When Fear of the Internet Manifests as a Desire to Throw Cheerios?
In Time magazine's "When the Patient is a Googler", Dr. Scott Haig constructs a straw lady for our entertainment. His female patient "brandish[es]" information during an office visit and her unruly child spews chocolate milk and Cheerios about his office. Haig holds up his caricature of a harried mom and compares her to his ideal patient, the engineer who is "accustomed to the concept of consultation". The engineer's kids are no doubt being cared for somewhere else, and his Mr. or Ms. "Logical" probably sports a pocket protector to prevent ink from the Pilot Extra Fine Point permanent marker from accidentally marring the doctor's fine upholstery. Kudos to engineers for knowing their rightful place.
To be fair, Haig likes nurses too. They're his "favorites", because "they know our language and they're used to putting their trust in doctors. And they laugh at my jokes."
The doctor holds a seemingly exalted position in New York's medical circles. He teaches, runs a private practice, and "punts" his undesirable patient, her "mispronounced words and half-baked ideas", after only one short visit. Such skill! Such fortune! Hospitalists, emergency docs, managed care docs, brilliant and dedicated private practice doctors, nurses, lab techs, physical therapists, administrators and medical workers are often stuck with their clients -- even when said individuals taunt outrageous anti-medical ideas like "yin-yang", or "nutrition"! But imagine Haig's scenario. Imagine if after a mere twenty minutes of your insufferable patient, co-worker, doctor, or boss, you could simply opt out? You could just bid that arrogant pill adieu and never have to endure whatever blah, blah, blah, blah...again? Without sacrificing your (let's say) $500,000K+ salary? Oh, should such a world be mine! To hell with compassion.
For a man of his stature, Haig's stereotyped "brainsucker" female protagonist with her wayward toddler provokes a strong reaction -- "I soon felt like throwing Cheerios at her too", "I couldn't dance with this one". Why such indignation? In Haig's telling she knows his address, but it's hard to imagine any real rage or paranoia built around that. It's easy enough to keep an address private, and she's obviously harmless.
Haig did not write 'Googler Patient' for Acronym Required's rhetorical amusement. If we were to hazard a guess, we'd suspect there's something more, and the doctor didn't diagnose his problem correctly. We'd suggest that it's psychological. That he's upset, unsettled perhaps, thinking about how the internet might further disrupt the cozy information asymmetry implicit in doctor patient relationships. Does Google masquerade in Haig's tale as some pushy female, "rude" and "too personal"? Does "she" jostle the power structure? Does "she" psychophysiologically unnerve the doctor?
An Apple a Day....More Pablum For Busy, Distracted Minds
When patients visit the doctor they generally get one 10-30 minute office visit with the "expert". Doctors are pricey, even if insurance buffers the $200-$500 bill. "Personalized" medicine? Patients are often lucky if the doctor gets their name and age right. Stressed by whatever ails them, patients don't see doctors for a living, as doctors do patients, so they could be forgiven their unpracticed manner. Think of your dear grandmother, born in a time not too long after the town doctor made patient rounds with his horse-drawn carriage. Does she have to ape the behavior of a dispassionate engineer in order to avoid the scorn?
Many doctors agree that patients should be as informed as possible for their own health. We all acknowledge that American medicine is often a broken system. Sure "experts" abound, but complacent doctors are easy to find too. Medical errors occur in "44,000 to 98,000" patients a year according to the FDA (via Google). Patients, being human, aren't all equally subtle or adept at integrating their new found internet information with the doctor's expertise. But doctors should be able to adjust to this. They should be able to relate to inevitable unevenness in "bedside manners", and the variable ability of patients to see the body in the same way that the well-trained and indoctrinated doctor does.
There's a phenomenon at work here concerning the internet, medical information, and doctor/patient relationships. Unfortunately this Time column doesn't get around to exploring the more subtle and interesting aspects of the story.
'Fessing Up For Health
In a related piece, Tom Delbanco, M.D., and Sigall K. Bell, M.D write in "Guilty, Afraid, and Alone - Struggling with Medical Error", (New England Journal of Medicine NEJM Volume 357:1682-1683, October 25, 2007), about mutual fear on the part of patients and doctors that exacerbates suffering due to medical mistakes. They note that "because of the power dynamics between physicians and patients, questioning the expertise or skill of an authority figure is particularly fraught for the least empowered members of society". The authors have made a film for third year medical students and suggest that in the case of medical errors, there should be a forum for some sort of reconciliation: "patients and families will bring ideas to the table that expand the horizons of health care professionals".
The doctor certainly drew up an irritating caricature combining a whole bunch of annoying traits to cheaply harness his audience's agreement... As you point out, his true problem isn't really with mom as much as it is with the erosion of unquestioned authority - and the idea people might start to question him and his ilk.
This guy's already enough of a creaky old dinosaur, at least he sounds like one, that he won't have to sweat losing out on the lucre - but younger docs take note: future patients will find it easier and easier to get well-informed, expert opinions, not only from the net. Doctors in other parts of the world are also well-educated,and more than willing to keep up with the current research and dispense with the obnoxious attitude.
He really doesn't get it -- the woman wasn't googling him on the phone! People google me all the time - before they call. Frankly, when someone's health is at stake, I'd hope they'd research their illness, and good for them for trying to figure out a doctor's credentials, opinions, and whether he's worth the call. Anyway, "she" was probably just texting someone while on the phone, as any multitasker would...