Op-ed: Empowered e-patients are failed by our health system

The following op-ed was published on June 7th, 2010 in CNN.com.

“I read all about my condition on the Internet,” a recent patient proudly told me. Like other doctors, I’m seeing more patients research their symptoms thoroughly before setting foot in the exam room.

Patients are using the Web in unprecedented ways for their own health empowerment. According to the Pew Internet & American Life Project, 61 percent of American adults looked online for health information in 2009, up from 46 percent in 2000.

These “e-patients” are an essential part of the health care team, and play an increasingly influential role in the shared decision making process with their physicians.

Health technology commentator Esther Dyson observed in the Journal of Participatory Medicine that “the amount of medical knowledge is beyond the reach of any one person,” and, “because clinicians are overwhelmed … a huge amount of responsibility is devolving to individuals.” But she also noted that e-patients encounter physicians “who are often hostile to their efforts.”

Indeed, not every physician is enamored with the e-patient. In a TIME opinion piece, orthopedic surgeon Scott Haig called a patient who Googled her own health information a “brainsucker.” And, frustrated with the time needed to engage e-patients, he wondered, “if there [were] patients like this in poor, war-torn countries where the need for doctors is more dire.”

Most doctors, however, want their patients to be conscientious about their health and informed about their diseases. In a recent survey, health marketing firm Manhattan Research found that virtually all doctors had patients who searched for health information online, and more than two-thirds of physicians found this to be a positive trend.

Given that the majority of doctors support those who take a pro-active stance with their health, why would some patients perceive physicians as hostile to their empowerment?

Simply put, our health system does not promote the communication necessary for physicians to engage e-patients.

Most primary care doctors practice in an environment dominated by 15-minute office visits, where encounters are rushed and questions discouraged. Patients, on average, are interrupted less than 20 seconds after they start talking, and half of them leave their appointment without fully understanding what the doctor actually said.

As far back as a decade ago, more than two-thirds of physicians already reported not having enough time to spend with patients. And in the face of rising practice and malpractice insurance costs, doctors today are more fiscally pressured than ever to see a greater number of patients.

Harvard internist Katherine Treadway wrote in the New England Journal of Medicine that this leads to “care [becoming] increasingly fragmented, leaving patients angry and doctors frustrated. The time demands have exploded, which has eroded everyone’s ability to develop the personal, long-term relationships that are a great source of satisfaction for providers and comfort for patients.”

Furthermore, as other industries have embraced e-mail and digital record keeping, there is little financial incentive for doctors to use them. When a primary care doctor routinely sees 30 patients or more in a day, combined with hours wasted on health insurer bureaucracy, taking the additional time to e-mail patients is not fiscally feasible when it is not reimbursed by Medicare or most health insurers.

And with doctors receiving only 11 percent of the savings from implementing expensive digital records — most of which goes to health insurance companies or the government — it’s no wonder that only 13 percent of physicians have implemented an electronic record system.

Most doctors applaud patients who want to play an active role in their health. But neither the time physicians spend with their patients, nor the use of the tools necessary to facilitate a stronger patient-doctor relationship, are valued. Instead of encouraging physicians to see more patients, Medicare and the health insurers need to reward doctors who take the effort to engage e-patients both in the exam room and outside the clinic.

E-patients can help, by recognizing the constraints on physicians and demanding that changes be made in the health system that will help doctors better meet the needs of empowered patients.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • http://www.pacificpsych.com/ pacificpsych

    Physicians get annoyed because patients think they know more about medicine than them. They might know more about their specific condition than a particular doctor, especially if the condition is rare. But there’s a certain arrogance to thinking that a bit of googling is equivalent to many years of schooling and experience. Physicians like informed patients; they don’t like to be devalued. It’s irritating when a patient who is cognitively capable of understanding their illness and treatment stares at you blankly when you aks the most basic questions. Conversely, it’s irritating to be treated as a script writing servant who must follow orders.

