Presented at the 2011 Philippine College of Physicians Annual Convention

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/

4. Image from adactio
http://www.flickr.com/photos/adactio/78600196/
Web 2.0
“the wildly read-write Web”

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

27. Medline Plus
http://www.nlm.nih.gov/medlineplus

28. Mayo Clinic
http://www.mayoclinic.com

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/