An Initial Diagnosis

A generation ago, your local doctor had it relatively easy. For the most part, a few know-it-alls aside, his patients would pretty much trust him and listen to his advice. After all, he was a professional and they weren’t. He knew the rules of how the body worked and they didn’t. So when he applied those rules, they listened to him and deferred to his professional discretion. That was the old relationship.

The internet has changed the basic doctor-patient relationship. Now before or instead of visiting a doctor, many patients are attempting to self-diagnose their ailments with the help of online sources. Of course, like with any educational information, the widespread online publication of biomedical literature is a good thing. If people want to spend their free time reading PubMed, the world will probably be the better for it. But as things have developed thus far, the online proliferation of user-friendly diagnostic information, a cure for ignorance, has been accompanied by more than a few adverse side effects.

The capture of online medical websites like WebMD by pharmaceutical companies is problematic, but it is not new. It can roughly be understood as a simple continuation of the capture of a large portion of the non-online medical community by those same pharmaceutical companies. Cyberchondria, on the other hand, is both problematic and new. Referring to the extreme hypochondria exhibited in some users of medical websites, cyberchondria is an example of a new complication affecting the basic doctor-patient relationship. Furthermore, healthcare providers have noted that medical websites regularly confuse or worry patients and undermine doctors’ authority. Thus in some ways, the doctor in the digital age has a relatively harder job. He encounters more patients who are resistant to his advice and his professional discretion is generally afforded less credence than his predecessor’s. But while the basic doctor-patient relationship has surely changed because of the internet, that doesn’t mean the doctor in the digital age will necessarily be a less effective healer. Not at all. In fact he has the potential to use technology to drastically increase the efficacy of his practice.

It is unsurprising that stakeholders in medical websites have suggested expanding the use of those sites. Similarly, it is unsurprising that major technology developers have seen the potential inherent in streamlining the delivery of online medical information to internet users. Yet while a variety of other players have begun to make use of the online medical information community, healthcare providers have been slow to join the fray. Perhaps this too is unsurprising; like other professionals, doctors as a group often lack technological expertise and tend to err towards the traditional in their conception of patient relationships. But for a profession where a duty to provide the best available care is owed, that does not make an apathetic approach to new solutions excusable. Too many doctors believe that the optimal function of the internet is simply to give healthcare providers access to new information, or to allow doctors to e-mail patients their test results. These doctors apparently do not see the internet’s vast potential to provide genuine patient education and more. Or alternatively, they lack the initiative to take ownership of the online medical information community and thereby transform it into an eminently useful treatment platform. So long as the internet’s potential goes untapped, these doctors will continue to see their jobs become more difficult and their patient relationships grow more strained as they skirt the boundary of violating their Hippocratic oaths.

Through this point, my primary response to the draft was that it fell into two segments, imperfectly coordinated. In the first, the use of the medical information flow in the net by the pharmaceutical molecule merchants is the subject. They have the wealth to buy up the new media, as they bought up the old ones, leading to the television-advertising nightmare in the US, for example. In the second, the relative passivity of the physicians in using medical education to improve treatment of their own patients is described. The connection between the first and second, however, which has to do with the overall capture of delivery by pharma and the reduction of physicians to pill pushers on the clock, is not described.

A Second Opinion

A generation ago, your local lawyer also had it relatively easy. For the most part, a few know-it-alls aside, his clients would pretty much trust him and listen to his advice. After all, he was a professional and they weren’t. He knew the rules of how the legal system worked and they didn’t. So when he applied those rules, they listened to him and deferred to his professional discretion. That was the old relationship. Like the doctor in the digital age, the lawyer in the digital age has to acknowledge that his profession has changed: among other things, his client relationships begin from a new default position, his professional opinion means something different than it used to, and as a result, the use of technology will be pivotal to both the efficacy of his practice and the satisfaction of his ethical obligations.

The changing social structure and behavior of the health care system of the US, as we moved from small-businessmen-doctors and a rich but subservient pharma, to a managed care universe in which doctors are employees on the clock and pharma owns more than anyone else, are the implicit subject of part one. This brief part two deals with a profession differently organized and therefore differently affected by the changes we are considering.

So my overall response to the draft is that it tries to do too much in 1,000 words, and would do a far better job of less. Less would also be capable of trenchant and brief statement at the outset, involving the presentation of a single new idea to the reader, who could then follow its development through the line of the essay, which is not, as I have tried to show, very easy now.

-- NigelMustapha - 30 Nov 2014