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The Informatics Client:
            Dealing with Patients Who Surf the Net
                                           Iris Thiele Isip Tan MD, MSc, FPCP, FPSEM




                                                                         Image from asifthebes
                                                             http://www.sxc.hu/photo/1060873

3 May 2011
Philippine College of Physicians Annual Convention
Image from zizzy0104
http://www.sxc.hu/photo/794884




               Do you practice Participatory Medicine?
               Have you met the e-Patient?
               Are you Internet-hostile?
Web 1.0
“the mostly read-only Web”




                                              Image from liquene
               http://www.flickr.com/photos/liquene/3900145161/
Image from adactio
http://www.flickr.com/photos/adactio/78600196/




                                                Web 2.0
                            “the wildly read-write Web”
Crowd-sourcing
Harnessing collective intelligence




                                                    Image from antigone78
                          http://www.flickr.com/photos/antigone/457089364/
Physician as INTERMEDIARY:
gatekeeper of health information




                                                         Image by judepics
                         http://www.flickr.com/photos/judepics/2059494008/
APOMEDIATION
Less reliance on traditional experts
                                                           Image by migclick
                           http://www.flickr.com/photos/migclick/2535570629/
“As opposed to the doctor-centric, curative
model of the past, the future is going to be
           patient-centric and proactive.”
                       Elias A. Zerhouni MD, NIH Director
                                               Dec 2007




                                                              Image by JD Hancock
                                http://www.flickr.com/photos/jdhancock/4100030094/
“Movement in which networked patients
                                       shift from being mere passengers to
                                      responsible drivers of their health ...
                                                   providers encourage and
                                                 value them as full partners”
                                                         Society for Participatory Medicine




Image by Liz Grace
http://www.flickr.com/photos/liz-grace/5078868809/




                    Participatory Medicine
Patients as members of
                                              collaborative treatment teams
Community health
decision-making




           Image fro
                     m
           http://ww network
                    w.sxc.hu/
                              photo/98
                                       5516




                                          “Mindfully”
                                          involved in
                                          treatment
Online community/
                                                               “Participatory Medicine”
support group                                                            from Wikipedia
Image from zizzy0104
http://www.sxc.hu/photo/794884




               Do you practice Participatory Medicine?
               Have you met the e-Patient?
               Are you Internet-hostile?
3 Categories of e-Patients*
                   from Cain, Sarasohn-Kahn & Wayne (2000)
               “Health e-People: The Online Consumer Experience”



    The Well                                                                         Image by WebWizzard
                                                       http://www.flickr.com/photos/webwizzard/3931165028/


    The Acutes
         Facing a new
         medical challenge

    The Chronics
         Chronic but
         stable illnesses

* Includes caregivers
Image by iwd
http://www.sxc.hu/photo/1129780




                   60-                          5-                        30-
                  65%             1            6%         2              35%        3

                         The                   The                        The
                         Well                 Acutes                    Chronics
                   every                                                 several
                    few                      everyday                    times a
                  months                                                  month


                                      Internet Access
                  from Tom Ferguson, MD & the e-Patients Scholars Working Group (2007)
                            “e-patients: how they can help us heal healthcare”
8   out of 10 American
    internet users have
    searched online for at
    least 1 major health topic!
                     from Tom Ferguson, MD
        & the e-Patients Scholars Working Group (2007)
       “e-patients: how they can help us heal healthcare”
Diet, nutrition,    Exercise
   Specific             vitamins,         or fitness
  disease or         supplements           42%
medical problem           51%
     66%                                Prescription or
                Medical
             treatment or                OTC drugs
              procedure                     40%
                 51%




Health Topics Searched Online
from Pew Internet & American Life Project Nov 2004 Survey
e-patient & Empowerment
          From Von Knoop at al of Boston Consulting Group (2003)
                 “Vital Signs: e-Health in the United States

Severity of
 Condition
       High                                    In control
                                     Involved


