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“e-Patient Dave” deBronkart
Twitter: @ePatientDave
facebook.com/ePatientDave
LinkedIn.com/in/ePatientDave
dave@epatientdave.com
The patient of the future:
empowered and engaged
$39.95 baby contact
2006
Me? An indicator
of the future??
• Who’s getting online:
– 1989: Me (CompuServe sysop)
– 2009: 83% of US adults (Pew)
• Who’s romancing
online:
– 1999: I met my wife (Match.com)
– 2009: One in eight weddings
in the U.S. met online
– 2011: One in five couples
met online
Classic
Stage IV,
Grade 4
Renal Cell
Carcinoma
Illustration on
the drug company’s
web site
Median Survival:
24 weeks
How can this be??
Because of the Web, patients can
connect to information and each other
Observation:
We perform better
when we’re informed better.
Corollary:
It’s perverse to keep someone in the dark
then say they’re ignorant.
The old (1871): Oliver Wendell Holmes
“Your patient has no more
right to all the truth you
know than he has to all the
medicine in your saddle-bags.
He should get only just so
much as is good for him.”
Paternalistic caring
“No, honey –
you don’t know
what you need.”
“I’ll take care of you.”
Sensible – up to a point
“I’ll decide for you.”
When does
autonomy
become
appropriate?
Observation:
When assets digitize,
things change fast.
Source:
@Asymco
Current information-powered
e-patient reality:
Hugo Campos and
Dana Lewis
Hugo Campos wants his ICD data
#OpenAPS & @DanaMLewis
(Open Source Artificial Pancreas System)
Many “loopers” are better controlled
than people with a working pancreas
My weight loss, enabled
(not “caused”) by apps:
My providers can’t see this
in their computers!
OpenNotes
What happens
when patients see
their doctors’
notes?
O
• 99% of patients wanted to continue
• 17-26% of docs preferred not to…
– But when given the chance to stop, none did
• 85-89% of patients said availability of
open notes would influence their choice
of providers and health plans
“My patients
aren’t like that.”
“They aren’t
asking for this.”
Objection:
“E” is not a new idea
• Doctor Spock’s Baby and Child Care (1946)
• Our Bodies, Ourselves (1973)
“We weren’t encouraged to ask questions,
but to depend on the so-called experts,”
Hawley told Women’s eNews.
“We didn’t have the information we needed,
so we decided to find it on our own.”
The old (1871): Oliver Wendell Holmes
“Your patient has no more
right to all the truth you
know than he has to all the
medicine in your saddle-bags.
He should get only just so
much as is good for him.”
“A new scientific truth
does not triumph
by convincing its opponents
and making them see the light,
Max Planck Nobel Prize, 1918
“A new scientific truth
does not triumph
by convincing its opponents
and making them see the light,
but rather because
its opponents eventually die,
Max Planck Nobel Prize, 1918
“A new scientific truth
does not triumph
by convincing its opponents
and making them see the light,
but rather because
its opponents eventually die,
and a new generation grows up
that is familiar with it.”
Max Planck Nobel Prize, 1918
“e-Patient Dave” deBronkart
Twitter: @ePatientDave
facebook.com/ePatientDave
LinkedIn.com/in/ePatientDave
dave@epatientdave.com
The patient of the
arriving future:
empowered and engaged

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Address to 50th Congress of Dutch OB/GYNs, Nov 18 2016