Healthcare in the Information Era: Patients Are Taking Control

By J.C., on September 24th, 2008

I was reading an interesting article the other day that used the term “cyberchondriac.” I couldn’t stop laughing at the apt description of a patient who used the internet to gather information about their health concerns. Cyberchondriacs have been described in the popular media as ranging from those with neurotic excess to hypochondria. In my experience, it is common to have a cyberchondriac as a patient.

In my practice, I describe a cyberchondriac as a patient who does research on their condition or who comes up with a self-diagnosis based on their reading. They often tote a stack of papers and articles with them in to their doctor’s appointment. They usually take up more than the allotted 20-minute time slot per patient, and they usually have a slew of questions regarding their diagnosis. If your diagnosis of them is not consistent with what they have read, they will ask even more questions. Often these are the types of patients who will call your office wanting to speak with you and leaving messages with specific questions.

Most doctors are not big fans of cyberchondriacs. I actually am a big fan of them but just not in my practice. They tend to take up way too much time and really throw off my schedule. Additionally, they often have unrealistic expectations about their prognosis. With that being said, the reason I am a fan of them is that I think everybody should be a cyberchondriac.

Whenever I have a bump or bruise or ailment, I immediately start reading my textbooks or looking up stuff on the Internet. Patients who have this tremendous resource at their hands and do not utilize it place a lot of faith in the medical system and their physicians. I have been on both sides of the treatment table and know that, the more you know and the more you can take control of your care, the better off you will be. Physicians are not always correct, and the system moves very slowly. At every step of the way, it does pay off to be a cyberchondriac and make sure that no one has dropped the ball.

I like to view the medical system as a logistical pathway that ends with treatment, follow-up, and resolution. It’s kind of like when you order something online. A good online store will have a great logistical system and will email you or allow you to check online the status of your order. If there is a delay, you will get an email notice of it. If your credit card expires and they need updated information, they will notify you of this online. And finally, you get that email saying that your order is shipped and that you can look up the tracking number online.

Unfortunately, there is no logistics feedback in the process of medical care. If you have a problem with your knee that requires an MRI, radiologist read of the MRI, follow-up appointment, surgery scheduling, pre-operative lab work, etc., there is no way you can find out how all of this stuff is going. Did your MRI results come back? The only way is to bug the office and keep asking if the doctor got the result. Were your lab results OK? The only way to find out is to call the office or come back for another appointment.

It’s a real cumbersome system, but the cyberchondriac is the one who challenges and demands that the system works better for his own care. Someday this will all change but not until we have a world of cyberchondriacs that demand change. When an office becomes inundated with phone calls and demands for lab results from cyberchondriacs, it will figure out an efficient way to provide feedback on the progress of medical care.



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Should Physicians Advertise for Their Services?

By J.C., on August 19th, 2008

We’ve been talking a lot here about physicians and the business of running a medical practice. Lately, I have been seeing a growing number of physicians advertise on television. This makes me wonder – Should physicians advertise for their services?

In some circles many feel that it is unethical for physicians to advertise. It is sort of like ambulance chasing attorneys. More and more I am seeing cheesy ads by Plastic Surgeons on TV. They brag about how you can get a breast augmentation and how no one will even know. They talk about how they stand out above all other plastic surgeons. It all seems so tacky to me, kind of like the lawyers who advertise on TV.

Everybody knows that when you look for a lawyer you don’t find one from a TV ad. In general you find one by word of mouth and referral. The same goes for doctors. If you want to find a good specialist, you see your primary care physician who refers you to who they think is a good specialist. That is the way insurance companies want the business to work. Your primary care physician is the “gatekeeper” who handles and approves the referrals.

Television advertising does appeal to mass populations. However, most lay persons do not know who is a good doctor and who is a bad doctor. Although there are websites out there that now provide patient feedback and opinion on doctors, the truth is that only people who work closely with that doctor know how good they are. Thus one good way to find a doctor is to get in touch with your doctor friends and people who work in the healthcare industry. They will give you the skinny on that doctor you are considering seeing.

So what is the deal with physicians and advertising? Well you will find that physicians who advertise do so because they are in a lucrative field and want to drive up their business. Alternatively it may be the medical center or hospital they work at who would like to advertise a special “center” where that doctor works. For example, a regional cardiac center may want to brag that they have the best heart specialists. Thus they will put up a billboard or TV spot advertising their center with the faces and names of their heart doctors.

In general I believe doctors have the right to advertise their business, but I am not a big fan of it because I don’t believe it places physicians in a good light.



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How to Choose Your Doctor Online…and Annoy the AMA

By Jennifer Bunn, on July 6th, 2008

A recent poll by the California HealthCare Foundation found that even though a substantial amount of patients use the Internet to obtain their health information, few patients make use of the physician rating sites, and fewer still (2%) used the information available to change their physician. However, this could change as more people become aware of the availability of this “service” and insurers push patients to use them.

The AMA has certainly voiced their reservations about this practice. The push for these types of sites seems to be coming from insurers in tiered networks.

“In such networks, health plan members pay less out of pocket for seeing physicians who meet the insurer’s quality criteria, which doctors generally have criticized as faulty.”

-P. Dolan (http://www.ama-assn.org/amednews/2008/06/23/bil10623.htm)

The author goes on to say,

“Much of the growth in physician ratings sites have come from health plans pushing a consumer-driven approach to health care.”

Also of concern, according to Dolan, are insurer-based sites that allow patients to post unproven comments regarding their doctors, a practice that seems dangerously close to the definition of libel. The legal definition of libel is “a false and malicious publication printed for the purpose of defaming a living person.”

Patients should be aware that there might be ulterior motives to these sites before taking advantage of the information contained within. It is doubtful that insurance companies are sponsoring some of these sites simply for altruistic reasons; rather, they are hoping that they will be able to steer their customers to doctors that fit into their system in terms of cost-efficiency.

As for whether or not it can be considered libel to make potentially career-altering statements about physicians online, patients should take these statements with a grain of salt, as they must for a lot of information found on the web that is often misleading or blatantly false.



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