I’ve known several doctors who refused to read e-mail from patients. They said it was simply a bad use of their time.
I also used to have a doctor who hated it whenever you came in and asked questions about some article you’d read in The Times about Lyme disease or some such. He’d get a pained look on his face — here we go again; patients pretending to be doctors — and then ignore the question.
But surely it’s in everyone’s best interest for patients to stay informed, right? For patients to do their own research, to ask lots of questions — especially of their own doctors — and so forth, right? Right?
Wrong. At least that’s what Hai Fang, Nolan H. Miller, John A. Rizzo, and Richard J. Zeckhauser write in a new working paper called “Demanding Customers: Consumerist Patients and Quality of Care.”
From the abstract:
Consumerism arises when patients acquire and use medical information from sources apart from their physicians, such as the Internet and direct-to-patient advertising.
Consumerism has been hailed as a means of improving quality. This need not be the result. Consumerist patients place additional demands on their doctors’ time, thus imposing a negative externality on other patients. … Data from a large national survey of physicians shows that high levels of consumerism are associated with lower perceived quality.
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I did find a very good doctor at an HMO-type center who would prescribe and order tests for a recurring problem by e-mail. I hesitate to name them since I don’t want to bring down the AMA on them. Of course, he gets paid the same if he sees 0 or 100 patients in a day. His incentives are more aligned with mine.
The problem, they claim, is consumerism, which does not arise from the seeking of information, but from a person’s mentality in-itself. I am a good patient that is keen on appropriate care. However, I aim to be truly informed and seek information from my doctor and outside of him/her for the very purpose of expediency in my business-client relationship. In all, I fault the loose wording in the abstract which makes an “A from B” argument that is untrue. Consumerism, while being the problem they seek to address, is not caused by seeking information, but from not seeking it deeply enough beyond shallow awareness and speculation.
Funny that they don’t care when pharmaceutical reps, who may or may not be more educated than your average patient, are pushing their products but they are getting free meals, gifts & other products.
As a group, I’ve found doctors to be a most arrogant lot (the most). I absolutely love the fact that they need to “prove” their knowledge level now – just like any other profession. If the Dr. can’t answer my questions he/she is out the door.
@6
Same here! I am alive today because when I was a child my parents *insisted* (3 times) that my doctor take another look at my condition.
Far too often patients know better that something is wrong, far too often to just go along with the happy delusion that doctors fathom *significantly* better than I do the complexities and intricacies of the human body. I’m glad to have doctors (I’d be dead without some good ones), but can’t they lay off the hubris just a little?
“Data from a large national survey of physicians shows that high levels of consumerism are associated with lower perceived quality.”
Wait, I’m not quite clear here – so patients who know more are also more likely to realize the low level of care their doctors give them? Or is it the fact that the doctor gets “a pained look on his face – here we go again; patients pretending to be doctors – and then ignore the question” that makes people mad?
Look, let’s be honest here – most doctors aren’t House. Sure, they have a huge range ofknowledge, but so does Google. When a patient comes in with a cold and a fever, the doctor is going to say “Aha! It’s the flu” and give them an antiviral. The patient probably spent 20 minutes to a few hours waiting in a lounge, surrounded by other sick people. If the person realizes that they could have gotten the same diagnosis in about 5 minutes on WebMD.com, they’re probably going to be much less happy about the visit.
I can easily imagine a program that takes in symptoms and spits out probable diagnoses, then takes the persons medical record and matches them up with the best medicine to treat the most likely issue. Poof – general practitioners aren’t needed anymore.
A doctor who relishes his or her patients’ involvement in their care is a rare individual and clearly not in it for the money. Docs that you actually talk to–like internists and family physicians–get paid $70 to talk to a medicare patient for 25 minutes. Scoping a colon takes 15 minutes and costs a thousand bucks. There are monumental financial disincentives for us to listen to patients. It sucks.
“Experts” always prefer information asymmetry, as it adds value and power/control to them. The more a service client knows, the harder it is for the expert to have control and advantage. This is no different than querying taxi drivers whether they prefer customers who know the fastest way or not.
But, that said, the problem with informed consumers is that they tend to take a lot of the Doctors time, and with most insurance these days, they do not get to charge for longer visits and/or more questions (unlike a Lawyer or Accountant for example). It should also be noted that more patients tend to self-diagnose and so answer questions from their Doctor in a way that affirms their own diagnosis rather than the truth. This is often done to make sure they get some test – but this results in worse care and often wasteful tests and the like. It is part of the broken health care system we have.
But, properly and well informed patients can be a lot of help when the Doctor can make the patient an assistant in their own care.