnostic uncertainty.