Plenary presentation at the Cebu Institute of Medicine (CIM) World Congress, 4 Dec 2019.

1. GOOGLE & THE
PHYSICIAN-
PATIENT
RELATIONSHIP
IRIS THIELE ISIP TAN MD,MSc
Professor, UP College of Medicine
Director, UP Manila Interactive
Learning Center
Chief, UP Medical Informatics Unit

2. NOTHING TO DISCLOSE
I give consent for the audience to tweet this talk
and give me feedback (@endocrine_witch).
Feel free take pictures of my slides (though the
deck is at www.slideshare.net/isiptan).

3. DO YOU HATE
“DR.” GOOGLE?
HAS GOOGLE ALTERED
THE PHYSICIAN-PATIENT
RELATIONSHIP?
HOW CAN WE
SUPPORT PATIENTS
WHO GOOGLE?

4. Pei-Li Teh & Marc Yates (2013)
researchpartnership.com
Nine in ten had accessed the internet looking
for healthcare information, with almost 3/4s
having done so in the last month.

5. GENERAL HEALTHCARE WEBSITES
ONLINE HEALTH FORUMS
HEALTH COMMUNITY WEBSITES
DISEASE WEBSITES
CLINICAL WEBSITES
PHARMACEUTICAL WEBSITES
WIKIS
E-NEWSLETTER
FACEBOOK
%
0 25 50 75 100
HEALTH INFORMATION SOURCES EVER USED
Pei-Li Teh & Marc Yates (2013)
researchpartnership.com
(Philippines)

6. Internet-hostile
Clearly uncomfortable with, and sometimes seem to feel
offended by patient’s attempts to learn more online
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”

7. “[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/

9. WHY DOES SELF-DIAGNOSIS ANNOY DOCTORS?
http://www.endocrine-witch.net/2015/07/05/why-does-self-diagnosis-annoy-doctors/
#Bloggys2015 Blog Post of the Year

11. And I went viral!
(for the wrong reasons)

13. – Dr. Tracey Delaplain, www.kevinmd.com
“Dr. Google doesn’t really care about your
health. Does that shock you? It shouldn’t. The
Internet will never replace human interaction. It
can’t show you compassion, empathize with you,
give you a shoulder to lean on, hold your hand,
rejoice with you or grieve with you. Dr. Google
will never know you or care as much as I do.”

14. DO YOU HATE
“DR.” GOOGLE?
HAS GOOGLE ALTERED
THE MD-PATIENT
RELATIONSHIP?
HOW CAN WE
SUPPORT PATIENTS
WHO GOOGLE?

15. The
Well
every
few
months
The
Acutes
everyday
The
Chronics
several
times a
month
Image by iwd
http://www.sxc.hu/photo/1129780
60-
65%
5-
6%
30-
35%1 32
Internet Access
from Tom Ferguson, MD & the e-Patients Scholars Working Group (2007)
“e-patients: how they can help us heal healthcare”

16. Accepting
Doctor-
dependent &
uninformed
Rarely go
online for
health
information
From Von Knoop at al of Boston Consulting Group (2003)
“Vital Signs: e-Health in the United States
1
Image by iwd
http://www.sxc.hu/photo/1129780

17. Accepting Informed
Doctor-
dependent &
uninformed
Doctor-
dependent
but informed
Rarely go
online for
health
information
Go online
before or
after MD visit
From Von Knoop at al of Boston Consulting Group (2003)
“Vital Signs: e-Health in the United States
1 2
Image by iwd
http://www.sxc.hu/photo/1129780

18. Accepting Informed Involved
Doctor-
dependent &
uninformed
Doctor-
dependent
but informed
Junior
medical
partners
Rarely go
online for
health
information
Go online
before or
after MD visit
Prefer to
make joint
decisions but
defer to MD
From Von Knoop at al of Boston Consulting Group (2003)
“Vital Signs: e-Health in the United States
1 32
Image by iwd
http://www.sxc.hu/photo/1129780

19. Accepting Informed Involved In control
Doctor-
dependent &
uninformed
Doctor-
dependent
but informed
Junior
medical
partners
Autonomous
patients
Rarely go
online for
health
information
Go online
before or
after MD visit
Prefer to
make joint
decisions but
defer to MD
Make their
own decision
even if MD
disagrees
From Von Knoop at al of Boston Consulting Group (2003)
“Vital Signs: e-Health in the United States
1 32 4
Image by iwd
http://www.sxc.hu/photo/1129780

20. Accepting
Informed
Involved
In control
Severity of
Condition
Attitude Toward Physician
High
Moderate
Low
Godlike Partner Supplier
e-patient & Empowerment
From Von Knoop at al of Boston Consulting Group (2003)
“Vital Signs: e-Health in the United States

21. “Paradoxically, a patient’s 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/

22. WEB 2.0 THE WRITING & PARTICIPATING WEB
Slide from https://www.slideshare.net/bettamedislem/web-evolution-wlframe-alpha

23. Crowd-sourcing
Harnessing collective intelligence
Image from antigone78
http://www.flickr.com/photos/antigone/457089364/

24. PATIENTSLIKEME
2005
Crowdsourcing Patient Platform for Healthcare

25. WEB 3.0 THE SEMANTIC EXECUTING WEB
Slide from https://www.slideshare.net/bettamedislem/web-evolution-wlframe-alpha

26. Loh LC. Autocomplete: Dr Google's "helpful" assistant? Can Fam Physician. 2016
Aug;62(8):622-3. PMID: 27521382; PMCID: PMC4982714.
Do you know how Google’s
autocomplete feature actually works?

