There’s a revolution beginning in the practice of medicine. It’s about a shift in power which will change the way doctors work. It’s quite fascinating to see the early shoots appearing and it’s way too early to be able to say exactly how this is going to develop.
One of the change factors is what is being termed “Health 2.0”. This term is being used in different ways but it mainly refers to the use of social networking tools. This is one of them – a blog. Blogs allow anybody to publish anything of interest. Some blogs are just websites trying to sell something, and some are so highly personal that they are only of interest to readers who already know the blog author. But the most exciting blogs are those which allow sharing of experiences, views, information through tools like links, tags, comments, blogrolls and so on. Social networking sites like Facebook, Myspace, Bebo and so on are other ways of sharing experiences views and information. I could go on, but I won’t! There are more and more tools emerging all the time. What do they have in common? They are about sharing. They allow people to access the stories of others’ experiences.
What’s this got to do with health?
Well, the traditional doctor-patient relationship is based on a doctor as the expert who knows best and a patient who will passively accept the doctor’s recommendations, whether that be a prescription or an operation or whatever. The power sits with the doctor and the patient often feels intimidated or unheard. The new way is patient-centred, another term which means different things to different people, but which usually includes giving a higher prioirty to the patient’s issues and wishes.
There are two elements to this “Health 2.0” change – doctor-patient communication and patient-patient communication. The US Institute of Medicine’s report “Crossing the Quality Chasm” suggested that care be seen in future as less “event based” and more “relationship based”. It recommended that doctors and other members of health care teams be more accessible to patients and that care becomes an ongoing process rather than conceived of as something that only happens in “consultations” or “office visits” or “admissions”. An article about these changes was published in the BMJ last week. It highlighted the need to shift towards what it called “conversations”, giving one example of moving the patient record from being a doctor-held property to being a document co-created and shared between doctor and patient –
An example of this conversation is that created when general practitioners share records with their patients by posting them on the web. It is being pioneered by a group of English GPs in the patient access electronic records collaborative, using the EMIS information system for primary care. GPs will post up the patient records on a password protected site and patients and their GP will be able to access them.
This sharing of information is a major driver in the shift of power. Not only will personal information no longer be the sole preserve of the authorities (think also of Donald Berwick’s speech to the NHS where his first recommendation for improvement was this – “Put the patient at the absolute centre of your system of care—In its most authentic form, this rule feels very risky to both professionals and managers, especially at first. It means the active presence of patients, families, and communities in the design, management, assessment, and improvement of care. It means total transparency. It means that patients have their own medical records and that restricted visiting hours are eliminated. It means, “Nothing about me without me.”) but more and more information is being shared. The BMJ article, for example, highlights the development of the NHS Choices supersite http://www.nhs.uk and facilities like Healthspace and Medpedia as examples of the much wider publication of health related information.
The second element is collaboration and sharing between individuals. These new tools allow people with similar problems to not only share their experiences but also to discuss what they’ve personally found helpful or harmful.
Demos, a UK-based thinktank has recently published an excellent document entitled “The Talking Cure” which encourages people to think about these changes. In that document they state –
“If we are serious about engaging patients in their own care, we need to recognise that current structures of choice inhibit responsibility.” Choice “requires a genuine negotiation, a conversation between patient and doctor, and a shift in logic.”
and
Truly personalised healthcare allows patients to articulate their experiences, express their values, set their priorities, be aware of their options, exercise their preferences and be educated in managing their health. This means an end to paternalism
The Demos document very interestingly compares the mechanics and hairdressers as models of ways in which doctors work – yes, really!
Today, the typical motorist may have a rough idea of what is wrong with his or her car but leaves it to the mechanic to make an exact diagnosis, define a successful outcome, and prescribe the procedures needed. A visit to the hairdresser on the other hand begins with a conversation to elucidate what the client wants done (and whether it is practical) and may continue throughout the visit. At the end, the client assesses the outcome.
I find all this very exciting. It’s going to shift health care into collaborative relationships which focus on the needs, experiences and wishes of individual patients. This represents a huge challenge to the command and control, expert knows best, model of passive patients who are told what to do by others who claim to know better than the patient what will make their life better.
nice article.
You were on the front page of WordPress with this very interesting post. I had to click through.
I, myself am absolutely amazed at the power of the blog for sharing experience and advice. So many people now are taking it into their own hands to get to the root of their health problems, perhaps after seeing that mainstream health care is sometimes only at best a sticking plaster for the problem. They are searching through all the channels you list.
I have been continually surprised by a post of mine on colon cleansing which has had close to 60,000 views alone.
