Patients and physicians in the digital age

The digital age has had a deep and likely permanent effect on the patient-physician relationship. I can’t tell you how many times I’ve had physicians beg me to provide them with a way to stop their patients from Googling their symptoms and diagnosing themselves before their first office visit and much to their chagrin, my answer is always the same, “You can’t stop them. Get over it.”

The Internet acts as an enormous and easily accessible virtual research library for patients, granting them access on the one hand to quality, data-driven information and personal perspectives that can provide tremendous value and on the other hand to information that is no better than old-fashioned quackery.

But this access to information has not translated into improved interactions between patients and their physicians. It is clear to me that we all need help in rethinking how we can best work together, especially because I believe that we are still in the nascent stages of this age of disruptive new tools that delight some and threaten others. Time and time again I hear stories describing the ways in which this technology seems to be moving us backward instead of ahead:

  • When Timothy B. Lee went to a dentist highly recommended on Yelp, he was asked to sign a “mutual privacy agreement” that would transfer ownership of any public commentary he might make in the future to the dentist.
  • A TechDirt blog post reported that plastic surgeons have sued patients for their online negative reviews and a neurologist sued the son of a stroke victim for negative comments about the physician’s bedside manner.

Instead of pitting patient against doctor, these tools should be increasing our collaboration.

The days of the paternalistic family doctor who dispenses advice and counsel to an acquiescent, unquestioning patient are clearly over, but that needn’t be a bad thing.

Importantly, this issue features prominently in the new proposed CMS rules for accountable care organizations (ACOs) under the Affordable Care Act. An ACO is a network of doctors and hospitals that share responsibility for providing care to patients. ACOs play an important role in healthcare reform because they are intended to make providers jointly accountable for the health of their patients, providing them with strong incentives to cooperate and save money by avoiding unnecessary tests and procedures. While the focus of ACOs is collaboration at the provider level, the end game is all about the patient and increasing the quality of his or her healthcare experience.

In order for ACOs to qualify for shared savings, they must provide patient-centered care that is influenced by the patient autonomy movement. Before becoming CMS Administrator, Don Berwick wrote a provocative article in Health Affairs calling for a new definition of patient centered care as “the experience… of transparency, individualization, recognition, respect, dignity, and choice in all matters, without exception, related to one’s person, circumstances, and relationships in health care.”

In order to facilitate this shift, we need to resolve the current tension between the philosophy that idealizes the physician as always being right and patients’ newfound autonomy and access to information. We need to engage in a thoughtful discussion about how the new disruptive digital technologies can help both patients and physicians get what they need. After all, both have the same ultimate goals: good clinical outcomes and a meaningful relationship.

The good news is that these disruptive technologies can be the very mechanism we need to develop more accountable, quality-driven healthcare delivery systems because they can address some of the significant gaps in patient-physician communications that are so detrimental to the relationship. The Consumer Reports National Research Center conducted patient and provider surveys about the doctor/patient relationship and concluded that patients would get more from doctor office visits if they planned ahead, took notes during the appointments, and conducted careful online research for information. Other studies have shown that patients remember only about half of what physicians tell them during their visit and that 90 percent of patients receiving a new medication reported their physician never described the drug’s side effects. Perhaps most disturbing of all, more than 30 percent of patients were unable to name their diagnosis after being discharged.

Technology, far from being the villainous entities that so many care providers see, can actually improve a patient’s experience and address those disturbing statistics. Websites now provide patients with the tools to prepare for upcoming visits by listening to actual conversations between providers and patients that have the same diagnosis; they can organize their questions before the visit; they can record their visit using digital or mobile recording devices; and they can review the recording after the visit with caregivers and family members to better understand how they can partner with their physician’s advice.

For disruptive solutions to be successful, all of us must be willing to adapt the traditional doctor-patient relationship. Patients and physicians alike are confused and disoriented by the new digital world, even while being empowered by the knowledge they can impart. These cutting edge technologies have the potential to dramatically improve a patient’s healthcare experience, but to get there, we first have to engage in some good old fashioned talk.

