There is a dramatic paradigm shift taking place in healthcare and it’s changing the doctor-patient relationship in ways we never imagined. When I started medical school in 1989, there was no internet and my 20MB hard drive PC was really nothing more than a word processor but it was top of the line. When we researched diseases and conditions, it required going to a textbook or a trip to the library to review the hardcopies of journals. During residency, I saw the birth of the internet and experienced my first exposure to public discussions of medical conditions, if a disease existed, there was a chat room on AOL for people to openly discuss. Today, the resources of the world are only a few clicks away and you can quickly find an answer to almost any question you could think to ask.
What does all of this mean to physicians? It means that we have to be aware of the fact many patients coming to us actually possess more current knowledge on a disease or condition than might. This is the reality of medicine now and those physicians who refuse to check their ego at the door are soon going to find empty waiting rooms. Patients are now exhaustively researching their conditions and symptoms, they are going to online discussion sites, joining online support groups, and they are even able to access the most up to date research articles. The well researched patient is knowledgable and we need to be listening. I have found myself learning quite a bit from patients and they have certainly improved my patient care by giving me direction on some current research. Medicine is now a team approach and physicians need to function in a role that is collaborative with patients.
There are many physicians, however, that are resistant to this concept. They are letting their ego’s get in the way of good patient care. I frequently see new clients that come to our practice due to frustrations with their current providers – most common complaint, “my Doctor would not listen.” A recent patient had developed mild chest pain while doing Crossfit so he went to his primary care provider, he ended up having a cardiac catheterization and subsequent heart bypass surgery within 48 hours of that visit. He says that he cannot even remember being told what was happening. At the one month follow-up with the heart surgeon, he complained that he felt lousy on the statin drugs and since he did not have cholesterol problems in the first place and he knew that there was some risks with statin drugs, he felt it was best to discontinue use. In a very harsh tone, he surgeon told him that he could not stop the statin drug. The patient held his ground and the surgeon stormed out of the room only to return, fuming, 5 minutes later to argue his point and get the patient to admit he was wrong. The patient did not resume the statin drug but he did fire his surgeon. I have also had patients who repeatedly asked their physician for specific testing which was ordered begrudgingly only after they had been through a litanny of other unnecesary tests. Its amazing how many times these patients turned out to be right.
So, as physicians, what is our role now? Physicians are partners in each clients care. We need to be open to what each patient has to say about their needs and what they have discovered in their research. If we don’t have the appropriate knowledge, then we need to look it up and have an open discussion regarding our interpretation from a medical standpoint. We must be open to ordering requested tests since most patients can go online and order just about any test they desire. Patients are taking the reins and we have a choice to either ride shotgun or get off the stagecoach.