When Patients Read What Their Doctors Write
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Re: When Patients Read What Their Doctors Write
#2I think this is great; I know for a fact that when I try to describe a series of symptoms to my doctor he will be typing away, and I think there's a lot of what I'm saying that gets lost going from the ears to the fingers. I also think, having both patient and doctor "on the same side" makes it seem more like a team effort and empowers people to take more of an active role in their health.
Re: When Patients Read What Their Doctors Write
#3As a complete outsides I don't see why anyone would be surprised, going to the doctor is quite often an expression of powerlessness, you have no idea and no control over what is going on in your own body and you need this powerful semi-stranger to do some divination on you and tell you what's wrong. Of course giving someone even a semblance of control over the proceedings helps them feel more engaged and more knowledgeable about themselves.
Re: When Patients Read What Their Doctors Write
#4I would imagine a lot of the concern over this is more of the existential fear resulting from the balance of power between patient and doctor than anything else. The Internet started that, with patients able to become much more knowledgable about their own conditions (with the unfortunate side effect of every symptom being cancer).
Once patients become knowledgable, the doctor moves from a pillar of all knowledge to a (hopefully) trusted, knowledgable advisor. That change frightens many in the medical community[1], but it will yield better outcomes.
My own story is one of overcoming obesity and, at times, nearly crippling depression using that ability to gain knowledge to learn how to feed my body. In the process, I've stopped medications and have had to teach my doctor certain things (like why I'm not gong to either worry about my cholesterol or take any drugs for it).
The medical community currently has an abysmal record with treating chronic health problems. There are a lot of reasons for that, but, IMO, the most glaring is people abdicating their health reonsibility to somebody else (whether doctors, pharmaceutical companies, or government guidelines). As people take control back...when they realize they have some control...they will become more healthy.
1. Source: my wife is part of that community and sees it regularly.
Re: When Patients Read What Their Doctors Write
#5One problem with this approach is patients who are making stuff up entirely. They're not a large part of the population, but since they relentlessly seek medical attention (often to the point of self-harm), every doctor is familiar with them.
Giving such patients editorial power over doctors' notes gives them a further lever with which to manipulate the system.
It's a weird situation in which the doctor/patient relationship is actually adversarial, and it poisons a lot of otherwise good ideas predicated on the assumption that doctors and patients want the same thing.
Re: When Patients Read What Their Doctors Write
#6As a complete outsides I don't see why anyone would be surprised, going to the doctor is quite often an expression of powerlessness, you have no idea and no control over what is going on in your own body and you need this powerful semi-stranger to do some divination on you and tell you what's wrong. Of course giving someone even a semblance of control over the proceedings helps them feel more engaged and more knowled…
I think it can be pretty complex. A lot of people (especially older people) will have a preconceived idea of what they have, and come to the doctor only to get confirmation, or have a prescription. Then some will only take the drugs matching what they think they have, and just ignore everything else the doctor told them (my parents do that).
Or for people with chronic issues, there isn't much mystery about what's going on, only some variations between a month and another, most of the time. What's special is that the patient will be motivated enough to do a lot of research (in the time there was no internet, go through medical documentation, even research papers), taking time to understand well enough what's happening to them. Then, a doctor might diagnose something different than their previous doctor. Or prescribe different drugs with different side effects. Or sometimes the doctor might not be as well informed on the subject as their patient is, because it's not their specialty for instance.
These might be the cases where having transparency and trust between the doctor and patient are the most important and crucial to have the patient cooperate.
Re: When Patients Read What Their Doctors Write
#7One problem with this approach is patients who are making stuff up entirely. They're not a large part of the population, but since they relentlessly seek medical attention (often to the point of self-harm), every doctor is familiar with them. Giving such patients editorial power over doctors' notes gives them a further lever with which to manipulate the system. It's a weird situation in which the doctor/patient relat…
This could be fixed by having a section of the notes that only doctors can read. Hopefully it wouldn't be needed most of the time.
Re: When Patients Read What Their Doctors Write
#8My doctor types at a computer whose screen is explicitly set up to point at both of us. I was surprised and appreciative when he first did so.
Re: When Patients Read What Their Doctors Write
#9I would imagine a lot of the concern over this is more of the existential fear resulting from the balance of power between patient and doctor than anything else. The Internet started that, with patients able to become much more knowledgable about their own conditions (with the unfortunate side effect of every symptom being cancer). Once patients become knowledgable, the doctor moves from a pillar of all knowledge to…
> My own story is one of overcoming obesity and, at times, nearly crippling depression using that ability to gain knowledge to learn how to feed my body. In the process, I've stopped medications and have had to teach my doctor certain things (like why I'm not gong to either worry about my cholesterol or take any drugs for it).
> As people take control back...when they realize they have some control...they will become more healthy.
Your story is great, and a good example of the upside of patient control and involvement in care.
However, the downside also exists, and is very real. For some patients, having control over their care means demanding unnecessary tests and treatments, which leads to phenomenal increases in costs to the insurer and/or provider, as well as a reduction in compliance with medication and treatment regimens[0] - this has implications both for public health and the patient's own health. Or, worse, demanding medications that they think are helpful but are actually harmful (this happens all the time).
The problem is that control isn't very meaningful without an appropriate level of knowledge to supplement it, and even when the resources are available, very few patients are willing to take the time to educate themselves to the extent necessary to make informed decisions about their own care.
> Once patients become knowledgable, the doctor moves from a pillar of all knowledge to a (hopefully) trusted, knowledgable advisor. That change frightens many in the medical community[1], but it will yield better outcomes.
To be blunt, it's more likely that the doctor will move towards being the person who enacts the wishes of the insurer (or whichever entity is acting as the insurer). This isn't a particularly bold prediction - it's already happened, in that doctors are increasingly beholden to the pressures of insurers. Once you take into account the massive costs that arise from mismanagement of long-term conditions (whether from the patient or the doctor), it's not hard to understand why insurers are taking increasingly active roles in patient care.
[0] This isn't always bad, but think of diseases which require adherence to antibiotics (or, worse, diseases like HIV, which are chronic and for which compliance is a matter of public health) and you'll see why this can get problematic very quickly.
Re: When Patients Read What Their Doctors Write
#10My doctor types at a computer whose screen is explicitly set up to point at both of us. I was surprised and appreciative when he first did so.
I too have seen this at a chain of clinics where I live: the doctor's laptop is hooked up to a wall-mounted screen, where I can actively watch what is being typed into my reports. It surprised me too, and makes me feel much better about the whole experience.