    Then comes the question — what information do patients find on the internet? Who wrote it? In psychiatry, the answer is invariably Pharma. I sometimes read discussions on various random forums where someone will ask a medical question and everyone will pop in with their advice. Their knowledge is extremely tainted by Pharma propaganda that pushes various diseases and medications, but most are not aware of this. They think that when they are “diagnosed with Adult ADD,” for example, it is a “fact” of some sort. If you as a physician were to attempt to explain the complexity of attentional problems and that being inattentive doesn’t mean you “have adult ADD,” you would be shouted out of the room.

    In psychiatry the “chemical imbalance” nonsense is so deeply ingrained in the minds of the public that if you say there’s no basis to it, lay people and therapists who are not MDs look at you as though you’re an idiot.

    There’s little respect in today’s society for intellect, knowledge and experience. Physicians are treated not as experts but as impediments to self treatment.

    The ideal patient is knowledgeable and curious and informed. He doesn’t ‘comply’ with things that go against his gut feeling. He’s also respectful of the doctor’s education and experience, and appreciative of the doctor’s wish to do the very best for him that she can.

  • http://nostrums.blogspot.com Doc D

    My spouse does this, although I’m the “internet source.” I tell her (anonymously, of course) about a patient I’ve seen, and the patient’s diagnosis.

    She then says, “Oh, I think I have that, too.”

    Voila. The power of suggestion.

    Online astrology is also a good source for e-Diagnosis.

  • Julie

    Perhaps you’ve might consider reading comments on a previous post on this blog regarding patient dissatisfaction with Primary Care Physicians. The topic of e-patients was brought up there as well.

    As an e-patient myself, yes, I use Google, use Google Scholar, Bing, Medscape, Medline, UpToDate, etc. (the same literature you read).

    Yes, I am fortunate to have access to substantial medical literature AND I’m an online participant in a select patient forum where scientific knowledge abounds. I also happen to have worked in healthcare for 30+ years (clinical laboratory, healthcare information technology, etc.)

    I’m well aware of patients with limited knowledge of the basics but give patients some credit for trying. You know damn well that you, as physicians, do not know everything. Patronizing patients only further alienates them.

    I help family members learn as much as they can about what ever issue they are dealing with and I help them to be more specific in their communications. They are well aware of the time constraints physicians face.

    However, there is such a huge divide between patients and physicians and this gap needs to be bridged. Personally, the nurse working for my PCP is far better at communication and at times more aware of current trends than my PCP is. I rarely go to him for anything because my knowledge of my issues so far surpasses his at this point.

    My interactions with most docs, whether at work or for my personal health, are participatory or they do not exist. I don’t receive or take crap from docs where I work but they also know I am working in their and the patients best interest.

    Just my two cents.

    While he is board certified in several areas, his time is limited and God only knows how he keeps up with all the illnesses that present at his office.

  • Donald Green MD

    Julie, Your 2 cents makes sense. This sensitivity that patients are trying to show you up is nonsense. They just want to be well and make sure they or their family are treated properly. Any chance I get to share my knowledge and corroborate or clarify what a patient has learned is one of the satisfactions I take from practice. The days of the robot patients is over and quite frankly, thank goodness. If the patient didn’t need your help they would just treat themselves. A desire to understand and become a more informed partner is welcome. It also foreshadows that they are more likely to follow through on a treatment regimen since they have more of a stake in its design.

  • http://wellescent.com/health_forum/topics Wellescent Health Forums

    Since there is no diploma that indicates just how much a patient knows about their own condition or on the other hand, how little they might actually know, e-patients will continue to be difficult for doctors who must err on the side of caution in dealing with their patients. Regardless of the type of interaction, one can never simply trust that someone is an expert based solely on their word. Consequently, it will take a number of visits before a doctor will know just how well informed a particular patient actually is. The key is that both sides must be have patience in developing the ongoing relationship.

  • Doc99

    Trial lawyers should love this one.