Oftentimes, an emotional dimension can be at the root of an illness, this is where the internet comes into its own by providing the seeker with a readily available community of others who have had or are having the same troubles. A support group that is accessible at any time of day, from most anywhere in the world can help individuals with their emotional pain. And as you say, perhaps even the fact that one can talk and share their problems in this way, goes some length to diminishing them.
I find it all absolutely fascinating and writing a blog has helped me no end.
They say Blogging is better than therapy, I just might believe it.
I would like to relate and experience to you and find out what you think.
I don’t think about health care much as a 20 something guy who has for the last several years been relatively healthy. I had a bought with a serious intestinal problem that was never diagnosed but caused me to drop about 35lbs in little over a month and vomit almost daily. Since then I have been in good health.
That being said, I just got done having my dog Kane treated for a herniated/ruptured disk in his back that caused him to be paralyzed in his hind legs. He had several radiographs, and MRI, and a surgery to remove the piece of bone that was causing his spinal cord to bunch up.
Here is the point of my story. The doctors I dealt with at the veterinary hospital we far more kind, patient, open, and understanding than any people doctors I have ever dealt with. They not only took the time to explain the MRI to me, but visited with me and my family as we visited our dog after surgery. Moreover, they called me daily (sometimes twice) to update me on the condition of our beloved family pet. I know they have many other patients since this is one of the top five vet schools in the nation and the doctor who operated on my dog is considered one of the best neurologists in the nation who specializes in doggy spinal cord injuries.
I’ve never been treated this way by a people doctor. Why do you think there is such a great difference? Law suits? The fact that there is no third party payer who will take care of the medical bills? Anything else?
A global, patient-led website for patients struggling with keratoconus (www.kcglobal.org) helped me to find the best treatments for my child’s failing eyesight, when all the local cornea specialist would offer was a double cornea transplant. I was able to find up-to-date medical information from around the globe as well as significant emotional support during the diagnosis, treatment and recovery periods.
US doctors are still a bit un-nerved by patients who don’t agree with their every word, and who come into consultations armed with the latest research. It will take a few years for the situation to change here.
Yes, Lune, it’s about making connections, isn’t it? That lets us both find things out we didn’t know, and develop emotionally supportive relationships.
Wow, “totaltransformation”, THANK YOU for posting this story! The example you give of the way the vets interacted with you, should, in my opinion, be exactly what you should experience with a “people doctor”. Yet, you’re right. It’s seldom (if ever) like that. Why? I don’t have the answers but I would say it wouldn’t at all surprise me to have heard a similar story here in the UK. We don’t have the law suit issue here that you have so I doubt that’s the explanation. We do have a universal cover Health Service for people but not for animals here, and I’m not sure…..is that part of the explanation? Maybe it is. But I’ve heard plenty of stories from patients who consulted a doctor privately (not under the NHS) and the only difference was they got to see the doctor more quickly……it wasn’t a different relationship. I don’t know much about vets. I don’t have any pets and I’m not a farmer. However, I was recently asked to teach a bit at a congress for vets who practice homeopathy and my experience was that every single one of those vets was passionate about their work, amazingly compassionate about their patients and totally enthusiastic about being a vet. That impressed me. In defence of “people doctors” I would say that my experience amongst doctors who practice homeopathy is the same as the one I had with the vets.
So, I think it’s an attitude of mind as much as anything else. It’s about caring. Really caring about a patient’s experience and what happens to them. That’s what makes the difference.
That’s what we need to more of in Medicine. Maybe it’d be a good idea for vets to run courses for doctors!
@americanpostcards, thanks for sharing that. The example you give is typical of what’s happening and you’re right it is shaking the old, traditional model at its roots. I find it very sad that a doctor should be challenged by a patient turning up with the fruits of their own research into their problem. Whose problem is it? Whose life is it? Isn’t it the doctor’s job to help the patient? To understand them, their agenda, their experience and help them find the solutions which will work best FOR THEM?
I ran a pre-operative preparation clinic for more than 10 years at greater than 50,000 patients per year. Interviewing older patients (over 55 years), I was impressed by their shallow depth of knowledge of their own medical problems or their medications. I interpreted this to mean that they explicitely trusted their doctors to decide what therapy (meds or surgery) were right for them. In contrast, younger patients are usually armed with data (?Googlefied) at their visit and want to discuss options. Are we in the midst of a transformative era in our service-oriented society? This parallels the new attitude of government as a provider of “government services” to its’ “customers”. We all realize that we have choices and given the easy access to all sorts of data as well as the sharing of blogs, we are more likely to demand a say in our consumption of services (medical or other).
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