I find that people tend to fall
into two camps: The “doctors should know everything” camp, and the “doctors
don’t know anything” camp. The truth, of course, as it is with most things, is
somewhere in the middle.
Humans love to learn. None of us knows everything about everything, but most of us know a lot about a few things. The process of learning is part of what makes us better and helps us grow. But because we don’t all have specialized knowledge, we go to experts who do. That’s why, when you are sick, you go to the expert who knows the most about sickness—the doctor.
When people go to see their
doctors, they expect them to know more about sickness than they do. They expect
their doctors to guide them, based on each doctor’s specialized knowledge and
experience.
Doctors do indeed have
specialized knowledge, and what each physician knows the most about is what
that physician does every day and sees on a daily basis. You wouldn’t go to an
oncologist to treat your heart disease, and you wouldn’t go to a surgeon to do
a throat culture for strep. Doctors have chosen areas for specialized training.
And, far beyond that, they continue to learn and use the information they
gather through their daily experiences to better diagnose, detect and treat
their patients. We also learn from our patients because sometimes they have
information we don’t have. And we hope that patients learn from us.
But there is a third player in
the middle of this dynamic—another “voice” with a whole big set of
“information.” It’s the Internet, or what some people have dubbed “Dr. Google.”
Dr. Google has changed the game. In this day and age, the traditional exchange of information and education is not what it used to be. Patients no longer come in to get advice from their doctors. They come in having already consulted with Dr. Google. Most of them are pre-armed with information, data and research, along with a well-formed opinion of what is wrong with them, based on the knowledge (right or wrong) that they gained from the Internet. There is no doubt that technology has changed healthcare and the doctor-patient relationship. Multiple studies, papers, articles, conferences and research are currently looking at the repercussions of technology on healthcare.
Many of those effects are good.
Now, patients can access their charts, read their notes and follow along with
the doctor’s thought process as tests are ordered and medications are
prescribed. They are more involved in their own care and more empowered with
information about their treatment options. Where there was once a curtain between
the patient and the doctor, there is now an open door. We are sitting at the
table together. With the advent of technology, the relationship is now more of
a partnership.
I love the potential of this
relationship—the give and take and the more informed communication technology
has sparked. I love the idea of working with a patient with the same goal in
mind: getting them healthy. I like the notion that I could recommend a dietary
style, and the patient can research food options and find recipes, or that I
could prescribe an exercise program and the patient can use a smart watch to
log exercise minutes and monitor heart rate. These advancements can help with
compliance and increase the chances that lifestyle changes will be effective.
But Dr. Google also has a dark side, and that is a certain level of disintegration of the doctor-patient partnership. Consider the recent measles outbreak. How did this happen in 2019? I can’t say for sure, but it’s my feeling that there has been a communication breakdown due, not to good information, but to misinformation.
When patients believe Dr.
Google instead of the flesh-and-blood doctors who know them personally, and
when Dr. Google tells them things that aren’t true or that are even dangerous,
the result can be disastrous. I am not saying this is the sole cause of the
epidemic, which has deep, complicated causes. But the fact remains that for
many people today, online support groups and websites are the major source of
information.
People can become attached to
what they have discovered online, especially if it seems to them to match their
symptoms, concurs with their beliefs or explains their issues. If they bring
this information to their doctor, sometimes he or she is not receptive,
especially if the information seems, in the doctor’s expert opinion, to be
inaccurate, irresponsible or even ridiculous. This kind of response immediately
shuts down the conversation on both sides. The doctor feels that the patient
can’t be advised, and the patient feels like the doctor isn’t listening. The
result is mistrust, and once the trust is gone, Dr. Google wins.
I’ve experienced this situation
firsthand. There have been many instances when I suggested a medication to a
patient only to be told that she read on the Internet that the medication is
not good, is dangerous, can cause cancer or brain damage, or whatever it is she
read online. For these reasons, she is (understandably) hesitant to take it. I
believe that doctors can no longer deny this is happening. They have to admit
it and address it so they can help the patient understand.
If I really believe the patient
needs that medication, it is my job to listen to her, even if I disagree, and
then to explain why I think the information isn’t accurate, and why I think the
medication is necessary. The patient may or may not listen or agree, but if
doctors don’t do their part to make the patient feel heard, the doctor-patient
relationship is doomed.
Traditionally, when doctors are confronted with issues that they are unsure about, they called for a “consult” or a “second opinion.” This practice is considered standard-of-care amongst practitioners, since we all specialize in different things. Now when I suggest that patients consult a specialist or get a second opinion, they often feel like they’ve already gotten their second opinion from Facebook, an Internet group devoted to a particular condition, or a website that has information on how to reach optimal outcomes. All of this is information, sure…but it is not education and, even more importantly, it is not truly the practice of medicine.
Information without context
cannot be safely applied to an individual situation. Information is nothing
without understanding. For all these reasons, I propose that the new role of
the doctor is to help the patient synthesize information so that the entire
healthcare team—doctor, patient and specialists—can work together to make the
best decisions and consider the best options and potential outcomes. It’s time
to admit that high-quality, comprehensive, mutually satisfactory health care
and the achievement of overall wellness must stem from mutual respect, mutual
understanding and the willingness of both parties to listen to each other. This
is how we can work together.
Although it is true that the
doctor has the benefit of experience in making the decisions, the patient also
has knowledge in the form of a lifetime of living in his or her own body. Only
the patient knows who they are and how they feel, and doctors need to
acknowledge that this is one of the most important aspects of critical
healthcare decision making.
Technology, as a tool, is here for us, and I suggest that there are many ways to use it to our benefit. Let’s all try harder to understand, educate, communicate and even respectfully debate. Because, ultimately, successful health care must arise out of conversation that can lead to partnership. Trust goes both ways, and I predict that in the future, doctors will be judged less solely on their credentials, and more on their willingness to collaborate. In a perfect world, they would excel at both. Only then will Dr. Google be forced to step back and take a secondary role. And that is probably in the best interest of everyone.
Click here to buy Dr. Suzanne Steinbaum’s book, Dr. Suzanne Steinbaum’s Heart Book: Every Woman’s Guide to a Heart-Healthy Life
