Is the Culture Finally Shifting?

Thanks to friend Kavita Patel for pointing out this sign of shifting winds, in this week’s Time online: Googling Symptoms Helps Patients and Doctors. It’s a watershed moment, because the last physician column I saw on this was the unpleasant 2007 When the Patient is a Googler, by Scott Haig MD.

It drove me up a wall, because the title suggested Googling was the problem, when the story was actually about a nightmare patient who was just plain rude. To brand “googlers” as wack jobs was imprecise at best.  I responded with one of my first posts here, March 2008: When the Patient is a Yahoo.

Shortly after, our Alan Greene, physician c0-chair of SPM and co-founder of DrGreene.com, posted here about the article, with links to coverage in Salon.com. He summed up our status:

We live in a time of rapid tectonic shifts in what it means to be a doctor and what it means to be a patient. I’m not surprised that there are clashes of ideology and practice. Our labyrinthine, barnacle-encrusted healthcare system resists change. So do our social structures that have lasted for millennia.

But already many e-patients and many e-doctors are actively enjoying a new way of relating, rooted in mutual respect and open access to health information.

There was so much blog discussion that Dr. Haig led a physician roundtable, How to deal with the digitally empowered patient, reported in Orthopedics Today. Haig cited that twenty major blogs hosted lengthy discussion of his “When the Patient” article. (John Grohol posted here about the roundtable.)

That was the background, from 2008, against which yesterday’s Time piece landed. In the new piece I was thrilled to see author Dr. Zack Meisel describe how patient engagement actually plays out for him: (emphasis added, in all quotes here)

Recently I saw a patient who came to the ER with a strange rash. She arrived with color printouts that correctly identified her condition. Not only was she correct in her self-diagnosis, but I am not sure I would have considered the right diagnosis so quickly if she hadn’t brought in the pictures (it was a common condition with an atypical presentation). I know many health providers who have experienced similar circumstances.

Partnership! An engaged patient, trying to contribute what she can, helps the physician do his job.

The best part comes next:

But to debate whether patients should or should not Google their symptoms (which a surprising number of doctors seem to enjoy engaging in) is an absurd exercise. Patients already are doing it, it is now a fact of normal patient behavior, and it will only increase as Internet technology becomes ever more ubiquitous.

The average Joe has more health information at his fingertips — both credible and charlatan — than all the medical libraries ever built put together. So the real question is, What can professionals do to translate this phenomenon into better health for their patients and the public?

That information-at-the-fingertips point resonates with what a Dartmouth-Hitchcock anesthesiologist told me on a plane flight last May: “I have to take my laptop into the OR. We don’t physically have, here in the building, all the information I might need during the procedures.”

In all of this coverage I think the best perspective is what John G extracted for his post about the roundtable:

A well-educated patient is easier to treat. A badly educated patient is very difficult to treat.

I think it’d be great for the Society for Participatory Medicine to accelerate this shift by developing tools to teach smart info-shopping. Culture change doesn’t show up in life all that often, and we should guide it.

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5 replies »

  1. Dave –
    I agree. This is an important issue. E-prescribing took a decade to catch on. New medical standards take almost 17 years to become standards of practice. Some of this is an issue of timing. Some of this is a generational issue as younger physicians that grew up with ubiquitous technology will be more comfortable embracing this in their patient encounter.
    I think one of the key’s is helping patients make sense of data. One could argue that managed care and PBM sites are logical places for them to go for “approved” content, but most patients don’t use them.
    There certainly could be better tools out there for patients to navigate their symptoms to come up with a short-list of topics to discuss with their provider. I don’t know of any.
    Ultimately, it’s an information overload issue on both sides. The patient has a problem and has an immediate source of information – the Internet. They are going to use it. They will have found out lots of information – some useful, some not so much – before they get to the appointment with the physician.
    I think you’re asking the right question which is how does this get incorporated into the encounter and how do patients weigh this information in a constructive manner versus the information provided by their physician. We can expect that there will be times that they will find out new information about a condition via social media and other e-patients faster than it will become common knowledge.

  2. Understanding the Collaborative Shift in Bedside Manner
    Dr. Dave, according to Mario Moussa PhD and Jennifer Tomasik MS, when it comes to the doctor-patient relationship, Health 2.0 needs guidelines. Several leading health providers have begun to call for them. We think guidelines would, among other things, help define the right mix of virtual and live communication.
    Our relationship strategies take a step in this direction. Such a framework can be used to start a productive dialogue among health providers about social media. A hospital committee or some other governing body could easily use Web 2.0 tools—a blog or a wiki—to start the discussion. Before long, there would be ample case material to flesh out general principles.
    Health 2.0 Needs Guidelines
    Guidelines would also address a big barrier to using Health 2.0: getting paid. Currently reimbursement policies do not cover electronic communication, so physicians have little financial incentive to use it.
    In a 2003 study, only 9% of physicians were willing to use e-mail to communicate with patients. This has something to do with old habits. But it has a lot to do with payment schedules, too. Guidelines should feature the research that shows the positive health outcomes of strong physician-patient relationships and how social media tools help build relationships. In today’s “pay for performance” market, these outcomes help build credibility for wired communication.
    Training Support
    We also think Health 2.0 guidelines need to be supported by training. Studies show that training in interviewing and interpersonal skills produces substantial differences in the quality of care. Training in Health 2.0 communication would likely have a similar impact.
    Paradoxically, as patients can access and control more data, they have a greater need for trusted physicians who communicate well using various mediums. As Ted Epperly, President of the American Academy of Family Physicians, has said, patients need “wise counsel” in sifting through the prodigious amounts of information available via Health 2.0.
    And physicians as well as patients need to learn how to navigate this environment. No longer the sole authoritative source of medical information, physicians need to adapt, becoming an experienced partner and guide for inquiring patients. Training can help doctors get comfortable in this new role.
    Ann Miller RN MHA

  3. The culture has already shifted. It is our institutions that are slow to react. There is good reason that these forces are called disruptive. The health care industry is being forced to adapt primarily by a changing marketplace (not government) and that includes the empowered patient. There is no way this jeanie goes back in the bottle.

  4. I believe a little bit of information in the wrong hands can be very dangersous. Relying on the internet to diagnose what ails you, or “seeking” the direction from a doctor on-line seems very wrong. I believe this could end in disaster!

  5. Medical texts with search engines ought to be on line, for instance, Signs and Symptoms, or Differential Diagnosis. When patient come with their diagnosis, I can shmooze with them, cut and paste on the EHR, and bill the max!