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What Is The Physician’s Role In A Web-Based World



April 14th, 2009

Editor’s Note: Health Affairs is proud to be a media partner for the Health 2.0 Meets Ix conference, which will take place April 22 and 23 in Boston, Massachusetts. As part of the lead-up to the conference, which will focus on the interplay between the Health 2.0 and information therapy (Ix) movements, Health Affairs Blog and other participating blogs will feature a series of posts discussing ideas that will be featured at the conference.

The post below by Jay Parkinson addresses the question: Does the rise of Ix mean that physicians are captains of a wider care team, or does the rise of Health 2.0 mean that doctors find that their roles in patient care are increasingly marginalized? Earlier posts by Rushika Fernandopulle and John Halamka discussed building Health 2.0 and Ix into the delivery system. Parkinson, Fernandopulle, and Halamka will participate in debates on their topics in Boston.

The first post in the series described the background and main themes of the Health 2.0 and Ix movements.

With all of the super accessible health information now available, consumers have turned into the equivalent of first year medical students, armed with too much information but not enough objective experience. The ideal doctor patient relationship is a partnership centered around facts and good communication that is based on our experience. The internet has enabled us to communicate in ways which are more and more interesting and, ultimately, more efficient. Except the online doctor, the curator of all these personalized facts, is nowhere to be found.

I spent a few sessions with a psychiatrist my first year of med school because I was convinced I had MS. Well, 11 years later I’m symptom-free and here to tell you all about how I beat that crippling disease called Medical Student Syndrome. But as health professionals all know, it’s the combination of facts, experience, and reason that enables us to do our jobs well. Fortunately for our ability to earn a living, internet health information is just facts. So our jobs are still needed because, for the foreseeable future, we still offer experience and reason.

All jobs consist of executing the steps within a larger project. Most people have five or six projects at any one time that keep them busy for 40 hours a week. Web apps like Basecamp and Action Method were created to help people get these steps done. They help people organize with a team of people, delegate responsibility to any one of their teammates, and keep track of the project’s progress. They’re absolutely brilliant and a lifesaver for the modern workplace.

Doctors have about 2000 patient projects. And we get, on average, one hour with each patient per year to serve as their project leader, delegating the other 8,765 hours to our patient who manages their health on their own, disconnected from us and unable to receive personalized information or ask questions except during the occasional, all-too-short office visit.

Both Basecamp and Action Method were designed to share information and facilitate goal-oriented, efficient, online communication between teammates who aren’t working in the same geographic area. Awesome! Wouldn’t that be nice to have with our patients?

Ha, in an ideal world. We only get paid for office visits and procedures. We surely don’t get paid for communication and definitely not for prescribing links personalized to each patient. And there isn’t a single profession in the world that works for free.

The reality is this:

Percentage of people age 65 and over online today = 41%

Percentage of docs and hospitals who use computers = 9%

Percentage of people with home computers in 1985 = 15%

Even the elderly are more wired than doctors! And guess what they’re doing? They’re visiting Dr. Google. If their team leader isn’t accessible, well, folks, it looks like patients are on their own turning to really helpful resources like ACORMEDgle, other patients, Your Flowing Data, and rateadrug.com. Without a doctor on the other end of these links, even those cutting edge, senior netizens are leaving us behind blinded by their dust as we’re struggling to write our own chicken scratch paper notes.

Doctors…eating the elderly’s dust isn’t your fault. You can’t work for free. And since the Feds define how we get paid (with this, not for this), we’re going to limp along, weighed down by our paper charts and federal bureaucratic initiatives that will soon face stiff resistance from the people who don’t kill golden geese, while society races past us in this era of profound changes in the way humans communicate. If only the way we get paid could be updated for the 21st Century, our patients wouldn’t be marginalizing our efforts. I can dream, can’t I?

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4 Trackbacks for “What Is The Physician’s Role In A Web-Based World”

  1. Participatory Democracy, Participatory Medicine | writteninfo.com
    April 22nd, 2009 at 9:07 pm
  2. Health Care. (united health care, universal health care) » Blog Archive » Participatory Democracy, Participatory Medicine
    April 21st, 2009 at 8:30 am
  3. Are the elderly more technologically plugged in than doctors? | Hospital Health Care
    April 19th, 2009 at 7:00 am
  4. linkfeedr » Blog Archive » Are the elderly more technologically plugged in than doctors? - RSS Indexer (beta)
    April 18th, 2009 at 5:56 am

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