  Moderate


                                        Informed
       Low        Accepting
              Godlike                 Partner          Supplier
                   Attitude Toward Physician
From Von Knoop at al of Boston Consulting Group (2003)                                         Image by iwd
                                                                           http://www.sxc.hu/photo/1129780
       “Vital Signs: e-Health in the United States




         1                            2                     3              4

       Accepting                     Informed              Involved       In control
       Doctor-                    Doctor-                   Junior
                                 dependent                               Autonomous
    dependent &                                            medical
                                but informed                               patients
     uninformed                                            partners


     Rarely go                   Go online                 Prefer to      Make their
     online for                  before or                 make joint    own decision
       health                  after MD visit            decisions but    even if MD
    information                                           defer to MD     disagrees
“Paradoxically, a patientʼs interest in knowledge
    may not always accompany an interest
   in the medical decision making process.”
              Gerber & Eiser, Journal of Medical Internet Research 2001




                                                                                 Image by nightRPstar
                                               http://www.flickr.com/photos/ninjanoodles/1586212326/
Image by Kurhan
http://www.sxc.hu/photo/1314902




                                                                               Informed
                                                                         decision-maker


                                                                Knowledge-acquirer



         Physician-Patient Encounters
                                  Gerber & Eiser, Journal of Medical Internet Research 2001
Image from carbonNYC
http://www.flickr.com/photos/carbonnyc/3440688097/




                                       Interested in learning
                                       more about the
                                       treatment decided
                                       on by MD



                    The Knowledge-Acquirer
    Provides some personal values to the physician
                                                    Gerber & Eiser, Journal of Medical Internet Research 2001
http://www.flickr.com/photos/72341818@N00/4555752947/


Extra time to discuss
what patient knows
                                     Avoid frustration of not
                                      being the sole source
                                              of information




  The Informed Decision-Maker
 Possesses both preference and knowledge
                 Gerber & Eiser, Journal of Medical Internet Research 2001
Image from zizzy0104
http://www.sxc.hu/photo/794884




               Do you practice Participatory Medicine?
               Have you met the e-Patient?
               Are you Internet-hostile?
Image by Niklas Hellerstedt
                                                 http://www.flickr.com/photos/niklashellerstedt/2414448568/




              Tom Ferguson, MD & the e-Patients Scholars Working Group (2007)
                             “e-patients: how they can help us heal healthcare”


              Internet-hostile
Clearly uncomfortable with, and sometimes seem to feel
  offended by patientʼs attempts to learn more online
“[Most doctors] really
  do like to think they
have ALL the answers.
    This will never
 change, I am afraid.”

   Pew Internet Project e-Patient Survey




                                                   Image by caricaturas
          http://www.flickr.com/photos/caricaturesbynelson/2031107541/
Image by southerntabitha
http://www.flickr.com/photos/tabithahawk/567135091/




                                             Tom Ferguson, MD & the e-Patients Scholars Working Group (2007)
                                                            “e-patients: how they can help us heal healthcare”



                                           Internet-friendly
                                 Encourages patientʼs online efforts
Image by Charles Williams
                                           http://www.flickr.com/photos/charlesonflickr/3926259585/




Patients will likely seek
a “second opinion”
on the internet




                 Gerber & Eiser, Journal of Medical Internet Research 2001


   The Internet Prescription
      Recommend websites to the patient
Medline Plus
http://www.nlm.nih.gov/medlineplus
Mayo Clinic
http://www.mayoclinic.com
Look for the
HON Code seal

     Health on the Net Foundation
     Medical information you can trust!
            http://www.hon.ch
 also provides HONtools, HONsearch, HONtopics
Image by Yogendra174
http://www.flickr.com/photos/yogendra174/4437447471/




                                                                Do not underestimate
                                                                    patientsʼ ability to
                                                                       provide useful
                                                                     online resources




                                           Tom Ferguson, MD & the e-Patients Scholars Working Group (2007)
                                                          “e-patients: how they can help us heal healthcare”
Image by steved_np3
                                                                    http://www.sxc.hu/photo/1339516




