The Doctor Will Google You Now

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Is the internet taking the mystery out of medicine? Although access to healthcare hasn’t improved, access to medical information has. As a result, patients are now spending more time at PubMed than the neighborhood saloon. The effect is sobering to physicians who had enjoyed a centuries old monopoly on medspeak. Docs may have been knocked from their pedestals but they aren’t down for the count. They too are basking in the benefits of cyberspace. The inspired diagnosis is only a Blackberry away.

[Confirmed in Studio]
Thomas H. Lee, MD
CEO of Partners Community HealthCare, Inc. an internist and cardiologist, Lee is an associate editor of the New England Journal of Medicine, and editor-in-chief of TheHarvard Heart Letter.
From Chelsea’s pre-interview notes
There’s this huge explosion of knowledge, combine that with the emergence of the Internet as this amazing searching tool– well it’s transforming medicine. When I was a med student the idea was that you could be a great Dr. if you could just learn everything, which theoretically seemed possible when everything you needed to know was all contained in a medical library, in the stacks, in that one building. Now there are just so many choices; if a patient says she has a burning sensation when she urinates there are now five, six possibilities for me to consider. I google all the time. Instead of being a source of knowledge students are now leaning how to learn. We’re relying on “just-in-time” learning tactics. We’re having to come to terms with the fact that we aren’t these all-knowing healers. Instead we better be all-caring.
[Confirmed on Phone]
Susan Love, MD
Dr. Susan Love is a pioneer of the medical internet; she’s one of the first doctors to launch a website that not only contained hundreds of pages of information, but also hosted chats and webcasts and enabled breast cancer survivors to converse with experts by email.

Susan Love is President and Medical Director of the Dr. Susan Love Research Foundation in Pacific Palisades, CA, a nonprofit dedicated to supporting research on earlier detection of breast cancer. She is a Clinical Professor of Surgery, The David Geffen School of Medicine at UCLA, and founder and senior partner in LLuminari, a multimedia women’s health company.

She is also author of Dr. Susan Love’s Breast Book, now in its third edition, and Dr. Susan Love’s Menopause and Hormone Book (second edition January, 2003).

[Confirmed in Studio]
Deborah Wexler, MD
Deborah Wexler is chief resident in internal medicine and fellow in endocrinology at MGH.
From Chelsea’s pre-interview notes
Every single day residents are looking things up on the web. Unlike physicians from earlier generations we have no qualms about looking things up in front of our patients. That’s just how medicine is. The internet can allow us to streamline care, for instance I can email patients and I can electronically communicate with their primary care physicians about the kind of medicine I’ve perscribed, etc. The downside to this is that it is very time consuming to do all of this administrative work. This is time that doctors do not get compensated for. How has technology changed medicine? The pace and intensity has changed so much. People use to hang around in hospitals for three weeks, these days you’re usualy out of there the next day. This is stressful for both patients and doctors. A friend of mine who is about to have a baby was looking for the best hospital. I did some research and decided on a hospital that had the most advanced electronic media system. Up-to-date medical records allow for checks in the system—this is now how you’re going to get the best care.

Calling all patients. We want to hear from you. Have you diagnosed yourself on line? Do you correspond with your doctor via email? Do you check your records via the net? How do you feel about your doctor googling you? Is it reassuring to know that he/she is getting the most up-to-date information or is it shaking your confidence in your doctor and the practice of medicine as we know it? Call in during our live broadcast, Tueday, May 31, 7:00-8:00 PM.

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  • I think you should talk to a colleague of mine, George Bennett. George is the CEO of HEALTH DIALOG. Health Dialog via health coaches maintains a constant dialog with chronically ill people, answering their questions and monitoring their care. Health Dialog is in Boston and was just voted one of the fastest growing companies in the INC. 500. Their coaching is supported by a knowledge base.

    Here is a brief article about the services with a story about a patient:

    Informed, motivated patients who fully participate in the decision-making process with their physicians are the key to affordable, high-quality health care. That is the core strategy behind Health Dialog’s whole-person Collaborative CareSM program.

