The film “Up in the Air” is — ostensibly — all about George Clooney. Ryan Bingham (George Clooney) travels across the country 300+ days of the year and fires people for a living… Because bosses get scared and emotional ex-employees tend toward regrettable actions.

But “Natalie Keener” (Anna Kendrick) truly steals the show.

Natalie is the young hotshot character. She’s convinced Ryan’s boss to replace the guys’ jet-setting ways with New Technology: firing people over the computer screen. She’s going to make Ryan irrelevant, and the firees along with him.

Now replace “firing people” with “seeing patients”. Does the funny feeling grow?

This is the major reason “telemedicine” sets off alarm bells left and right.

We can accept pushing the “tele-” prefix onto other words. But not “medicine”. Medicine is sacred. Why? Because it should never be impersonal.

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“A warm smile is the universal language of kindness.”

Do you believe this? A recent question on Ask Mefi wondered the same thing, and received many interesting responses, both agreeing:

It’s supposedly one of the six universal expressions.
In my psychology class in college, the prof told us (IIRC) that these are the six expressions/emotions that babies have before they’re socialized to experience more self-conscious feelings like pride, shame, etc.

and disagreeing:

I’ve read that Vietnamese smile when they are frightened to show subservience and that this made American GIs think they were laughing at them with sometimes tragic results.

This, along with an interesting conversation (detailed below), set me wondering:

If even a smile is not universal, how universal can a medical tool that mediates human expression really be?

And furthermore, how universal can medicine 2.0 be?

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Dr. Vartabedian (@Doctor_V) recently posted about the pre-emptive strike delivered by a patient’s mother as DrV was trying to explain the condition. The weapon? Google!

I recently discussed endoscopic biopsy results with a patient’s mother. Her child had inflammation in the upper intestinal tract with cells called eosinophils. As I began to explain the basics of tummy irritation and the significance of the eosinophils in her daughter’s duodenum she cut me off, “Actually doctor, you don’t need to go into too much detail, just spell ‘eosinophil’ for me if you would.”

As it turns out mom was more interested in getting to Google than listening to how I think her daughter’s biopsy results related to her problem.

DrV’s story highlights a fundamental struggle in the development of Patient 2.0.

On one hand, the technology is facilitating patient education and empowerment in a myriad of ways. Knowing the name of a condition, I can look up treatments; knowing my symptoms, I can follow a flow-chart JPEG and self-diagnose; tracking how I eat/sleep/exercise/smoke/drink/etc. via DailyBurn-esque services, I can analyze habits from the comfort of my home. But the flip side is that the infosphere lacks guidance: accessibility to information is not a problem, yet accessibility to knowledge is.

Remember Google Answers? Nowadays, it has been written about in articles counting down the top Google Labs failures (couldn’t compete with Yahoo! Answers), but I believe it is useful to recall the reason for its creation. Google Answers employed real people who searched the Google inundation for the answers to your questions. The important point is that they didn’t simply give link lists; they tailored and annotated the answers extensively. It was like having a personal tour-guide to your own question. Similarly, the best-case scenario for the patient is to have a personal tour-guide to his condition, but the internet alone fails at this. It is a bit like being given the map, but not the guide.

So what does this mean for the current and next generation of physicians?

As DrV pointed out: “The internet isn’t going anywhere. If anything the web’s capacity to support patients will only improve.” It is only natural that patients and their families’ use of the web will grow more sophisticated, whether they are looking because it’s the middle of the night and they can’t go to the doctor, because they aren’t comfortable talking about their condition, or simply because they are interested in trying out these tools for themselves. We cannot begin to elucidate the gamut of reasons. Therefore, the paramount task of physicians will be to master the web to better support tech-savvy patients.

“Pre-Emptive Online Literacy”

Physicians should explore the web themselves and know what their patients will be seeing when they Google, something that DrV call Pre-Emptive Online Health Literacy. For example, a patient might find that the treatment for his condition that garners the most hits or that is treated in the most detail on Wikipedia is the not the one his doctor recommends; the doctor should be ready to explain why certain information on the web is not applicable to the patient’s specific situation.

1 Monologue + 1 Monologue /= Dialogue! If the doctor is able to anticipate the results of patient empowerment and act accordingly, then we have synergy. This is what makes the web truly useful.