dealing with patients who surf the net

3 May 2011Philippine College of Physicians Annual Convention

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The Informatics Client: Dealing with Patients Who Surf the Net

Iris Thiele Isip Tan MD, MSc, FPCP, FPSEM

Do you practice Participatory Medicine?Have you met the e-Patient?Are you Internet-hostile?

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Web 1.0“the mostly read-only Web”

Web 2.0“the wildly read-write Web”

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Crowd-sourcingHarnessing collective intelligence

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Physician as INTERMEDIARY: gatekeeper of health information

APOMEDIATIONLess reliance on traditional experts

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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

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Participatory Medicine

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“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

Online community/support group

Patients as members of collaborative treatment teams Community health

decision-making

“Mindfully” involved in treatment

“Participatory Medicine” from Wikipedia

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Do you practice Participatory Medicine?Have you met the e-Patient?Are you Internet-hostile?

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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

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

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60- 65%

5-6%

30- 35%1 32

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”

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%

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

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

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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

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Physician-Patient EncountersGerber & Eiser, Journal of Medical Internet Research 2001

Informed decision-maker

Knowledge-acquirer

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The Knowledge-AcquirerProvides some personal values to the physician

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Interested in learning more about the treatment decided on by MD

Gerber & Eiser, Journal of Medical Internet Research 2001

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

Do you practice Participatory Medicine?Have you met the e-Patient?Are you Internet-hostile?

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Internet-hostileClearly uncomfortable with, and sometimes seem to feel

offended by patientʼs attempts to learn more online

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Tom Ferguson, MD & the e-Patients Scholars Working Group (2007)“e-patients: how they can help us heal healthcare”

“[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

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Internet-friendlyEncourages patientʼs online efforts

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Tom Ferguson, MD & the e-Patients Scholars Working Group (2007)“e-patients: how they can help us heal healthcare”

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

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Medline Plushttp://www.nlm.nih.gov/medlineplus

Mayo Clinichttp://www.mayoclinic.com

Look for the HON Code seal

Health on the Net FoundationMedical information you can trust!

http://www.hon.ch

also provides HONtools, HONsearch, HONtopics

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”

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Do not overestimate the hazards of imperfect online information

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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

Do you practice Participatory Medicine?Have you met the e-Patient?Are you Internet-hostile?

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Thank Youhttp://www.endocrine-witch.net

@endocrine_witch

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