    As part of the Collaborative CareSM program, Health Dialog Health Coaches use the Healthwise® Knowledgebase as a primary reference tool for supporting members. The Healthwise Knowledgebase supports Health Dialog’s ability to integrate Chronic Condition Support (CAD, diabetes, asthma, CHF, COPD, etc.) with Decision Support services for Preference-Sensitive Medical Decisions and other health care issues. Both Health Coaches and eligible program members have access to the Healthwise Knowledgebase through the Dialog CenterSM Web site.

    Health Coaches use the Knowledgebase when discussing a member’s symptoms and helping the member determine the level of care that may be needed. Participants use the Knowledgebase tools and information to learn self- management and decision-making skills that enable them to play more active roles in the management of their health care. Here’s an example:

    David, a 64-year-old diabetes patient with CAD, had arrived home from the hospital after having an angioplasty when he received a post-hospital-discharge phone call from a Health Dialog Health Coach. Using the Knowledgebase, the Health Coach offered David information about the procedure, explained indicators of relapse symptoms, and described proactive lifestyle modifications David could make to improve his condition. The Health Coach answered David’s questions and discussed ways he could improve his self-care.

    Because this was David’s first experience with a Health Coach, the Health Coach began by asking David general questions about his medical history and the status of his diabetes care. The Health Coach reviewed information in the Knowledgebase to determine where David had gaps in knowledge about his condition, and provided him with education that could impact his overall health. In the course of their conversation, the Health Coach discovered that David didn’t check his blood sugar regularly at home and didn’t own a glucometer.

    The Health Coach walked David through the process of getting a glucometer through his health care provider. She also bookmarked information on home blood sugar monitoring for David to reference in the online Healthwise Knowledgebase. Once David received the glucometer, she worked with him to ensure that he was using it appropriately and that he was aware of how to get supplies. In addition, the Health Coach scheduled follow-up calls to ensure he was using it properly.

    During one follow-up conversation, David reported that his blood sugar level was at 295. Referring to the Knowledgebase, the Health Coach reviewed the symptoms of high blood sugar with David, encouraged him to call his provider immediately to discuss changing his medication dosage, and talked with him about how to develop a symptom response plan that could help him the next time his blood sugar became uncontrolled. The Health Coach also referred David to a Health Dialog dietitian to help David understand dietary changes appropriate for his condition. The Health Coaches continued to follow David over several months, coaching him and sending him information from Healthwise Knowledgebase on appropriate diet, and the importance of having a dilated retinal eye exam and getting a flu shot.

    David, who lives alone, said he feels more confident about managing his condition himself, knows when to call his doctor, and has a level of comfort knowing he can call his Health Coach at any time.

  • Looking forward to tonight’s show. I hope you get to discuss how the blogosphere influences how MSM’s medical stories are interpreted.

    I’ll be blogging my thoughts at:

  • My doctor just started an innovative new practice in Arlington, MA called Renaissance Health. They’re trying to re-approach health care in a number of ways, including using a lot more information technology. I can email my doctor directly and he emails me back. They give you access to your medical records over the web. They point you to articles and resources and encourage patients to take a more active role in their care. Here’s a quote from an article about the practice:

    “Technology is the third partner in this new model of primary care. “Health care is way behind every other industry in terms of using information technology,” says Fernandopulle. “The guy at Hertz knows more about you when you walk up to the counter than your doctor does.” From patient-specific Web sites to letting patients schedule their own appointments and e-mail their doctors, the team came up with many ways that technology can smooth this new model of health-care delivery.”

    ( )

  • KenLac

    Just like the discussion thread from last night’s show about “gatekeepers” and “filters”: a doctor is someone who can already sort through all the possibilites for you and present you with the right options quickly. Or, a doctor is “authority” who can keep you from participating in your own healthcare. Sometimes filters are helpful, sometimes they’re harmful.

    The theme is going to keep coming up over and over again: now that all the information is literally at our fingertips, how are we going to sort through it all, and how will we know which bits are trustworthy?

  • Jon

    KenLac makes a nice connection between the two programs. There is a great temptation to grasp onto fervently promoted claims whether presented in TV ads, magazines, or on the web. Yet many of these claims are based on precious little, if any, scientific scrutiny. Traditionally a doctor has been entrusted with being the filter for such claims. Without rigorous training, how are civilians to sort out the immense amount of “information”, often conflicting, on a given condition? While the number of hits on a web site cannot be relied upon as a tool to reveal likelihood of investigational rigor, something akin to this has served as a reasonable benchmark in the biomedical literature: bibliographic services are available that count the number of times a published scientific paper has itself been cited by subsequent scientific publications. Moreover, the journals themselves in which individual papers appear are in turn ranked by the frequency with which their contents are cited. This system, while imperfect, does provide us with at least a general sense of the extent to which these different journals are held in various levels of esteem by the scientific community, and such information could serve as at least one useful guidepost to anyone trying to explore the literature without the help of a gatekeeper or filterer of information.

