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In November 2007, Scott Haig, MD, an orthopedic surgeon and medical columnist for TIME, wrote an article for the magazine called “When the Patient is a Googler”. He described a patient of his he called Susan, whom he felt was emblematic of patients who research important aspects of their own health issues (and background information about their doctors). Haig writes:

“Susan had chosen me because she had researched my education, read a paper I had written, determined my university affiliation and knew where I lived…

Every doctor knows patients like this. They’re called “brainsuckers.” By the time they come in, they’ve visited many other docs already — somehow unable to stick with any of them. They have many complaints, which rarely translate to hard findings on any objective tests. They talk a lot. I often wonder, while waiting for them to pause, if there are patients like this in poor, war-torn countries where the need for doctors is more dire.

…Susan had neither the trust of a nurse nor the teachability of an engineer. She would ignore no theory of any culture or any quack, regarding her very common brand of knee pain. On and on she went as I retreated further within.

Susan got me thinking about patients. Nurses are my favorites — they know our language and they’re used to putting their trust in doctors. And they laugh at my jokes. But engineers, as a class, are possibly the best patients. They’re logical and they’re accustomed to the concept of consultation — they’re interested in how the doctor thinks about their problem. They know how to use experts. If your orthopedist thinks about arthritis, for instance, in terms of friction between roughened joint surfaces, you should try to think about it, generally, in the same way.”

The core of his article seems to be that the favorite patients of this type of doctor are those who just trust them or those who at least have the decency to think in the same way the doctor does, who agree with the doctor for their own reasons.

In response, Kaiser pediatrician and writer Rahul K. Parikh, MD, penned “Is there a doctor in the mouse? Arrogant doctors criticize their patients who go online to research ailments. But they’re wrong. The best health sites are a boon to patients and doctors alike” this month at Dr. Parikh offers an inspiring look at how e-patients can help heal our healthcare system:

“The medical establishment, in fact, has taken way too much time to understand that the Internet is a disruptive innovation that has overturned the status quo. It has leveled the playing field between expert and novice — in this case, doctor and patient. While some doctors like Haig may find that challenge threatening to their status as an expert, the Web is now providing the kind of information doctors need to be aware of if we want to continue to be good at our job, and the kind of trends that can help patients be smarter and healthier.”

Like me, this pediatrician is happy when his patients are online:

Patients who, prior to a visit, consult information online can better share in the decision-making process with their doctor. Afterward, they can go online to find information that reinforces their decision or introduces them to viable alternatives.

Dr. Parikh urges physicians to incorporate the health internet into their practice routine:
Today, there are many accurate, high-quality health sites, and doctors should make it a standard practice to recommend them to each and every patient. Besides reducing the randomness of a Web search, this can reinforce a physician’s advice during a visit, which is especially helpful, as studies show that patients typically remember no more than half of what their doctor tells them.

Obviously, my perspective is similar to Dr. Parikh’s, and I appreciate his articulate response to the resistance that too many e-patients still encounter. Patients and doctors alike have much to learn as we embark on healthcare in the 21s century.

We live in a time of rapid tectonic shifts in what it means to be a doctor and what it means to be a patient. I’m not surprised that there are clashes of ideology and practice. Our labyrinthine, barnacle-encrusted healthcare system resists change. So do our social structures that have lasted for millennia.

But already many e-patients and many e-doctors are actively enjoying a new way of relating, rooted in mutual respect and open access to health information.

I believe encouraging and equipping patients to search for health information is central to being a good doctor in the 21st century.