Wednesday, May 14, 2008

Richness and Reach Redux – Web 2.0 + Medicine

After posting on Richness and Reach I made the mistake of submitting the article to Grand Rounds at the Health Business Blog. I didn’t realize that David was a former Boston Consulting Group member and would run circles around my argument.

In short, people want you to believe that when your doctor (or primary care provider) embraces Web 2.0 (the socialization of the internet) a metamorphosis of medicine will occur. The argument goes that the internet will allow your doctor to reach more people with greater richness then ever before. Don’t believe them – it’s bullshit.

Technology and the internet have done a lot for primary care. I believe it has improved outcomes, standards and the velocity at which primary care is provided. But using the internet allows these improvements in the traditional Web 1.0 way, by increasing the resources at both the provider and patients’ disposal. Going away are the days of photocopied, index articles’ (that any doctor who graduated before 2000 likely has), hunting for x-rays, the latest textbook and lab coats full of plasticized cards and handbooks. They are being slowly replaced by information over the web. Even the much touted on-line personal health record (read more at KevinMD or Health Management Rx) is just another application of the Web 1.0 as a repository for your complete medical history.

The pundits foresee a revolution that will never come. A world where you can input your symptoms in a database, or bounce thoughts off your doctor through a chat room, or go for a virtual CT scan. Check out the science roll for the top ten ways to apply Web 2.0 to your life or learn to do your own cervicofascial advancement flap. The problem is that satisfaction with ones' primary care physician is highly dependant on communication and the perception of respect. The relationship between you and your doctor is independent, fraught with variation from patient to patient and intensely personal. There is fantastic evidence that a good history is not created by just asking the correct questions but by doing so in an appropriate manner. That includes allowing time, overcoming language barriers, laughter, and empathy for the patient as well as structure to the information exchange. The effect of Web 2.0, however, is to broaden and generalize the human experience. Where a good historian creates a quick personal connection with the patient Web 2.0 relies on group think. The two are at odds with one another.

Aside from the philosophical debate, there is the question of finances. When patients arrive they expect answers and are paying dearly to have us find them. Even when histories are directed they can drag on. To exchange information in a haphazard way is not only foolhardy but it takes time. And in a world of skyrocketing costs, litigation conscious patients and physicians who are increasingly bankrupt of time the likelihood of adding a tool that slows and generalizes the process is remote. I’ve said it repeatedly about IT roll-outs in the clinic. A new process should improve quality and velocity. If it only does one or the other it’s an uphill battle. If it does neither, it is doomed.

I have no idea if the blogosphere and the Web 2.0 are just this generation’s versions of public access television but I like to think it improves us by giving a broader perspective. A good doctor will make use of Web 2.0 as a tool for education, a means to bench mark their practices and a way to communicate with groups of patients or other clinicians. They will also make use of the internet to increase the efficiency of their practice. But make no mistake about it, the internet acting as a library of information is very different than it acting as a surrogate for access to your physician. When it is all said and done there are certain fundamental laws to health care the greatest of which is that a good diagnosis is made by a great history and a good examination. And that can’t be done through a web-site.

Over to you David & Jen.

To read Jen's response to this post go to this link at HealthMmgmtRx.

1 comment:

Jen McCabe Gorman said...

Hey Dr. Ian -

First congrats on your anniversary - great things done already and more to come. You are the only physician I know sharing such detailed information on how to reduce wait times and decrease delays in care. Bravo my friend!

So I was slacking on vacation last week, but here's the long overdue response to this post...

Enjoy (and en garde!)-