Do not overestimate
the hazards of
imperfect online
information
Database of Adverse Events Related
to Internet Use (DAERI) reported only
a single case of possible fatality from
2000-2004

Tom Ferguson, MD & the e-Patients Scholars Working Group (2007)
               “e-patients: how they can help us heal healthcare”
Image from zizzy0104
http://www.sxc.hu/photo/794884




               Do you practice Participatory Medicine?
               Have you met the e-Patient?
               Are you Internet-hostile?
Thank You
http://www.endocrine-witch.net
            @endocrine_witch




                                 Image from http://wthr.frumph.net/

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Dealing With Patients Who Surf the Net

  • 1. The Informatics Client: Dealing with Patients Who Surf the Net Iris Thiele Isip Tan MD, MSc, FPCP, FPSEM Image from asifthebes http://www.sxc.hu/photo/1060873 3 May 2011 Philippine College of Physicians Annual Convention
  • 2. Image from zizzy0104 http://www.sxc.hu/photo/794884 Do you practice Participatory Medicine? Have you met the e-Patient? Are you Internet-hostile?
  • 3. Web 1.0 “the mostly read-only Web” Image from liquene http://www.flickr.com/photos/liquene/3900145161/
  • 5. Crowd-sourcing Harnessing collective intelligence Image from antigone78 http://www.flickr.com/photos/antigone/457089364/
  • 6. Physician as INTERMEDIARY: gatekeeper of health information Image by judepics http://www.flickr.com/photos/judepics/2059494008/
  • 7. APOMEDIATION Less reliance on traditional experts Image by migclick http://www.flickr.com/photos/migclick/2535570629/
  • 8. “As opposed to the doctor-centric, curative model of the past, the future is going to be patient-centric and proactive.” Elias A. Zerhouni MD, NIH Director Dec 2007 Image by JD Hancock http://www.flickr.com/photos/jdhancock/4100030094/
  • 9. “Movement in which networked patients shift from being mere passengers to responsible drivers of their health ... providers encourage and value them as full partners” Society for Participatory Medicine Image by Liz Grace http://www.flickr.com/photos/liz-grace/5078868809/ Participatory Medicine
  • 10. Patients as members of collaborative treatment teams Community health decision-making Image fro m http://ww network w.sxc.hu/ photo/98 5516 “Mindfully” involved in treatment Online community/ “Participatory Medicine” support group from Wikipedia
  • 11. Image from zizzy0104 http://www.sxc.hu/photo/794884 Do you practice Participatory Medicine? Have you met the e-Patient? Are you Internet-hostile?
  • 12. 3 Categories of e-Patients* from Cain, Sarasohn-Kahn & Wayne (2000) “Health e-People: The Online Consumer Experience” The Well Image by WebWizzard http://www.flickr.com/photos/webwizzard/3931165028/ The Acutes Facing a new medical challenge The Chronics Chronic but stable illnesses * Includes caregivers
  • 13. Image by iwd http://www.sxc.hu/photo/1129780 60- 5- 30- 65% 1 6% 2 35% 3 The The The Well Acutes Chronics every several few everyday times a months month Internet Access from Tom Ferguson, MD & the e-Patients Scholars Working Group (2007) “e-patients: how they can help us heal healthcare”
  • 14. 8 out of 10 American internet users have searched online for at least 1 major health topic! from Tom Ferguson, MD & the e-Patients Scholars Working Group (2007) “e-patients: how they can help us heal healthcare”
  • 15. Diet, nutrition, Exercise Specific vitamins, or fitness disease or supplements 42% medical problem 51% 66% Prescription or Medical treatment or OTC drugs procedure 40% 51% Health Topics Searched Online from Pew Internet & American Life Project Nov 2004 Survey
  • 16. e-patient & Empowerment From Von Knoop at al of Boston Consulting Group (2003) “Vital Signs: e-Health in the United States Severity of Condition High In control Involved Moderate Informed Low Accepting Godlike Partner Supplier Attitude Toward Physician
