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 strews chocolate milk and Cheerios around his office. Haig caricatures a harried mom and compares her scornfully to his ideal patient, the engineer who is "accustomed to the concept of consultation". His Mr. or Ms. "Logical" leaves the kids in someone else's care and probably sports a pocket protector to prevent ink from the Pilot Extra Fine Point pen from spilling on the doctor's office 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."
Doctor Haig has a seemingly exalted position in New York's medical circles. He teaches, runs a private practice, and "punts" his undesirable patient, with her "mispronounced words and half-baked ideas", after only one short visit. Shouldn't we all be this spoiled? Hospitalists, emergency docs, managed care docs, brilliant and dedicated private practice doctors, nurses, lab techs, physical therapists, administrators and medical workers are usually stuck with their clients -- even when those individuals who have anti-medical ideas like yin-yang, or nutrition. But imagine if, like Haig, after a mere twenty minutes of most your insufferable patient, co-worker, doctor, or boss, you could simply boot them out? You could just bid that person adieu and never have to see them 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?
When patients visit the doctor they generally get one 5-30 minute office visit with the "expert". Doctors are pricey, even if insurance buffers the $200-$500 bill. "Personalized" medicine? Patients are 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 should be forgiven their unpracticed manner.
And mispronounciations? 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? Does the harried mom? She probably wishes she did have childcare. How and why would she know the pronunciations of words in the lexicon of an orthapedic surgeon?
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 "patient's bedside manners", and the variable ability of patients to see the body in the exact same way that a trained doctor does.
Google's Intrusion?
Haig did not write 'Googler Patient' for Acronym Required's rhetorical amusement. In his telling, his irritating patient knows his address, which unsettles him. But it's hard to imagine any real rage or paranoia built around that. It's easy enough to keep your address fairly private, and his patient is obviously harmless. If we were to hazard a guess, we'd suspect there's something underlying his irritation. We'd suggest 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 Seach masquerade in Haig's tale as his pushy female who is intruding, too "rude" and "too personal"? Does "she" (Google) jostle the power structure? Does "she" (Google) unnerve the doctor?
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.
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. 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". 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".
