How the abundance of information online alters a physician’s decision making

In Uncategorized by Michael Willis

David Seres MD

David S. Seres, MD is Associate Professor of Medicine and a Clinical Ethicist at Columbia University Medical Center. 

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Driven by the ready availability of inexpensive but low quality information from the internet, healthcare has been undergoing a dramatic transition.

But this surge in information, rather than augmenting the physician-patient partnership and empowering each to make better decisions, is replacing the traditional model of the physician-patient relationship, and changing it from that of an expert advisor counseling the patient, to that of an industry paradigm where the clinician is responding to the demands of the consumer. All of this information is clearly available at all points to all patients. And while physicians and hospital administrators are scrambling to react, they are ill equipped to respond appropriately.

Every day, patients walk into clinical settings armed with research and opinions. All you have to do is fire up your favorite internet browser and you’ll find out how to deal with any medical issue with “expert” opinions on wellness websites, Google searches, Wikipedia posts, and emotionally charged, moving, but scientifically incorrect anecdotal testimonials from well-intended patients and family members espousing unproven or even dangerous therapies. Turn on your television and you are inundated with salesmen hocking snake-oiled opinions with financial conflicts of interest on infomercials and talk shows. To say nothing of the billions ($3B direct to consumers, $24B marketing to doctors) spent on advertising prescription drugs.

To be sure, the medical profession has been advocating on behalf of insuring that our patients are well informed for years. We believe that the knowledgeable patient will be healthier. Moreover, the most important concept in medical ethics is patient autonomy, or the right to self-determination, which requires the decision-maker be well informed as to the risks and benefits of proposed therapy. One would think that a clinician-patient relationship based on a collaborative paradigm would be ideal. Patients are more engaged, interested in the management of their problems and in making sound decisions that suit their life choices and needs.

But this partnership, in this day and age of medical information surge, is not ready for prime time. You get what you pay for, and most of the information available to consumers is cheap and of extremely poor quality. Fueled by this easy access and perhaps their dissatisfaction with healthcare in general, patients are taking matters into their own hands, often ill-advisedly, and making bad decisions. Moreover, clinicians are horribly pressed for time, and counseling patients is often what is sacrificed.

Don’t think for a minute that physicians necessarily do any better with how they deal with medical research. Over one million research articles (in the hundreds of thousands in each major specialty) are being published every year, which no one physician can read. That which is higher quality is impossible to aggregate in a timely fashion so that it can be distilled down to a plain-spoken sound bite that both the patient and physician can understand during a 20 minute doctor visit. When the medical data is weak, and in particular when huge industries have profits at stake, we have the kinds of battles we see ongoing surrounding the new dietary guidelines.

The flow of peer reviewed properly controlled trials is so massive that even the most well-read physicians cannot keep up. In fact, a recent article in the Proceedings of the Mayo Clinic reported that 40% of the decisions made by physicians at the top institutions in the country are not concordant with the most up to date clinical outcomes research. That is an astonishing amount of out-of-date medical care. This at our best hospitals. Consider that the annual expenditure on health care in this country is $3.8 trillion. So it is conceivable that we spend somewhere in the vicinity of $1.5 trillion every year on bad decision making.

Ultimately the answer to this huge information mess is not returning to a 20th century physician-patient paradigm. Rather it is in embracing the brave new collaborative world and strengthening the engagement between the two parties by providing equal access to the highest quality, most accurate medical data possible: data that is not polluted by commercial or emotional bias, data that is presented in terms that both parties can clearly understand and around which they can have a meaningful, and scientifically accurate discussion about treatment options. Informing patients about their care is an ethical requirement. Doing so with up to date, clear, and unbiased data is a moral imperative.

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