Are you sick and tired, have a worrisome symptom, a question or problem with a medication, or have a hard time getting an appointment? If so, like millions of Americans, when they want a health question answered right away, you may need to turn to the internet! Yes, the internet has rapidly changed the way people obtain information, especially about health care. Over the last 5 years, use of the internet for health information has grown by more than 150%, from 46 million users in 2000 to 116 million users today. An astounding 80% of all internet users have at some point used the web to perform health related searches.
Currently, healthcare topics account for nearly 7.5% of all web queries. The late Tom Ferguson, MD, who spent his career promoting use of the computer and the internet to improve health care, defines e-patients as those: managing much of their own care, providing care for others, helping professionals improve the quality of their services, and participating in entirely new kinds of clinician-patient collaborations, patient-initiated research, and self-managed care.
My belief as a family physician in practice for over 30 years is that the internet has opened an exciting new frontier for doctors to interface with patients. I started eDocAmerica, an online health information company, with a mission to facilitate online doctor-patient interaction and to help empower patients and assist them with self-care. Routine interactions with patients who visited my office confirmed their desire for an online physician communication system. But, most of the time, their own physicians were unable or unwilling to communicate with them online.
I asked patients if they would like to be able to log onto a web site and ask an experienced, competent and interested physician a question about any health related issue and they answered a resounding "Yes"! Little did I imagine that my response to this request would soon make eDocAmerica the nation's largest third-party provider of physician-consumer online communications. My enthusiasm for this change in practices is so strong that I believe all persons should fundamentally change their approach to healthcare and become an "e patient".
Clearly, the internet's ability to efficiently disseminate large amounts of detailed information has made it an attractive option for delivering medical knowledge to the masses in a manner that was never previously possible. When one has a question about an obscure medical diagnosis or a desire to communicate with someone about a medical problem, the internet presents a wonderful platform to accomplish it. But, to take full advantage of this new tier in the health care system, it is important to become an effective e-patient. And, to do this, I encourage patients to begin by taking the following steps:
- Start getting into the habit of looking up health and medical issues on the web.
- If you have a chronic condition, join an online support group and start a dialogue about your condition.
- Find out if your own physician will respond to your e mails and, if not, sign on with a third party service, such as eDocAmerica so that you will have a reliable, online physician resource.
By taking these fundamental steps, you will be positioned to start taking control of your own health care. The opportunities and possibilities are enormous. The result will be a fundamental shift towards becoming an empowered, informed, more satisfied patient who can take much more responsibility for your health and for managing your own medical conditions. But the internet's information-rich landscape also results in the e-Patient's greatest dilemma: uncertainty about the reliability or relevance of what you are reading.
Almost 85% are concerned about unreliable online information, and 73% reject certain search results because of credibility issues within the sites they find. The amount of available information has become so massive that the average consumer becomes easily overwhelmed at the prospect of evaluating medical content on the web. Eventually, you may just decide to wait until your next doctor's office visit, or to phone a friend/ relative to ask the questions instead. Surveys show that approximately 30% of all Americans believe that they will be unsuccessful in their quest to find reliable health information on the webvii.
So What is an Aspiring E-Patient to do?
Although obtaining health information on the internet can sometimes be a hit or miss proposition, learning to use the web effectively is within the grasp of almost anyone, and has the potential to dramatically change the way you relate to health care providers. Moreover, by using the available information to its full potential, you can significantly reduce health care costs by avoiding unnecessary office visits, by taking actions to prevent potentially serious health problems, and by teaming up with your physician to improve the quality of care.
Along the way, you can greatly reduce the frustration and helplessness that often exists within our traditional health care system. Informed and empowered patients will usually be much happier patients!Interested? Of course! Who wouldn't want to become healthier, less frustrated and save money in the process, simply by learning to use the internet more effectively (see table 1).
Ten steps to becoming a better e-patient
- Become familiar with the categories of healthcare websites. (see appendix A)
- Get in the habit of accessing reliable information sites on a regular basis when you think of a health question concerning yourself or your family.
- Identify a reliable medical website resource (such as eDocAmerica) that will answer your questions and help guide you through the healthcare maze.
- If you have a chronic condition, join an online support group (such as ACOR) and begin networking with them about your condition.
- Discuss your research finding with your doctor at each visit; if he isn't interested, find a new doctor who is.
- Use a search engine, such as Google, frequently, typing phrases or questions directly into the search line to get answers to your questions, and practice sorting through responses to glean the most useful information.
- Steer clear of proprietary online advertising-oriented health web sites
- Avoid on line supplement, vitamin, weight loss and sexual enhancement sites.
- Use an online medical history site, such as WebMD's health manager, to store your information for future reference and for sharing with others when needed.
- Do not take new medications or undergo elective surgical procedures without doing your online research and discussing it with a "web savvy" physician.
Overcoming Barriers to Becoming an E Patient
How Much Time do you have to Spend?
The average user spends 30 minutes conducting a health related internet search. Yet, most users do so with no specific search plan. This may often result in becoming frustrated with the search process, and almost 6% of the users finally give up. Most individuals start their queries using general search engines rather than specific health sites. This can result in retrieval of an overwhelming number of websites that are difficult, if not impossible, for the user to assess.
But, since 77% of e-patients start a search because they want a specific answer, these users may benefit from using more specific web sites, targeted in the area of your interest. For instance, as a time-savvy consumer, you may find that compiling a list of previously identified health related portals and disease specific sites for repeat searches on a topic will provide pertinent information faster.
