Doctor patient relationship: Changing dynamics in the information ageShashank M Akerkar, LS Bichile
Department of Medicine, Seth G. S. Medical College and K. E. M. Hospital, Parel, Mumbai - 400012, India
Correspondence Address: Source of Support: None, Conflict of Interest: None PMID: 15235209
Source of Support: None, Conflict of Interest: None
They are arriving to your clinic armed with information they have found on the web, with a preconceived idea about their diagnosis and treatment options, more demanding regarding convenience and ease of access. They want to actively participate in therapeutic decisions and want all the decisions to be informed and intelligent. Meet the new empowered patient!; empowered by the information technology and its benefits.
Health information seekers on net have exponentially increased from 54 million in 1998 to 110 million (U.S. figures) in 2002 and are ever increasing. 80% of adult Internet users, or about 93 million Americans, have searched for at least one of the 16 major health topics online. This makes the act of looking for health or medical information one of the most popular activities online, after email (93%) and researching a product or service before buying it (83%). Studies in UK have shown that in November 1999, about 27% of adults were using the Internet on a regular basis and a further survey found that 84% of all users felt the Internet was indispensable. Apart from the community-based studies, even clinic-based studies have shown that one in four patients are accessing health information from the Internet and that half the patients who have computer access already search for medical information.
The classical e-patient belongs to the younger age group. Women are more likely to have searched for a health topic than males. The classical e-patient is better educated and is more likely to belong to the higher income group. They search for specific medical condition (63%), medical treatment or procedure (47%), diet and nutrition (44%), exercise and fitness (36%). This is the group of patients who are very critical of their health problems. They have been brought up in this information age andmake optimum use of it.
The information age revolution
Before the information era, knowledge of medicine belonged only to the physician. The patient's role in his or her physician's office was simply to listen and comply. However, the Internet has opened up the doors of information like never before. There are innumerable sites ready to dish out detail information about the patient's condition. Not just basic information, the e-patient also has easy access to latest developments, various different treatment modalities available for the condition and can then make an intelligent choice. He approaches the physician with preconceived notions based on the Internet information.
The “Informed patient”
Due to the extensive resources available on the net, e-patient is a highly informed patient. They use information technology to take informed decisions for themselves as well as their elderly relatives. An informed patient is obviously an intelligent patient and wants to play a much more active part in the management of his condition.
The “Impatient patient-service at the speed of thought!”
This generation also makes up the impatient patient. They are used to cellulars, ATMs, broadband access, net banking. They are used to the pace of life and “at the click of the mouse” convenience in life. They are used to the convenient, personalized services provided by the other sectors like travel, finance etc. They want quick, convenient and personalized approach to their health problems too.
“Lobbying for care”
The e-patient has the latest information about the various modalities of treatment and advantages/disadvantages of each. Thus armed with this information, they lobby for a particular form of care.
Internet “The influential web of information”
A recent survey showed how influential the internet has been in the patient's decision making:
Web information changed their decision
about how to treat their illness 70%
Web information led them to ask new questions
or take second opinion from another doctor 50%
Web information influenced their decision as to
whether or not to visit a doctor 28%
Web information improved the way they take care
of themselves 48%
It has been the traditional responsibility of the health care provider to integrate all the sources of medical information and convey to the patient at the time of the consultation. Traditionally, the relationship between the physician and the patient was asymmetrical; that is to say, doctors had significantly more information about medical conditions than their patients. Increasingly however this traditional sole professional filter is being bypassed by the patients who now have access to both external means of procuring health information as also to their health records. The locus of power in health care is shifting: instead of the doctor acting as sole manager of patient care (i.e., “the captain of the ship”), a consumerist model has emerged in which patients and their doctors are partners in managing the patient's care. These changes are already finding resistance from the provider community.
Doctor patient relationship - The trust
Trust has been described as the scarcest of medical commodities. Most of the 20th century, due to the lack of information, was the era of “Doctor knows the best”. However, come the information age and patients are empowered with information. The immediate fallout is the replacement of trust by skepticism and weariness. “Blind trust” is being replaced by “Informed trust”. In fact the first health contact which traditionally was the family physician; is slowly being replaced by the internet in many cases. Patients search the net and consult their physician armed with information. An survey of 500 online 'health seekers' revealed that 55% gathered online information before visiting a doctor, and 32% sought information about a particular doctor or hospital. Of those who considered their online searches successful, 38% reported that it “led them to ask a doctor new questions or get a second opinion.” European e-patient also seems to be catching up; a recent Internet survey on this website in five languages found that, among 6,699 European respondents, 73% indicated the physician as their preferred source of health information; but 45% also used the Internet, while 19% mentioned the Internet but not the doctor as preferred.
Resistance to the changing dynamics
There has been a tremendous resistance from the health care professional to the changing dynamics of the doctor-patient relationship in this information age. The main concerns being the variable and unreliable nature of medical information on the net, the lost human touch and also the perception of the informed patient as the problem patient.
“The falling barriers”
More than a century ago, a similar backlash in health care accompanied introduction of another technology: the telephone. Soon after invention of the telephone by Alexander Graham Bell, much cultural opposition to it was generated by physicians who doubted that the telephone could add value to medical practice. These physicians complained that answering calls would diminish the time available for in-person interaction with patients. Other physicians questioned whether patients would be willing to use the new technology. Some physicians worried that the telephone might destroy the patient-physician relationship. Health care industry has been the last bastion in this information technology revolution and that is falling too.
The positive side
The flip side
Here are some suggestions for the health care providers in dealing with the Internet literate patients -
Thus the role of the Physician is that of a Consultant helping the patient through the tons of information of differing quality on the net. Not long ago, treatment decisions were based on personal experiences, anecdotal reports and a few case reports. But this is the age of information and information about various trials is available to anyone who has access to it. Not very far are the days when the net empowered patients start talking In terms of trial outcomes. Thus is the need to polish our own knowledge about research methodologies and various important trials. Results of some single trials could be biased and can be pointed at by the patients. A good solution to this is to have a look at the metaanalysis of these trials in the Cochrane database.
This type of patient is here to stay and the Life Sciences- Information technology convergence will shape up faster than we think. If not by themselves, health care providers will be dragged to the internet by their patients. Hence, as David Blumenthal, of Massachusetts General Hospital puts it; let's prove to the our patients that we are as good at surfing the web as listening to the heart or at appendicectomy.