  • 17. From Von Knoop at al of Boston Consulting Group (2003) Image by iwd http://www.sxc.hu/photo/1129780 “Vital Signs: e-Health in the United States 1 2 3 4 Accepting Informed Involved In control Doctor- Doctor- Junior dependent Autonomous dependent & medical but informed patients uninformed partners Rarely go Go online Prefer to Make their online for before or make joint own decision health after MD visit decisions but even if MD information defer to MD disagrees
  • 18. “Paradoxically, a patientʼs interest in knowledge may not always accompany an interest in the medical decision making process.” Gerber & Eiser, Journal of Medical Internet Research 2001 Image by nightRPstar http://www.flickr.com/photos/ninjanoodles/1586212326/
  • 19. Image by Kurhan http://www.sxc.hu/photo/1314902 Informed decision-maker Knowledge-acquirer Physician-Patient Encounters Gerber & Eiser, Journal of Medical Internet Research 2001
  • 20. Image from carbonNYC http://www.flickr.com/photos/carbonnyc/3440688097/ Interested in learning more about the treatment decided on by MD The Knowledge-Acquirer Provides some personal values to the physician Gerber & Eiser, Journal of Medical Internet Research 2001
  • 21. http://www.flickr.com/photos/72341818@N00/4555752947/ Extra time to discuss what patient knows Avoid frustration of not being the sole source of information The Informed Decision-Maker Possesses both preference and knowledge Gerber & Eiser, Journal of Medical Internet Research 2001
  • 22. Image from zizzy0104 http://www.sxc.hu/photo/794884 Do you practice Participatory Medicine? Have you met the e-Patient? Are you Internet-hostile?
  • 23. Image by Niklas Hellerstedt http://www.flickr.com/photos/niklashellerstedt/2414448568/ Tom Ferguson, MD & the e-Patients Scholars Working Group (2007) “e-patients: how they can help us heal healthcare” Internet-hostile Clearly uncomfortable with, and sometimes seem to feel offended by patientʼs attempts to learn more online
  • 24. “[Most doctors] really do like to think they have ALL the answers. This will never change, I am afraid.” Pew Internet Project e-Patient Survey Image by caricaturas http://www.flickr.com/photos/caricaturesbynelson/2031107541/
  • 25. Image by southerntabitha http://www.flickr.com/photos/tabithahawk/567135091/ Tom Ferguson, MD & the e-Patients Scholars Working Group (2007) “e-patients: how they can help us heal healthcare” Internet-friendly Encourages patientʼs online efforts
  • 26. Image by Charles Williams http://www.flickr.com/photos/charlesonflickr/3926259585/ Patients will likely seek a “second opinion” on the internet Gerber & Eiser, Journal of Medical Internet Research 2001 The Internet Prescription Recommend websites to the patient
  • 29. Look for the HON Code seal Health on the Net Foundation Medical information you can trust! http://www.hon.ch also provides HONtools, HONsearch, HONtopics
  • 30. Image by Yogendra174 http://www.flickr.com/photos/yogendra174/4437447471/ Do not underestimate patientsʼ ability to provide useful online resources Tom Ferguson, MD & the e-Patients Scholars Working Group (2007) “e-patients: how they can help us heal healthcare”
  • 31. Image by steved_np3 http://www.sxc.hu/photo/1339516 Do not overestimate the hazards of imperfect online information Database of Adverse Events Related to Internet Use (DAERI) reported only a single case of possible fatality from 2000-2004 Tom Ferguson, MD & the e-Patients Scholars Working Group (2007) “e-patients: how they can help us heal healthcare”
  • 32. Image from zizzy0104 http://www.sxc.hu/photo/794884 Do you practice Participatory Medicine? Have you met the e-Patient? Are you Internet-hostile?
  • 33. Thank You http://www.endocrine-witch.net @endocrine_witch Image from http://wthr.frumph.net/