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Do-It-Yourself Health Care: A New Form Of Outsourcing?

Jessie GrumanThe outsourcing of work by businesses to the cheapest available workers has received a lot of attention in recent years.  It has largely escaped notice, however, that the new labor force isn’t necessarily located in Southeast Asia, but is often found here at home and is virtually free.  It is us, using our laptops and smart phones to perform more and more functions once carried out by knowledgeable salespeople and service reps.

This was particularly salient to me this week: I spent an hour online browsing, comparing prices, reading customer reviews and filling out the required billing and shipping information to get a great deal on a new lamp.  An airline would charge me 99 cents to talk to a person but provides information for free online.  Calls to Amtrak to make train reservations are routinely answered with a message that the wait to talk to an agent is 30 minutes, but that I can book travel myself – plus get better deals – if I do it online.  My bank has a small staff, limited hours and it charges extra for paper checks and mailed hard copy statements… but its Website is welcoming and useful, even at 3 a.m. Read more »

*This blog post was originally published at CFAH PPF Blog*

How Doctors Feel About Patients Who Google Their Symptoms

Many doctors roll their eyes whenever patients bring in a stack of research they printed out, stemming from a Google search of their symptoms. A piece by Dr. Zachary Meisel on describes a familiar scenario:

The medical intern started her presentation with an eye roll. “The patient in Room 3 had some blood in the toilet bowl this morning and is here with a pile of Internet printouts listing all the crazy things she thinks she might have.”

The intern continued, “I think she has a hemorrhoid.”

“Another case of cyberchondria,” added the nurse behind me.

It’s time to stop debating whether patients should research their own symptoms. It’s happening already, and the medical profession would be better served to handle this new reality.

According to the Pew Internet and American Life Project, 61 percent of patients turn to the web to research health information. That number is from 2009, so presumably it’s higher today. Health information online is akin to the Wild, Wild West. Stories from questionable sites come up on Google as high — or higher — than information from reputable institutions. Read more »

*This blog post was originally published at*

Doctors Really Want Well-Informed Patients

I met a patient today in the emergency department and had what is becoming a common interaction. Despite feeling quite ill, the woman had taken the time to prepare for her visit. When I first spoke with her, she enumerated her symptoms and how frequently she had suffered them. Then she reached into her purse, pulled out a stack of printed pages derived from several medical Internet sites – all of them names you would recognize. The pages covered her specific symptoms, a wide range of possible conditions, and a myriad of treatments. Some of the information was good, and some of it was not so good. But, the information was better than it would have been a year ago, or even six months ago.

This patient’s preparedness pointed out to me how well-informed many consumers are becoming as they attempt to manage own health. The fact that she may have been influenced by some misinformation merely underscores how much responsibility there is for information quality control, and how much of the assurance process is being delegated by default to the individual patients.

My take on this is that certain aspects of healthcare are increasingly shifting to self-care. Between the increased strain on healthcare resources (when was the last time that a doctor in a busy practice could expect to spend more than ten minutes with a patient) and increase in specialization, patients are forced to encounter numerous clinicians and coordinate their responses, in effect becoming navigators of the health care system.

Rather than resent it, I appreciate it when a patient is well informed, particularly if they have the ability to understand some of the basics of disease and disease management. The Internet has vastly changed the landscape of possibilities for understanding and confusion. The sheer quantity of health information that is easily and rapidly available to consumers via the Internet is staggering, and far exceeds what was formerly available to trained medical professionals.

If the reader is not overwhelmed and can apply practical filters to what is presented, then he or she becomes an educated patient. An educated patient makes smarter decisions and tends to be a strong partner in the treatment decision process.

The caveat is that every patient must recognize his or her limitations, and not attempt to self-treat beyond prudent boundaries, which will be determined over time. Of course, if one acts on incorrect information, that is a formula for failure, or worse. But what about good information? The downside of the increasing ubiquity of information occurs when any patient becomes overly convinced of particular facts of his or her diagnosis or treatment in the absence of proper clinical oversight.

I’ve heard colleagues tell stories of patients that were so completely convinced of a self-diagnosis based on articles they read online that they ended up opting not to pursue the treatment path recommended by their providers.  These patients inevitably ended up back in the doctors’ offices, having lost precious time. What this points out is that doctors have the greatest advantage to put everything in context. My advice is simply to be cautious. Even if the source is a trusted medical encyclopedia, “good information” misunderstood or misapplied can slow down the process. The goal is to apply superb information to make a layperson better informed, not overconfident.

As far as getting reliable information into a patient’s hands, in my relationship with Healthline Networks, I’ve advised on and reviewed Healthline Treatment Search, a product that creates customized, medically-guided pathways to inform and empower consumers on important health decisions. Whereas most treatment information is embedded deep within articles on health websites, Healthline Treatment Search surfaces a semantically-generated, stand-alone list of possible treatment options for diseases and conditions. The current release covers nearly 1000 health conditions, and includes 4,500 treatment options and 1,200 over-the-counter and prescription medications, with content from ADAM, Cerner Multum, Gale Cengage, Natural Standard, and others. It is Healthline’s policy that feedback from users, both consumer and professional, will allow their experience and observations to improve the product.

Not everyone is in agreement that the Internet is the best place for a consumer to begin his or her search to diagnosis or for treatment. But I would doubt whether this trend will be curtailed, because as the tools improve, we are witnessing increased demand for information. No other information source with the breadth and reach of the Internet looms on the horizon.

What do you think? If not with information from the Internet, how might we as professionals help empower consumers as they take control of their healthcare decisions? Perhaps another way would be to truly empower practitioners to use the Internet and electronic medical records for decision support, for we are also in need of assistance. Let me know.

*This post, Doctors Really Want Well-Informed Patients, was originally published on by Paul S. Auerbach, MD, MS.*

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