27. Loh LC. Autocomplete: Dr Google's "helpful" assistant? Can Fam Physician. 2016
Aug;62(8):622-3. PMID: 27521382; PMCID: PMC4982714.

28. https://www.commondreams.org/news/2018/05/21/evil-fine-now-google-ditches-dont-be-evil-company-code-conduct

29. Google Health: Tools to help healthcare
providers deliver better care
https://youtu.be/P3SYqcPXqNk

30. Cacciamani GE, et al. Asking “Dr. Google” for a Second Opinion: The Devil Is in the
Details. Eur Urol Focus (2019), https://doi.org/10.1016/j.euf.2019.10.011
How Google Search
Might Be Helpful or Harmful

31. Slide from https://www.slideshare.net/bettamedislem/web-evolution-wlframe-alpha
WEB 4.0 WEB OF THINGS

32. https://www.forbes.com/sites/davidphelan/2019/11/01/google-buys-fitbit-for-21-billion-heres-what-it-means/#6da9c954732f

33. Slide from https://www.slideshare.net/bettamedislem/web-evolution-wlframe-alpha
WEB 5.0 EMOTIONAL WEB

34. Image by judepics
http://www.flickr.com/photos/judepics/2059494008/
Physician as INTERMEDIARY:
gatekeeper of health information

35. APOMEDIATION
Less reliance on traditional experts
Image by migclick
http://www.flickr.com/photos/migclick/2535570629/

36. Dynamic Intermediation-Disintermidiation-
Apomediation model (DIDA)
Eysenbach G. Medicine 2.0: Social Networking, Collaboration, Participation,
Apomediation, and Openness J Med Internet Res 2008;10(3):e22

37. “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/

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

39. Online community/
support group
Patients as members of
collaborative treatment teams
Community health
decision-making
“Mindfully”
involved in
treatment
“Participatory Medicine”
from Wikipedia
Image from networkhttp://www.sxc.hu/photo/985516

40. Physician-Patient Encounters
Gerber & Eiser, Journal of Medical Internet Research 2001
Informed
decision-maker
Knowledge-acquirer
Image by Kurhan
http://www.sxc.hu/photo/1314902

41. The Knowledge-Acquirer
Provides some personal values to the physician
Image from carbonNYC
http://www.flickr.com/photos/carbonnyc/3440688097/
Interested in learning
more about the
treatment decided
on by MD
Gerber & Eiser, Journal of Medical Internet Research 2001

42. http://www.flickr.com/photos/72341818@N00/4555752947/
The Informed Decision-Maker
Possesses both preference and knowledge
Extra time to discuss
what patient knows
Avoid frustration of not
being the sole source
of information
Gerber & Eiser, Journal of Medical Internet Research 2001

43. DO YOU HATE
“DR.” GOOGLE?
HAS GOOGLE ALTERED
THE MD-PATIENT
RELATIONSHIP?
HOW CAN WE
SUPPORT PATIENTS
WHO GOOGLE?

44. Internet-friendly
Encourages patient’s online efforts
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”

45. DISCUSS WITH
YOUR PHYSICIAN

46. … the average person with
diabetes spends no more
than 0.1% of their time in
the course of an entire year
discussing health matters
with a medical professional.
Hernandez M. Diabetes Manage. 2013;3(3):203-205
“

47. Collins S & Lewis DM. Clinical Diabetes 2013

48. Collins S & Lewis DM. Clinical Diabetes 2013
Assess patient’s use of online resources
and level of health literacy

49. WHO runs or
created the site?
Can you trust
them?
WHAT is the site
promising or offering?
WHEN was its
information written
or reviewed?
WHERE does
the information
come from?
WHY does the
site exist?
http://nccih.nih.gov/health/webresources

50. http://nccih.nih.gov/health/webresources
Are you
reading news
or advertising?

51. Endorses a product. Only quotes people
who say good things about the product.
Presents research findings
that seem too good to be true.
Contains links to a sales site.
Includes only positive reader comments.
You can’t add a comment of your own.
ADVERTISEMENT NOT NEWS
nccih.nih.gov/health/webresources

52. The Internet Prescription
Recommend websites to the patient
Patients will likely seek
a “second opinion”
on the internet
Gerber & Eiser, Journal of Medical Internet Research 2001
Image by Charles Williams
http://www.flickr.com/photos/charlesonflickr/3926259585/

53. THE INTERNET PRESCRIPTION

54. Volk & Obeid. Virtual Projects. dx.doi.org/10.5195/jmla.2019.774

55. STOP SAYING
“DR.” GOOGLE.
LET US ACTIVELY
SUPPORT PATIENTS
WHO GOOGLE.
THE MD-PATIENT
RELATIONSHIP MUST
EVOLVE WITH GOOGLE.

56. @endocrine_witch