The Doctor’s Role in a Health 2.0 World

Posted April 23, 2009 by Lygeia Ricciardi

One of the recurring themes at the Health 2.0 - Information Therapy Conference is the challenge of merging the new world of Health 2.0 – in which many patients create, share, record, aggregate, and manage their own data -- and the traditional health system. The theme is also closely linked to Project HealthDesign’s emphasis in its upcoming round of grants.

How an existing health organization absorbs or adapts to Health 2.0 depends on its unique characteristics and character. Yesterday at the conference we heard from healthcare organizations ranging from large integrated systems to small, independent clinics. Some are trying to fit Health 2.0 into their existing paradigms, while others are completely overhauling the way they do business.

A number of observations about incorporating Health 2.0 emerged. For example, according to James Hereford (Group Health), you have to deliver to patients only information that is relevant to them, and do so in a way that also makes sense to doctors--both from a clinical and a workflow perspective. It’s also important to provide incentives to share and use information. Perhaps most of all, whatever you do must strengthen rather than undermine trust in the patient-doctor relationship.

How might Health 2.0 change that relationship? For one thing, in the past, doctors functioned as repositories of a significant proportion of health knowledge. But with the volume of new research generated today, it’s impossible for any individual to keep up. ePatient Dave (patient, blogger) relayed some testimony by Don Lindberg, Director of the National Library of Medicine, who said that even if he read two medical journal articles each day, at the end of one year he’d still be 648 years behind in the medical literature. 

So of course, combining that point with Health 2.0 resources, many patients have begun to know more about their particular health conditions than their doctors do. Which begins to shift the traditional patient-doctor relationship and power dynamic.

What should a doctor’s role be? Obviously a key part is providing clinical care or guidance, especially in response to particular health events or conditions. Another part may be leading or managing a team of other caregivers. With regard to health knowledge, Danny Sands (Cisco and Beth Israel Deaconess Medical Center) says doctors should know how and where to find information, and must freely admit—whether to colleagues or patients—when they don’t know it. Doctors and patients can seek and interpret information together, and doctors can help patients understand how generic facts apply in an individual’s particular case. An important aspect of information gathering is, in fact, collecting and contextualizing information about the individual patient.

Along the same lines, Jamie Heywood (PatientsLikeMe) observed (quoting an unnamed source), that the patient is the CEO of his or her own body, and the doctor is the consultant. The doctor’s job is to  support patients in caring for themselves on an ongoing basis. Several other people emphasized the extent to which most things that impact patient health, such as behavior choices related to diet, exercise, compliance, smoking, etc—take place outside the formal health system and are under the control of patients themselves—so doctors need to help point people toward the tools that can let them succeed in maintaining their own health on an everyday basis. Another comment by Jamie was about the responsibility of doctors in balancing the demands of individual patients and population health.

Susan Edgman-Levitan (Mass General Stoecle Center) emphasized yet another aspect of the doctor role – doctor as healer: a person who cares deeply about the patient and contributes to health not merely through clinical knowledge, procedures and techniques, but with kindness and compassion.

While on the one hand there are elements of truth in all of the observations above, on the other, as Paul Wallace (Kaiser Permanente & Ix Center) pointed out, we have to keep in mind that no one doctor can be all things to all patients.

In my opinion, it’s important to consider the doctor’s role in the context of a much larger care team, which includes not only other clinical providers, but patients and the teams they assemble to support themselves, too – including families, friends, and, increasingly, members of virtual communities. How do you think the advent of Health 2.0 should impact the doctor’s role?