Sunday, July 17, 2011

Technology: Information technology and the informed patient

As technology continues to advance many facets of our lives, patients will become more knowledgable about and have better access to their health information. This is already very evident in multiple patient interactions I have every day.

Often when I meet with a patient, particularly a computer literate patient, they have already googled their symptoms and they have their own provisional diagnosis. I have even been told which lab tests I should order. There are obviously both benefits and drawbacks to improved patient access to health information.

First and foremost, I love having informed patients. Caring enough to look up symptoms on the internet is correlated with patients being motivated to actually get better. The apathetic, deflated patients who aren't interested in taking an active role in improving their own health are notoriously difficult to treat because even if I develop an amazing therapeutic plan for them, they often do not care to follow it. These patients need two treatment plans. The therapeutic plan for the disease and the motivational plan to get them interested in following through with the therapeutic plan.

Second, patients who have researched their illness have often learned about the physiology surrounding their disease and treatment. Obviously, it is easier to teach someone about their disease if they have done their homework.

Third, these patients have often studied the different available treatment options and reflected on their illness giving them a better idea about what kind of treatment they want and what they are willing to sacrifice to get better.

However, patient access to health information over the internet is not always positive. For instance, patients can come to their own diagnoses for their symptoms because they read something from "Dr. Google". I had a patient who knew she had endometrial cancer because she had uterine bleeding after menopause. Now, endometrial cancer is certainly something that needs to be ruled out when a patient has postmenopausal uterine bleeding; however, there are many more common, benign diseases that cause postmenopausal uterine bleeding that should be considered too. These patients are often fixed in their belief that they have a serious disease and it can be very difficult to prove to them that they have a more benign illness.

Patients may also decide they know which test needs to be ordered because they read an internet post about a person who claims that their disease was misdiagnosed until some doctor ran the correct (but rarely indicated) test. For example, I had a patient who was suffering from jaundice, abnormal liver enzymes, and abdominal pain who admitted to heavy drinking. Unfortunately, he would not accept a diagnosis of alcoholic liver disease. Instead, he insisted that he first get tested for alpha-1 antitrypsin deficiency with a liver biopsy because he read about a patient online who had similar symptoms and was misdiagnosed with other diseases, including alcoholic liver disease, until one doctor ordered a liver biopsy. This patient would not accept that we can look at alpha-1 antitrypsin levels in his blood to screen for the disease, he wanted the gold standard test, which is the biopsy. Any surgical procedure has associated risks that only make them worthwhile when they are the best option and for a patient who has new onset hepatitis and a known history of alcoholism... a liver biopsy is notthe best or safest first option.

Of course, overall I think it is better to have informed patients than ignorant patients. The benefits of the internet educating people about their health far outweigh the problems. However, I would prefer if patient used their internet research to question and challenge doctors and not assume physician incompetence when your doctor presents a differing view than John Doe does in his blog.

No comments: