When I was a resident, one of my least favorite things to hear from the parent of a patient was “Well, my mother thinks he has….” The current equivalent is “I looked on the Internet and I found…” Many of you know that fear of having to contradict grandma or Google, of the often lengthy and sometimes contentious discussions that would ensue.
Now along come new apps and devices that are only going to make this kind of conversation more common. Examples include an iPhone attachment that turns the camera into an otoscope, and another that obtains an EKG. In both cases, the image or tracing can be transmitted to a health care provider for interpretation, but naturally the patient and family have access to it as well. Most electronic health records have some form of patient portal (such as Epic’s MyChart) that allows access to test results.
Health care, like many other sectors of the economy, is becoming democratized. Patients are demanding a more active role in their care, a decades-long trend that is being facilitated and accelerated by advances in information and other technologies. It is understandable that health professionals would, to varying degrees, lament or resist this change. Our roles become, if not necessarily, harder, at least different. I liken it to how the role of educators has shifted. Teachers used to be the experts, valued for their ability to master a subject and convey information to passive recipients, usually via lecture and recitation. In the early 20th century, Woodrow Wilson introduced the concept of the preceptorial – education not as passive transmission of knowledge but facilitated discussion – which quickly became the dominant model at the university level.
Similarly, medicine is becoming less of a hierarchy and more of a partnership. Providers need to be not only technically skilled, but able to serve as preceptors to patients who become active participants in their own health management. We can bemoan or belittle the use of the Internet and other resources by patients and families seeking a greater role in their care, or the use of a smart phone to look in their child’s ears, but it’s not going away. Our best bet is to guide them, so they can make good use of what can be at best confusing and at worst misleading information. Last summer my son sent me this email:” I have a rash on my hands. According to Google, I either have eczema or AIDS. I hope it’s the former.”
At a national pediatric meeting a couple of years ago, one speaker contended that the area of “medical interpretation” – communicating medical concepts to the general public – would be one of tremendous growth in the next decade. Undoubtedly there will be non-physicians who will do this, and do it well – I think, for example, of Rebecca Skloot, author of The Immortal Life of Henrietta Lacks – but it’s also part of our job as providers. As an academic medical center, we embrace innovation and education; it should be just as true of our patients as our students and trainees. As Sy Syms used to say, “An educated consumer is our best customer.”