Wednesday, July 30, 2008

Health Care and Doctors

The long standing relationship between patients and doctors has long been revered as the sacred cow of the medical industry. Health care has been a critical component of how people relate to physicians and other medical providers. For hundreds of years, no one would dare to rock that boat. However, more and more these days, reports indicate that many patients are losing faith and trust in their doctors. An article in the NY Times this week shows that about 25% of patients feel their doctors expose them to unnecessary risks and medical treatment.

Another study indicated that trust between patients and doctors determines how strongly people take recommended medications. This mistrust is now showing up in books, on the internet, and with personal testimonies of patients. Additionally, patients are big on privacy which improves satisfaction with medical providers according to a report released this month by Atlantic Information Services. Patients with shared hospital rooms had lower satisfaction than patients in private rooms, and patients like to be in settings where no one else is listening to the details of their medical condition.

The NY Times stated that the reasons for the frustration are complex. Physicians only have a few minutes to spend with each patient due to more demands on time and less reimbursements per patient from insurance companies. People are also upset about the increasing number of medical errors and lack of personal interest by doctors when patients are being treated. The rise of direct-to-consumer advertising by drug companies and internet sites have taught patients how to research their own health issues leading to more skepticism and questioning. Doctors were once the primary source of medical information and how to be treated, but that has changed now with the advent of the internet and other media. Patients become very annoyed and impatient with medical providers when doctors appear not to be attentive with what the patients are saying or requesting.

The article goes on to report that there appears to be a disconnect between the way patients and doctors view medicine. Patients are interested in being tended to, listened to, and being well while doctors are trained to diagnose disease and treat it. However, even though it may be challenging and time consuming, patients can find a new provider to help improve the relationship between them and the doctor for more open communication. You should also go to the doctor's office with a list of questions so you don't forget any important medical issues; and if the physician tries to exit the exam room too fast, you can stop the doctor by saying, "I still have some more questions." Patients who are open with their doctors about their feelings and fears will often get a similar return of open dialogue.

According to the Journal of Post Graduate Medicine, patients are arriving to their clinics armed with information they have found on the web, with a preconceived idea about their diagnosis and treatment options, more demanding regarding convenience and ease of access. They want to actively participate in therapeutic decisions and want all the decisions to be informed and intelligent. Meet the new empowered patient; empowered by the information technology and its benefits. Health information seekers on net have exponentially increased from 54 million in 1998 to 110 million (U.S. figures) in 2002 and are ever increasing; and 80% of adult Internet users, or about 93 million Americans, have searched for at least one of the sixteen major health topics online. This makes the act of looking for health or medical information one of the most popular activities online, after email (93%) and researching a product or service before buying it (83%).

The Journal reports that the classical e-patient belongs to the younger age group. Women are more likely to have searched for a health topic than males. The classical e-patient is better educated and is more likely to belong to the higher income group. They search for specific medical condition (63%), medical treatment or procedure (47%), diet and nutrition (44%), exercise and fitness (36%). This is the group of patients who are very critical of their health problems. They have been brought up in this information age and make optimum use of the internet and other sources. Before the information era, knowledge of medicine belonged only to the physician. The patient's role in his or her physician's office was simply to listen and comply.

However, the Internet has opened up the doors of information like never before according to the Journal report. There are innumerable sites ready to dish out detail information about the patient's condition. Not just basic information, the e-patient also has easy access to latest developments, various different treatment modalities available for the condition and can then make an intelligent choice. He approaches the physician with preconceived notions based on the Internet information. Due to the extensive resources available on the net, e-patient is a highly informed patient. They use information technology to take informed decisions for themselves as well as their elderly relatives. An informed patient is obviously an intelligent patient and wants to play a much more active part in the management of his condition. This generation also makes up the impatient patient. They are used to cellulars, ATMs, broadband access, net banking. They are used to the pace of life and “at the click of the mouse” convenience in life. They are used to the convenient, personalized services provided by the other sectors like travel, finance etc. They want quick, convenient and personalized approach to their health problems, too.

The JPGM Journal continues to indicate that for most of the 20th century, due to the lack of information, patients suffered the era of “Doctor knows best”. However, come the information age and patients are empowered with information. The immediate fallout is the replacement of trust by skepticism and weariness. “Blind trust” is being replaced by “Informed trust”. In fact the first health contact which traditionally was the family physician; is slowly being replaced by the internet in many cases. Patients search the net and consult their physician armed with information. A Harris Online poll found that patients who use the Internet to look for health information are more likely to ask more specific and informed questions of their doctors and to comply with prescribed treatment plans.

Yet, there has been a tremendous resistance from the health care professional to the changing dynamics of the doctor-patient relationship in this information age. The main concerns being the variable and unreliable nature of medical information on the net, the lost human touch and also the perception of the informed patient as the problem patient. The Internet age offers opportunities to improve the patient-physician relationship by sharing the burden of responsibility for knowledge. Patients still trust the information given by their physician than what is available on the net. The physician should now assume the role of Consultant helping his patient to sort the information available on the internet and arrive at informed and intelligent decisions. Doctors have found that it may take less time to explain complex medical information to Internet users than to non-users. Physicians should accept consumer contribution as valuable.

The doctor-patient relationship can be a great one when patients are informed and feel that their health care provider is genuinely interested in them as a patient and a person. When physicians start treating patients as numbers on a chart they will lose the confidence of those who are relying on them for health care. When patients feel like they are cattle being herded in and out of offices, they are likely to stampede.

Until next time. Let me know what you think.

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