Sometimes, the future arrives so swiftly that we don’t even notice the subtle revolutions unfolding before our eyes.
For years, the notion of patients searching for health information online was anathema to physicians. The slightest mention of patients as engaged consumers of health information would cue a noxious reflex from most providers, fueled, no doubt, by stereotypes of patients like these:
As recently as 2013, when I interviewed for medical school, stated interests and curiosities in healthcare social media, e-health, and participatory medicine were best, bold propositions, and at worst, toxic taboos.
“Do me a favor,” one dean of admissions quipped, “When you’re a third-year on clerkships, you’ll meet the man who’s been convinced by a WebMD search that his toe pain is diagnostic for brain cancer. Spend 15 minutes with that guy, then come find me and let me know if you’re still an optimist about online resources as tools for patient empowerment and engagement.”
Fast forward to 2015, where I’m now a clinical-phase student on an outpatient pediatrics rotation, and I finally have an answer for that dean–though it’s probably not the one he expected. I’m still an optimist in the power of online communities and digital content to equip patients with the information they need to engage in their clinical-decision making, as equals, with their providers.
Actually, after the conversations and clinical interactions I’ve witnessed these past weeks on pediatrics, that optimism has never held more firm.
Figure 1. An adolescent seen one week earlier for an acute infection and prescribed antibiotics returns with unresolved infection. The physician makes a diagnosis of antibiotic treatment failure. As she studies the literature for an appropriate second-line treatment, the patient’s mother does a Google search on her phone–and suggests a finding of her own. The physician reviews it, confirms it, prescribes it. Snap.
Figure 2. A child who is seen frequently for recurrent febrile illnesses presents for a well-child visit. The child’s parent mentions having searched online and identified a periodic fever syndrome consistent with the child’s clinical history. The parent shares printouts of relevant patient education materials, academic review articles, and diagnostic manuals with the physician. The physician agrees with the parent’s impression, and makes the diagnosis. Snap, crackle.
Figure 3. A neonate with a congenital condition arrives for a new-patient evaluation. The patient’s mother admits she selected this physician based upon reviews and recommendations from a local online patient community for disease-specific support. At the visit’s conclusion, the mother impresses the physician when she suggests a prescription for ondansetron–a tip she found through, yes, an online patient community. Snap, crackle, and pop.
As a health technologies optimist and medical futurist, it’s evident I’ve been so focused looking ahead to the future that I’ve missed the simple reality: in subtle ways, it’s already arrived.
We used to see e-health as synonymous with WebMD, the digital quack doc where all differential diagnoses lead to cancer. We used to think too much information would break the patient, break the doctor-patient relationship, or worst of all, break the monopoly on expertise that gave our profession relevance. We were, clearly, misguided.
The patient’s access to communities and open-access platforms for online health information is breaking healthcare–but not as doctors once thought it would. Instead, it’s breaking hierarchies, allowing patients to contribute to differentials and suggest treatments as engaged participants on their care team. It’s breaking barriers, connecting patients to insights and innovations previously sealed beyond paywalls and subscriptions. And it’s breaking the metaphorical walls of isolation, bringing patients in touch with others who understand the experience of living with illness and navigating a complex health system.
And every evening, as I drive home from another day in medical school, I’m inspired by the resilience of children, the resourcefulness of their caregivers, and the realization that I’m blessed to be entering medicine at a time of profound transformation, revolution, and creative destruction.