Docs Still Hold Web at Arm’s Length

A new Pew Internet and American Life study published January 15 provides insights into how Americans use the Internet to find health information. Some highlights:

  • 59% of American adults have gone online in the past year to look up health information, representing a continuation of existing trends
  • 70% turned to their doctor the last time they had a serious health issue, and almost all of their conversations were offline
  • 1 in 4 hit a paywall when trying to find health information online
  • Only 3-4% of users have posted reviews of health care services or providers
  • People looking up health information on mobile phones are more likely to be young and of minority ethnicity
  • While people with health insurance are more likely than those without to see a doctor for help, statistically equivalent proportions of the insured and uninsured search for health information online. (Read more of Pew Internet’s Health Online 2013 report.)

It’s refreshing, as other coverage of the report points out, that most physicians no longer assume the worst stereotypes of hypochondriac patients searching online or merely tell patients to stay off the web. In fact, the tech-savvy physicians in these articles encourage their colleagues to ask patients more about what they’re finding online and point them to reputable sources.

The most remarkable thing I noticed, however–as a soon-to-be M.D. but also as a millennial who takes for granted the scope and reach of the Internet into almost every aspect of my daily life–is that while physicians are becoming decidedly more accepting of patients’ searches for information online, they still seem to hold the web at arm’s length, observing it with increasing interest and even respect, but refraining from direct participation.

We’re running parallel worlds here. Patients search online, patients talk to their doctors offline, and Pew measures and compares how much they do of each. We as providers are missing a huge opportunity to merge these tracks and engage directly with patients online. Instead of referring people to websites, doctors could band together to create the online content that they want patients to see. Better yet, instead of creating additional (albeit more medically trustworthy) static content about symptoms, diagnoses, and treatments, doctors and nurses could port certain aspects of their interactions with patients to the cloud–as almost everyone has done analogously with our real-life friendships on social networking sites–beyond simply filling requests for e-prescriptions and e-confirming appointments. Nothing will replace putting “eyes on the patient”, as we say in medicine, but there’s so much about the web and information technology that we can leverage, not only to help patients find answers, but also to make health care delivery more efficient and less costly.

Here’s a great example: One of the major activities that the report focuses on is online self-diagnosis; according to Pew, over a third of Americans are doing it. Around half of these online diagnosers still go in to see a doctor, and about half of those have their suspected diagnosis confirmed. But let’s take a step back. The implicit intermediate step in a patient’s search for a diagnosis is triage: “Is this something I should be worried or not worried about?” “Is this something I need to see a doctor for, or could I just chat with a nurse?” “Is this something that’s urgent, or can I wait for an appointment?” “What information would be good to bring along if I want to have a productive conversation and maybe save myself a follow-up visit?”

Since the beginning of the doctor’s office, patients have been trying to answer these questions on their own, and of course they don’t always get it right. Every physician has patients who come in unnecessarily for a common cold virus or wait too long for an invasive pneumonia. I’ll call this the “triage gap,” and startups like Sherpaa and Moxe Health who are trying to solve the problem of how to help patients most effectively before they come in to the office or ER are on the right track to save patients, doctors, and the healthcare system as a whole significant amounts of time and money.