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e-Patients

By David Mendosa

Last Update: January 2, 2003

Doctors hate it when their patients hand them reams of information downloaded from the Web about their medical condition. Half the time that information is bad, says Jack Jue Jr., MD, family physician at the University of California, Davis, Health System in Sacramento. Patients are fooled by sites that look fancy and expensive.

‘A new cultural…system is emerging.’

These doctors had better learn to deal with it. They need to collaborate with their Internet-savvy patients, say experts at the 14th National Forum on Quality Improvement in Health Care. Sponsored by the Institute for Healthcare Improvement, the forum took place in Orlando, Florida, last month.

Tom Ferguson, MD, suggests that doctors "take a quick read of their patients" in terms of their level of Internet research. An adjunct associate professor of consumer health informatics at the University of Texas Health Science Center in Houston, he is also the editor and publisher of "The Ferguson Report," a free e-mail newsletter about online health.

Dr. Ferguson says that in terms of their research skills, patients tend to fall along a continuum. At one end is someone who is a professional online researcher. At the other end is someone who has no medical or research savvy at all. Between those two extremes is a wide range of people with different levels of education, medical sophistication, and interest in participating in medical decisions. Doctors have to work with each type of patient differently.

"People in the lower range—the passive medical consumer—as you treated patients before," he says. "People in the middle range, you educate, and people in the upper range, you treat as you would a colleague."

Colleague? Yes, treat them like equals. That certainly would change the dynamics between doctor and patient. Dr. Ferguson would go so far as to say that often patients know more than their doctors.

That's especially true when people with diabetes get their treatment from a general practitioner. It may be less true when their doctor is a specialist in treating diabetes.

"E-Patients are driving a health care revolution," Dr. Ferguson told the Forum on Quality Improvement in Health Care in a white paper on What e-Patients Can Teach Us About Health Care Reform." "The old, Industrial Age paradigm, in which health professionals were viewed as the exclusive source of medical knowledge and wisdom, is gradually giving way to a new, Information Age paradigm in which patients and family caregivers are also seen as potential managers and producers of health information and care. And since the cultural operating system of the former does not always effectively support the later, a new cultural operating system is emerging."

The numbers support Dr. Ferguson's thesis. The best current sources are the U.S. Department of Commerce's February 2002 report, "A Nation Online: How Americans are Expanding Their Use of the Internet", the Pew Internet Project's May 2002 report, "Vital Decisions", and The Harris Poll #21 of May 1, 2002, "Cyberchondriacs Update."

The Commerce Department's report says that two million Americans go online for the first time every month. Most of them use online health resources. In fact, the report says that six million of us use these health resources every day.

Dr. Ferguson and John Lester, his co-presenter at the health care forum, urged other doctors to capitalize on their patients' interest in taking care of their health and to direct them to sites formed by other patients. Mr. Lester is director of information systems at Massachusetts General Hospital' s neurology service. Despite the concerns of some doctors, "patients don't want to be doctors," Mr. Lester says. "They want to be better patients." 


The American Diabetes Association originally published this article on its Web site as one of my “About the Internet” columns.


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