Empowered patients, electronic health records, open data; all internet engendered and all are disrupting the very nature of the medical relationship. Where once, the physician was atop the hierarchy of medical power, and medical societies controlled access to knowledge, technology, and policy, the sheer economics of modern healthcare has blasted that structure to smithereens. More often than we’d like to admit, healthcare related industries such as pharmaceutical, insurance companies and now even legislators and political bureaucrats, supplant medical decision-making and override the doctor-patient relationship.
E-Health and the Internet
Patients have moved away from traditional medical care in droves. Pew Research suggests a whopping 80% of internet users and 59% of all American adults search for health information online. This includes the 34% of adult consumers who utilize peer-to-peer information to make medical decisions rather than trust their doctor. E-health is on the rise.
This represents a huge shift in power over medical decision-making. Patients are becoming more educated. Having empowered and educated patients is a positive development in healthcare. The more one understands the healthcare process or a disease process, the better able one is to make good medical decisions. There is a downside, however. What happens when the information and the data patients are relying on to make those decisions is less than accurate? It is here that physicians and patients often collide. Can e-health and all that it entails, be trusted? Many physicians believe it cannot.
Not everything on the internet is valid and sometimes it is just downright foolhardy. Anyone can set up shop and be an expert on any topic. Without appropriate digging, no one is the wiser. A case and point, PCOS nutritionist, Monika Woolsey points out, women often incorrectly self–diagnose PCOS, based upon internet information, when in fact they have other conditions. Examples like this abound and lead many physicians to resist e-health trends, including the concept of empowered patients and the very real need for electronic health records.
E-Health Fills the Trust Void for Patients
From the patients perspective e-health represents a valid counterpoint to modern medicine. The complaints are many, but boil down to a lack of trust. How does one trust one’s physician when appointments are less than 10 minutes (often after a two hour wait); when symptoms are dismissed; when medications are dispensed as requested by the patient without the proper diagnostics (anti-depressants and many other medications are over-prescribed); when, as in OB/GYN, fewer than 30% of clinical practice guidelines are based on evidence?
How does an educated consumer trust her health care provider when scandal after scandal in the pharmaceutical industry, from hiring ghost writers to write favorable publications in respected journals or publishing only the positive results of a study, to the outright withholding of data, the ethical breeches of the FDA and the massive multi-billion dollar lawsuits that ensue, influence a physician’s medical decision-making? With all the problems of modern healthcare, seeking information from the internet or from peers seems a lot less risky and certainly less time-consuming and frustrating than seeking that same information from a physician. It shouldn’t be that way.
The distrust and frustration many patients feel towards the marketing practices of the pharmaceutical industry, though often rightly placed, has come at a cost. It has made patients adversaries of physicians and physicians adversaries of innovation. Where we should be partnering with physicians to improve healthcare, we are, at best, working in spite of them, and at worst, against them.
Is E-Health a Wedge Issue?
Yes, e-health is a wedge issue, but it shouldn’t be. Much like the political wedge issues that divide and conquer, pitting patients against doctors and doctors against the internet or anything else that seeks to change the perceived hegemony of medical knowledge (EMR/EHR) benefits only those who rely on the status quo. Certainly, neither physicians nor patients benefit by maintaining the status quo of the current healthcare system. Physicians and patients, the two most important stakeholders in the healthcare system, must come together and innovate collaboratively. Otherwise, we will continue to have a system that benefits neither.