    But all that said, specific clinical context is so critical, that the next challenge to a person exploring the literature in this manner is to avoid confusing a treatment that has worked well in one context with another context in which it might not be expected to work as well. In the end, I think that patients can make a great deal of headway by exploring the literature independently, but then–just as physcians themselves do, to enter into discussions with those even more knowledgable in the area, in order to translate the known literature into meaningful information relevant to the specific clinical challenge at hand.

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  • mijohn

    What about patients using the web to research physicians? I had major surgery last year and before I picked a doctor I did some extensive online research, including scoping out docs.

    I probably know more about the guy I picked than I’ve ever known about a doctor, including some personal information. In fact, I feel a little guilty about spying on him to that degree, but it was pretty easy to do.

  • BJ

    Can any of the doctors foresee a time when clinical trials will be conducted online?

  • Chelsea-by-the-sea

    Please talk about the dynamic of MONEY.

    The 800 lb gorilla in the room.

    How does the internet trumph HMO/MBAs take-over of doctor’s ‘gut’ instincts on ow to treat me?

  • jefem

    Regarding mental health care and the web:

    1. there’s a new field called “telepsychiatry” that aims to bring psychiatrists into underserved areas of the country using closed-circuit video.

    2. There are many therapists providing “virtual” psychotherapy on the web, and many of them are lacking in credentials and skill; these deficits are more easily obscured by the anonymity of the internet.

  • deccher

    Good sources of health info online:

    Please recommend these.

  • mijohn

    Hey, you guys read my question on air and it sounded like your guests aren’t impressed by the info about doctors that’s available online. They’re thinking about this in a very traditional way.

    I went beyond the usual malpractice database. For instance, I did a Lexis.Nexis search and found several recent news articles that showed one surgeon had operated on a city official and had been named one of the top doctors in his field in Boston. That’s not info I would have found out by asking a neighbor.

    There are also tons of discussion forums on various ailments and people are very quick to drop a dime on doctors, good and bad.

    Patients have gotten a bit savvier about how they use the web, and that includes going beyond the usual sources to research people in the medical field.

  • Kerry647

    I have noticed as a lupus patient, and therefore all too familiar with the medical community in Boston, that many doctors seem to get threatened by any research done on the web on my own. They do not want me to have access to my lab results unless first okayed by them. Often, even a request to have the test results mailed is met with a kind of surprise. I would say many doctors are not yet ready for patient access online to lab results, or especially afternotes taken. Could you please post a listing of good websites for patients simply looking for in depth information on a particular disease?

  • Abby

    Mhmm, I think you could do a lot of shows on healthcare before I’d get bored. There are so many angles.

    Can we use the internet to make healthcare cheaper? Right now, I’d say no. Technological innovation is very slow to be adopted.

    And please do shows on the coverage crisis. In Boston the GBIO is trying to push a bill supported by Health Care for All Massachusetts, but I’m sure that there are other bills in other places. It’s a local issue with national repercussions.

    Two blogs to look at.

    (1.) The Health Care Blog

    (2.) Jim McDonough of HCFAMA’s A Healthy Blog

  • bft

    I tried, Chris! They told me the doctors were happy talking about doctors playing God. Thanks for the post-game note about patients’ anger. But it wasn’t anger I wanted to express, it was facts. Sorry, folks, if it came out the other way.

  • AZgarfield

    Chris what are you talking about? “Needing to be ruder..?” This wasn’t the kind conversation that asked for rudeness and controversy–nothing is more boring than listening to raw anger on the radio. (I doubt there are lots of patients out there full of raw anger on this issue anyway–leave that for a show on malpractice) Chris, you had a great conversation going; , one that covered lots of intersting turf. I agree, you could have talked for two hours–there’s just SO much to talk abo when it comes to Healthcare. As Abby mentions, you guys need to a lot of shows on this topic.

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