Dealing With Patients Who Surf the Net
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3 May 2011Philippine College of Physicians Annual Convention
Image from asifthebeshttp://www.sxc.hu/photo/1060873
The Informatics Client: Dealing with Patients Who Surf the Net
Iris Thiele Isip Tan MD, MSc, FPCP, FPSEM
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Do you practice Participatory Medicine?Have you met the e-Patient?Are you Internet-hostile?
Image from zizzy0104http://www.sxc.hu/photo/794884
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Image from liquenehttp://www.flickr.com/photos/liquene/3900145161/
Web 1.0“the mostly read-only Web”
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Web 2.0“the wildly read-write Web”
Image from adactiohttp://www.flickr.com/photos/adactio/78600196/
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Crowd-sourcingHarnessing collective intelligence
Image from antigone78http://www.flickr.com/photos/antigone/457089364/
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Image by judepicshttp://www.flickr.com/photos/judepics/2059494008/
Physician as INTERMEDIARY: gatekeeper of health information
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APOMEDIATIONLess reliance on traditional experts
Image by migclickhttp://www.flickr.com/photos/migclick/2535570629/
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“As opposed to the doctor-centric, curative model of the past, the future is going to be
patient-centric and proactive.”Elias A. Zerhouni MD, NIH Director
Dec 2007
Image by JD Hancockhttp://www.flickr.com/photos/jdhancock/4100030094/
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Participatory Medicine
Image by Liz Gracehttp://www.flickr.com/photos/liz-grace/5078868809/
“Movement in which networked patients shift from being mere passengers to responsible drivers of their health ...
providers encourage and value them as full partners”
Society for Participatory Medicine
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Online community/support group
Patients as members of collaborative treatment teams Community health
decision-making
“Mindfully” involved in treatment
“Participatory Medicine” from Wikipedia
Image from networkhttp://www.sxc.hu/photo/985516
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Do you practice Participatory Medicine?Have you met the e-Patient?Are you Internet-hostile?
Image from zizzy0104http://www.sxc.hu/photo/794884
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Image by WebWizzardhttp://www.flickr.com/photos/webwizzard/3931165028/
The Well The Acutes
Facing a new medical challenge
The Chronics Chronic but stable illnesses
3 Categories of e-Patients*from Cain, Sarasohn-Kahn & Wayne (2000)
“Health e-People: The Online Consumer Experience”
* Includes caregivers
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Internet Accessfrom Tom Ferguson, MD & the e-Patients Scholars Working Group (2007)
“e-patients: how they can help us heal healthcare”
The Well
every few
months
The Acutes
everyday
The Chronicsseveral times a month
Image by iwdhttp://www.sxc.hu/photo/1129780
60- 65%
5-6%
30- 35%1 32
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8out of 10 American internet users have searched online for at least 1 major health topic!
from Tom Ferguson, MD & the e-Patients Scholars Working Group (2007)
“e-patients: how they can help us heal healthcare”
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Health Topics Searched Onlinefrom Pew Internet & American Life Project Nov 2004 Survey
Specific disease or
medical problem 66% Medical
treatment or procedure
51%
Exercise or fitness
42%
Diet, nutrition, vitamins,
supplements51%
Prescription or OTC drugs
40%
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e-patient & EmpowermentFrom Von Knoop at al of Boston Consulting Group (2003)
“Vital Signs: e-Health in the United States
AcceptingInformed
Involved
In control
Severity of Condition
Attitude Toward Physician
High
Moderate
Low
Godlike Partner Supplier
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Accepting Informed Involved In controlDoctor-
dependent & uninformed
Doctor- dependent
but informed
Junior medical partners
Autonomous patients
Rarely go online for
health information
Go online before or
after MD visit
Prefer to make joint
decisions but defer to MD
Make their own decision even if MD disagrees
From Von Knoop at al of Boston Consulting Group (2003)“Vital Signs: e-Health in the United States
1 32 4
Image by iwdhttp://www.sxc.hu/photo/1129780
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“Paradoxically, a patientʼs interest in knowledge may not always accompany an interest
in the medical decision making process.”Gerber & Eiser, Journal of Medical Internet Research 2001
Image by nightRPstarhttp://www.flickr.com/photos/ninjanoodles/1586212326/
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Physician-Patient EncountersGerber & Eiser, Journal of Medical Internet Research 2001
Informed decision-maker
Knowledge-acquirer
Image by Kurhanhttp://www.sxc.hu/photo/1314902
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The Knowledge-AcquirerProvides some personal values to the physician
Image from carbonNYChttp://www.flickr.com/photos/carbonnyc/3440688097/
Interested in learning more about the treatment decided on by MD
Gerber & Eiser, Journal of Medical Internet Research 2001
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http://www.flickr.com/photos/72341818@N00/4555752947/
The Informed Decision-MakerPossesses both preference and knowledge
Extra time to discuss what patient knows
Avoid frustration of not being the sole source
of information
Gerber & Eiser, Journal of Medical Internet Research 2001
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Do you practice Participatory Medicine?Have you met the e-Patient?Are you Internet-hostile?
Image from zizzy0104http://www.sxc.hu/photo/794884
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Internet-hostileClearly uncomfortable with, and sometimes seem to feel
offended by patientʼs attempts to learn more online
Image by Niklas Hellerstedthttp://www.flickr.com/photos/niklashellerstedt/2414448568/
Tom Ferguson, MD & the e-Patients Scholars Working Group (2007)“e-patients: how they can help us heal healthcare”
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“[Most doctors] really do like to think they
have ALL the answers. This will never
change, I am afraid.”
Pew Internet Project e-Patient Survey
Image by caricaturashttp://www.flickr.com/photos/caricaturesbynelson/2031107541/
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Internet-friendlyEncourages patientʼs online efforts
Image by southerntabithahttp://www.flickr.com/photos/tabithahawk/567135091/
Tom Ferguson, MD & the e-Patients Scholars Working Group (2007)“e-patients: how they can help us heal healthcare”
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The Internet PrescriptionRecommend websites to the patient
Patients will likely seek a “second opinion” on the internet
Gerber & Eiser, Journal of Medical Internet Research 2001
Image by Charles Williamshttp://www.flickr.com/photos/charlesonflickr/3926259585/
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Medline Plushttp://www.nlm.nih.gov/medlineplus
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Mayo Clinichttp://www.mayoclinic.com
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Look for the HON Code seal
Health on the Net FoundationMedical information you can trust!
http://www.hon.ch
also provides HONtools, HONsearch, HONtopics
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Do not underestimate patientsʼ ability to
provide useful online resources
Tom Ferguson, MD & the e-Patients Scholars Working Group (2007)“e-patients: how they can help us heal healthcare”
Image by Yogendra174http://www.flickr.com/photos/yogendra174/4437447471/
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Do not overestimate the hazards of imperfect online information
Image by steved_np3http://www.sxc.hu/photo/1339516
Tom Ferguson, MD & the e-Patients Scholars Working Group (2007)“e-patients: how they can help us heal healthcare”
Database of Adverse Events Related to Internet Use (DAERI) reported only a single case of possible fatality from 2000-2004
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Do you practice Participatory Medicine?Have you met the e-Patient?Are you Internet-hostile?
Image from zizzy0104http://www.sxc.hu/photo/794884
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Thank Youhttp://www.endocrine-witch.net
@endocrine_witch
Image from http://wthr.frumph.net/