Informed Patients are Bad Patients?
So That’s Why Doctors Don’t Use E-Mail
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.
Having grown up in a medical family, I know many medical practitioners feel this way. However, I do find that at least some physicians are inconsistent on this point in several ways. First of all, physicians often speak to patients, or at least to me, as if I have a medical degree or advanced training in biology. In order for me to communicate effectively with them, I need to read up on whatever I am discussing so I can have a hope of understanding and remembering what they say to me. However, if you use this specialized verbiage, then the above reaction is a risk. However, if you use uninformed language to attempt to describe how you are feeling, the likely reaction is that you are not being specific enough.
The last sentence in the quoted text is what concerns me, however. When I am taking medication, I almost do not want to read the side effects. Many are quite subjective, and I am afraid I will turn into some kind of paranoid hypochondriac paying attention to the daily variations of my bodily functions. This could very well be what causes the ‘lower perceived quality’ without any real reduction in health outcomes. The other possibility is that the patients suddenly have an inkling of how they are supposed to be treated and that their inept doctor is failing to do so. Which is to say that the main thrust of the study is totally ambiguous.
I do think, however, that there is a substantial difference between pure marketing materials (e.g. direct-to-consumer advertising) and the more generic medical information. The willingness of marketers in general and pharmaceutical companies in particular to distort the truth makes them not worth listening to. Maybe the patient/consumer will not understand all the nuances in the medical literature being presented to them by the likes of WebMD, but hopefully they are not reading material that is designed specifically to goad them into asking their doctor for a prescription.
The last thing to note is that physicians are almost universally recognized as being the worst patients.
