Nice post. Thanks for referencing my posts on this subject as well. (FYI: I referenced this article in my post and tried to trackback, but it didn’t work.)

Best,

Fard

I’ve spent a lot of time on this blog analyzing the benefits and drawbacks of Internet search and applying it to healthcare communications.  I’m a big fan of these technologies and think they have a lot of potential to help…

I started seeing the term ‘Information Therapy’ more and more in my research, but still don’t see physicians adopting it as part of their treatment/patient visits. Part of the reason being – there’s not enough time to have a complete understanding of the best sites to search for information about particular diseases/conditions/medications, etc. It would be helpful if hospitals who want to promote their specialists to referring physicians, created information prescription pads with suggested sites and search terms for conditions their specialists treat. Include a link to a bio of the specialist the primary care physician is recommending the patient see… I know from experience, this is the first thing that my mother looks up when she is being sent to a specialist. She wants to know all about her doctors.

If a doctor is affiliated with a hospital, often, that hospital is leasing information from a trusted source like mayoclinic.com, or harvard, or greystone for their website… directing your patients to search on the hospital’s site helps to build patient loyalty. Not to mention… giving the patient a couple search terms helps to extend the physcian-patient visit and improves patient satisfaction.

Where Google Co-op is concerned is a bit different than a medical dictionary. A medical dictionary is a scientific resource that has gone through many revisions and is edited by professionals. “Bob’s Cancer Emporium Website” is not subjected to the same regulations as peer-reviewed medical journal. If a patient came in with a journal article from the CMAJ, I would be happy to read it and discuss my opinion about it with them and to hear their own. If someone came in with a printout of “Bob’s Cancer Emporium Website” that says “chemotherapy has no proven benefit to cancer patients,” I would be less inclined to take the information seriously, but I would use it as a starting point to address the patient’s fears or concerns about chemo. I don’t want people to think that I am dismissing their concerns when I mention the unreliability of their source. It is an uphill battle to convince people that what they read was probably not the most medically-sound advice. In the end, if a person refuses a treatment or chooses and alternative, then I will respect that. However, if their decision is based on false information, I may have a problem with it. Google Co-op could fix this by ranking sites by scientific reliability rather than number of hits.

Regarding involving the interests of patients in treatment, I’d like to mention the prescribed approach. At UBC, we are taught the “FIFE” model for interviewing. We ask about what Feelings someone has about their current disease/symptoms and we ask what their Ideas are (i.e. do they think they know what is causing it? what is it associated with? did they know someone with something similar and are they worried that it could be the same illness?). We ask how it influences their daily Functioning (i.e. does it get in the way of daily living tasks? are your more worried about some impairment in function than the illness itself?) and finally, about Expectations (what do you think we can do for you today? is there anything in particular that you want addressed as a priority?). As much as students may joke about the “touchy-feely”-ness of the FIFE approach, it is really useful for giving the patient what they want and need. Sometimes, there expectations are unrealistic or their feelings are complex and linked to other life events. In these cases, we do have to explain why such and such a test is not necessary, or that even though your friend had a pheochromocytoma, that is very rare and there are many other things we need to rule out before we suspect it is that.

Healthcare is a partnership between and individual and their health care providers. We need to work together and not against each other in order to reach the best possible outcome based on the values of a patient and the sound medical information available.

Probably the very best thing a good doctor could do would be to provide a patient handout with an explanation of how to tell whether or not a source is valid, how to spot things that can be misleading, the difference between anecdote and evidence, and other such research tools, as well as a list of reputable, useful sources for patient education. Then, when a patient comes to you with their own research, take a minute to listen to them, find out where they got the info and why they think it’s applicable. They might be right, and it might be useful. If not, then give them the handout, and maybe explain what mistake they made. But if you just tell everyone who comes to you with anything like that “I don’t want to hear it, I’m the doctor. You’re not,” then _you’re_ not using every tool you have available, which, when dealing with potential life or death situations is dangerously arrogant, and you are treating your patients as less than you, and they _will_ pick up on that disrespect. I’m not saying if some quack comes in and says “I’m diabetic, give me insulin shots,” or whatever, you should just go along with them, but if someone comes in and says, “I have these symptoms, they began this way, and that correlates to _this_ disease (that possibly you hadn’t heard of), and I think I should be tested for it,” then it’d probably be a good idea to look into it. Or if they come in, after diagnosis, and say, “I found this study about this new treatment…” then it doesn’t hurt to look at the study. It might be a clever ad for snakeoil, and you can take a minute to educate your patient about such scams. Or it might be a properly peer-reviewed, statistically valid study that just came out and you hadn’t heard of yet, which gives you an entire new way to treat the condition. I guess what it boils down to is that doctors are not infallible or omniscient, and just because your patient isn’t a doctor _does not_ mean that they’re incapable of doing proper research.

I do fear google information that leads people to mix ammonia and chlorine to clean something or feed their children only brown rice and water in a quest for health or to fast for a week to lose weight. My favourite expression is a little information is a dangerous thing.

Finally with the help of famous quotes:

Know where to find the information and how to use it. That’s the secret of success.
- Albert Einstein

You tell ‘em.

However, I think there’s a line where some patients will self diagnose and assume they need a certain drug and won’t take no for an answer, and I can’t see any good coming of that. (hello antibiotic overuse!)

Scepticism ( i swear, I’m smart, just can’t spell that word) is good whether researching online or talking to a doctor.

( Why is it that I have all these freaking brains and NOT in med school? right, all those squishy bits and gross things human bodies do.. erg.right.)