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Physician-patient interaction and the Internet: The Canadian Experience

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Presentation to Med 2.0'10 conference in Maastricht, Nov. 29, 2010

Presentation to Med 2.0'10 conference in Maastricht, Nov. 29, 2010

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  • Interesting slide deck. Definitely can see the barrier of lack of incentives for physicians. Clearly fee for service could use some work, perhaps a great time to re-evaluate how we pay physicians. Makes me wonder what types of actual 'health care' could actually be possible if we didn't have our current 'illness care' system. Pay providers based on improving patient health, not per service.
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  • 1. Physician – Patient Interaction and the Internet: The Canadian Experience Pat Rich – Director, CMA Online Content
  • 2. The problem?
    • “ A disconnect currently exists between patients' use of the Internet and their consultations with their physicians. Too often, patients don't tell their physicians about their Internet use and physicians don't ask; both suffer due to the erosion of trust and missed educational opportunities.”
    • From: Improving Patient-Physician Communication about Internet Use: Why “Don’t Ask, Don’t Tell” Doesn’t Work Lisa N Gualtieri, Tufts University School of Medicine, Boston, U.S.; Medicine 2.0, Toronto, 2009
  • 3. How doctors and patients use the Internet for health
    • Patients
    • search for health information
    • maintain Patient Health Record
    • write a blog
    • monitor and/or participate in online discussion fora
    • interact with physician on patient portal
    • Physicians
    • search for health information
    • maintain practice website
    • write a blog
    • participate in online discussion fora
    • interact with patients on patient portal
  • 4. CMA e-Panel
    • “ Help us represent the views of Canada's physicians by joining a panel of doctors who have agreed to be contacted by email four to six times per year for their input on matters of importance to the profession”
    • started in 2007
    • currently 3,258 participants (practising physicians, medical students, residents, retired physicians)
  • 5. Physician-patient interaction
    • 1) Do you use the Internet for personal or professional searches about health information?
    • 2) Do you suspect ― or know ― if patients are bringing information they have gathered from the Internet to their medical appointment?
    • 3) Has greater access to medical information on the Internet improved the interactions you have with your patients?
    • 4) Do you provide recommendations for disease and/or treatment- specific websites to your patients?
  • 6. Response rate
    • 687 responses from 2688 e-Panellists (26%)
      • 37% family physician or general practitioner
      • 52% other specialist
      • 4% medical resident (trainee)
      • 4% student
  • 7. Main survey findings
    • 98% use the Internet to search for health information (87% for both personal and professional reasons)
    • 94% know or suspect patients are bringing information from the Internet to their appointment
    • 51% feel greater access to medical information on the Internet has improved interactions with patients; 21% feel it has not
    • 75% recommend websites to patients (57% unprompted)
  • 8. Patients and the Internet MD survey comments
    • Positive physician comments:
    • * patients more informed
    • * patients more compliant
    • * patients more willing to share decision-making about their own care
    • * many patients able to accurately rate the value of information gained from the Internet
  • 9. Patients and the Internet MD survey comments
    • “ Internet access enables patients to have a greater understanding of their conditions and prognosis, all of which can mean greater compliance with treatment plans.”
    • “ Patients are more informed and feel that they can corroborate what I am telling them. Also, they feel more in control in terms of making informed decisions. I have found that patients are at times overwhelmed with the information and are very appreciative of my comments and interpretation, as a trusted medical advisor. Patients often appreciate a little help in sorting out websites that are likely to be evidence-based vs. those that are not.”
  • 10. Patients and the Internet MD Survey comments
    • Negative physician comments:
    • * lots of inaccurate information on the Internet
    • * patients unable to assess value of information
    • * information overload
    • * time-consuming to correct patients if information is incorrect
  • 11. Patients and the Internet MD survey comments
    • “ Almost all patients (save for patients that are physicians) do not have the necessary critical appraisal skills required to analyze the information they obtain from the Web. Being able to read an article capably these days essentially is like ‘decoding’ a message which involves its own set of algorithms and ciphers.”
    • “ Ill-informed, opinionated patients can always find something to buttress a poor argument and (this) often interferes with their understanding of the disease or how disease management might work.”
  • 12. Survey strengths/weaknesses
    • Strengths
      • representative of Canadian physician population
      • asked questions for which little data exists
      • relatively good response rate
    • Weaknesses
      • not randomized
      • voluntary; self-selected responders
      • generalized questions
      • relatively poor response rate
  • 13. Canadian physician use of the Internet II
    • Unpublished survey of 300 primary care physicians in Canada
      • 60% consult the Internet for medical information
        • 77% consult the Internet between patients
        • 61% access the Internet during patient visits
      • Source: Personal correspondence with Pfizer Canada
  • 14. The times they have a-changed
    • Then:
    • Physicians were fearful of patients coming to their appointment with reams of unverified health information taken from the Internet, demanding explanations or, worse yet, treatment based on that information.
    • Now:
    • The Internet is accepted by both health consumers and physicians as a potential valuable source of health information.
  • 15. But ….
    • Many Canadian physicians still do not use electronic medical records or have computers in their examining rooms.
    • A shortage of physicians means physicians often don’t have time to discuss health issues in-depth with patients.
    • The remuneration system does not reward physicians for working with patients online.
    • The quality of health information on the Internet is still hugely variable, and the level of health literacy means health consumers are often unable to make a good assessment of that quality.
  • 16. Physician practice website
  • 17. Physician blog 1
  • 18. Physician Blog 2
  • 19. To infinity …. and beyond
    • Both physicians and patients are learning how to use social media to expand the connectivity and conversations regarding health
  • 20. CMA Perspective
    • “Patients and health care consumers want to use IT to manage their health more conveniently. Physicians can strengthen their relationship with their patients by encouraging them to participate more fully in their care. At the same time we can foster our growing role as health advisors and knowledge navigators, and ensure patients continue to get the best health advice from the most trusted advisor”
    • Dr. Brian Day, then-CMA President, June 2007
  • 21. Acknowledgements
    • Carole Deburggraeve and Angela Moffatt for e-Panel management
    • Marla Fletcher for review and editing of content
    • Bill Pascal and Maryan McCarrey for ehealth insights
    • MDs too numerous to mention for sharing their perspectives on this issue