Assuring Reliability of Information
Even though most users will eventually find the information they desire, almost 85% of internet users are still concerned about unreliable online medical information. For many individuals, making this assessment can be a challenging task. Consider the tips below to help you with this problem:
- Use strategies such as The Medical Library Association (MLA) Guidelines, found at http://www.mlanet.org. The MLA encourages users to determine a site's sponsors, board members, and funding sources, along with the site's last revision date. This step will help ensure that reputable sources are being used to provide current information. Furthermore, site content should be carefully evaluated to distinguish fact from opinion, so that users have a clear starting point. At present, only 25% of e-patients follow these guidelines.
Visit sites that compile a list of other reputable web-based data and sources. Examples of these include
- The Internet Healthcare Coalition (www.ihealthcoalition.org)
- Federal government sponsored health sites (most ending in ".gov" )
- Health on the Net Foundation's (HON) Hunt services (http://www.hon.ch/Project/Hunt_projects.html)
- Ask an online medical resource, such as a patient support group or an on line health care provider to help authenticate the results found for a question.
- Compile a list of "reliable" web sites and, then, limit on line searches to these websites. Sites that fit into the latter category include: Yahoo Health, Mayoclinic.com, intellihealth.com, familydoctor.org, and others.
- Take a print out of the site to your physician at your next appointment. Almost 33% of users searching for health information already do this. You can share this information with him and ask if it is valid.
Encountering the Resistant Physician
What do you do when you find that your physician does not warm up to your interest in using the net for health matters? Almost 13% of physicians do not feel comfortable helping patients sort through online data. But it is likely that, in the future, patients will begin to gravitate away from physicians who do not support their patient's use of the internet to obtain information about their health. Unfortunately, at present, although 90% of patients have indicated a desire to communicate with their physician online, only about 6% of e-patients use email to interact with a healthcare professional.
Obviously, the e-patient movement has a long way to go! So, you may consider yourself fortunate if you find a physician like Dr. Danny Sands, an Internal Medicine physician who practices in the Boston area. He "gets rave reviews for his Net-friendliness from grateful patients. But he is still part of a tiny medical minority.
Only about 5% of clinicians invite all their patients to communicate via e-mail,' Sands says. And three out of four refuse to e-mail patients at all even though most patients want it. This is getting to be a real black eye for the medical community.'
"Why have physicians not more wholeheartedly embraced e-patients? Four reasons seem to account for this hesitation: First, for most patients, insurance companies do not reimburse for online services; however, as noted earlier in this article, this is changing rapidly.
Second, many physicians are not skilled at dealing with medical issues via e-mail communication and, therefore, feel more comfortable interacting with patients on the phone or in the office. Third, there are those who are concerned about potential breach of confidentiality. Yet, by implementing systems such as secure websites and data encryption, physicians can sharply reduce the risks of using online services. Finally, some physicians are worried about litigation.
Concerns about Litigation
You will probably be surprised to learn that there has never been a single malpractice suit arising from email use by physicians. This is a somewhat curious finding considering the range of potential issues that have been raised about use of e-mail in health care and due to the litigious environment that we live in. So, contrary to the fears of many that physicians increase their risk of malpractice litigation by mailing patients, it may turn out that use of online communication actually decreases the risk of litigation.
Reasons for this are likely to be that patients often sue because they are unhappy with the attention given or information provided by their doctor, whereas, in the online world, patients tend to be happy (if not thrilled) to have physicians who are willing to provide information and answers to their questions. Furthermore, in the online world, it is easy to document and preserve every online interaction, which does not leave any question "up in the air" for the courts to debate. Stay tuned for part two of this article where we will discuss tips for becoming an effective e-patient.
About the Author
Charles W. Smith, M.D., is the Founder, Chairman, and Medical Director of eDocAmerica, and is a board certified family physician with over 25 years of experience in practice. He is the executive associate dean for clinical affairs at the University of Arkansas for Medical Sciences (UAMS) and is professor in the Department of Family and Community Medicine where he has been serving since 1989. In his role at UAMS, he also serves as the medical director for UAMS Medical Center and the physician director of medical informatics at the University.
In this role, he is responsible for initiating and implementing software programs to assist physicians in the provision of care at UAMS. He is also responsible for the oversight of the quality of medical care provided at UAMS. He has served as a national leader in family medicine, as editor of the American Family Physician, a national journal for family physicians, and has also served as the president of the American Board of Family Practice, which is the national certifying body for family physicians. He recently served as the chair of the Group on Faculty Practice, a national organization of medical school faculty practice plans within the American Association of Medical Colleges.
He is author of numerous medical journal articles and is co-author of a medical textbook, 'The Handbook of Family Practice.' He continues to conduct an active practice and holds regular office hours in the Outpatient Center of the University of Arkansas. His areas of special interest and expertise include sports medicine and fitness, skin disorders and stress-induced disorders.
Smith did his medical training at the University of North Carolina and, after practicing in Muscatine, Iowa, became director of resident physician training in Dayton, Ohio at Wright State University. In 1986, he relocated to Huntsville, Alabama, where he served as the chair of family medicine and dean of the School of Primary Medical Care at the University of Alabama in Huntsville a branch of the University of Alabama at Birmingham. He came to Little Rock in 1989 to assume his current position at UAMS.