Kent Bottles provides health care leadership consulting and blogs at Kent Bottles Private Views.

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  • Jennifer Nelson

    I completely agree with this article and believe that, although there is more information out there for patients (which could be annoying for physicians), patients must take action in their own health. Physicians need patient cooperation to ensure that the patients participate in decision making and take the steps to improve their health. For an ACO to work, the model needs not only the collaboration of different health care systems and physicians, but also the support of the actual patients. I recently read a great article on how to take the next few steps to use health IT to benefit ACOs and help with patient engagement – this might help physicians think through how they’ll engage patients: https://ignite.optuminsight.com/archive/the-power-of-it/

  • http://twitter.com/Lunettecup Lunette

    Great post, excited to see where this conversation goes and what the future of doctor-patient relationships is.

  • James deMaine

     As a retired doc I’m now a “consumer.”  I can go to “mygrouphealth” web site, where I can make appointments, order meds, secure email, get health info, find wait times on my IPhone app for pharmacy and lab, plus get reminders for appointments, immunizations, etc.  The digital age is here.  Too much information can be a problem, but let’s steer the patients to the best web sites for the information they’re searching for.

  • http://twitter.com/ncscadsurvivor Laura Haywood-Cory

    Patients with rare diseases often find that we know more about what’s going on with our diagnoses than our health care providers do, and we band together online to provide answers and support to each other that the medical community hasn’t delivered. I don’t expect doctors to be superhuman and know everything; I do wish they would realize that we, as patients, can be a valuable resource, and that not everything online is junk. 

  • http://twitter.com/FairCareMD Alex Fair

    Another great post Kent.

    Just like Meals on Wheels and Peapod are great for those with less mobility are enabled to be well fed, our rapidly evolving innovations for health are enabling the elucidation, interaction, and dissemination of health related data.  Most interestingly, these methods can help the Physician as much as they can the grocer and in some ways mimic the methods of old that fell by the wayside as society became more disconnected.  Take, for example the low level “should I go to my doctor for this” question.  50 years ago you might have seen Dr. Jones around town and brought things up casually that he then said, “why don’t you come by the office tomorrow”, or told you not to worry about that compound nevus.  Now you can do that through myriad electronic methods, research it online, or send in your photo of the problem with an iPhone app (iPhone SpotCheck or ClickCare and probably others.)

    But just like the grocers who do not adopt the new methods, the future belongs to the providers and institutions that connect, engage, and collaborate with patients. As Clay Shirky noted in the 2008 Health 2.0 Keynote, the patients will lead and the providers and institutions will follow. And now in 2011 it is happening – patients and doctors and entrepreneurs like me have made new systems to advance the doctor-patient relationships in many ways.  The patients are using them, and the doctors, practices, and medical groups can choose to follow or not. The best companies and the best hospitals adapt and disrupt themselves.  Another example, when confronted by Amazon, Borders did not adapt and Barnes & Noble did.  Which is your institution currently behaving like?  Do you want to be a St. Vincent’s (NYC) or a Mayo?  

    As Kent knows, since I asked him to speak at it, we are actually running a Hospitals 2.0 Event at Health 2.0 NYC this month to showcase this shift, so stay tuned at health20nyc.com.  We will tweet and livestream it as well, as usual.

  • http://twitter.com/hospreviewmag Hospital Review

    Because self-diagnosis has become popularized by the internet, there have been modern studies conducted to track  the usage of health apps on tablets and smart phones. 29% of people who download apps to their cell phones or tablet computers have downloaded a health app, according to a survey by the Pew Research Center’s Internet & American Life Project. http://www.beckershospitalreview.com/healthcare-information-technology/pew-survey-29-of-people-downloading-apps-to-cell-phones-or-tablets-have-health-app.html
    –Becker