Wednesday, September 30, 2009

How to talk back to your doctor?

When was the last time you visited your doctor? What was it like? What happened? How did you communicate? Were you listened to? Were you able to develop, or deepen, your therapeutic relationship with them? Who else was part of the consultation? Was your doctor using a computer during the consultation? And if so, for what purpose?

There are a number of factors that are known to strengthen the therapeutic relationship that you have with your doctor, and they all fall under the broad heading of “patient empowerment”. There is a truism in healthcare that “knowledge is power” and that this is a key component of any good relationship. The capacity to make choices based on correct information, whether it is from your doctor, or the Internet, or elsewhere, is crucial. Another factor is responsibility – patients have to be aware of what is expected of them in the relationship, just as is the case for doctors – with any treatment program being designed to make the patient independent and able to take charge of their own lives and any future treatment programs. Finally patients need to know what are the expectations of their treatment program, who else might need to be involved (such as family, interpreters or other doctors), how can second opinions be arranged.

All of these matters are related to knowledge and information, and all can be improved by working with your doctor and the Internet to help yourself better. 38% of patients in a recent study from the Pew Foundation reported being able to email their doctors in 2008, compared with only 6% of patients in 2003, but over 80% of patients said they would like this ability. The same study estimated that over 8 million Americans use the Internet to search for health information every single day. This works out at over 140 million Americans each year. We all know the importance of communication, and doctors and patients are now increasingly communicating by using the Internet and email.

Think about all these questions. Have you, like many others, seen your doctor in the presence of a third “person” – a computer linked to the Internet? Most doctors have rapidly computerized their practices over the past decade. They are very aware of the extraordinary amount of health information on the Internet, and most are fluent users of email, and many other software packages. Doctors have taken to the Internet like ducks to water, and use many aspects of the Internet for their own lives just like most other people in the USA. They use it to manage their practices, and many now also communicate regularly with patients on email. This is not surprising. Most doctors will use any useful innovation or new technology that presents itself to allow them to provide better care. They are very aware that this is the Information Age, and that they and their patients can greatly benefit from the amazing amount of healthcare information that is now at their finger tips, and from the astonishing access that they have to this information.

It is national US health policy for all patients to have an electronic health record within a few years time, so many doctors and hospitals are implementing such records to hold patient information. Large health systems are forming partnerships with commercial companies such as Microsoft and Google to make health information more available to patients in the form of personal health records – another way for patients to see, and contribute to, their own health information. And another way for patients to learn more about themselves, and hence communicate better with their doctors.

So what happened when you saw your doctor? How did he or she then involve this “third person” in the consultation? How did you feel about it, and did it help you? Were you able to find and use the amazing amount of health information available online, to work with your doctor, to collaboratively become the winning team that is necessary to keep you healthy, happy, and fully productive in as many aspects of your life as possible. To teach you how to talk back to your doctor, to be heard, and to be empowered to improve your health.

Peter Yellowlees MD has recently published “Your Health in the Information Age – how you and your doctor can use the Internet to work together”. It is available at and most online bookstores.

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