This is a story about today.

So you’re a patient. You’ve been waiting a long, long time. This place never gets better. Even though this is “your appointment” and “your day”, despite knowing that the doctors are so, so nice — wonderful, really – you find yourself cringing at the unmistakable “busy” in the air.

We’re two hours behind schedule, you hear someone whisper from behind a pulled curtain, and you start to feel foolish.

Maybe you shouldn’t ask this question, you think. Maybe you need to do some more research…

Which is ridiculous, since research is all you’ve been doing! Even though you’ve been saving this question, carefully Google-searching, bookmarking, even scanning scholarly articles in foreign journals about the wrong gender and the wrong age bracket.

The unease unclenches and clenches again like a fist in your stomach.

Finally, they come in and probe, and smile, and reassure – doing their job you know — but still you don’t ask the question.

Why not?

You wonder how they would feel about the anxiety that has led you to Google. You wonder if what you know could possibly stack up against what they know.

Well, you really haven’t looked at everything… Maybe the forums have something to say about it. Try again next month?

So you go home. Your transport is here anyway. It’s always on time. And so is the internet.

- -

Today, a question was not asked.

Problem is, today could be any day.

We who work in health care may still be only a small slice of people’s lives — and I sincerely hope that their relationships with us will never define who they are — but our advice is shockingly weighty. It’s sometimes even alive, if you can imagine that.

Patients take it home with them. And it probably does live with them.

Therefore, I am disappointed when a question is not asked.

I am not sure if this disappointment has a direction or whether it is only a kind of haze – suspended, obscuring, and not quite right. But I think it means something.

It means that we have built fences. Psychological fences. We are told that good fences make good neighbours, but I for one don’t want to talk to people through fences. When we erect too many fences, at some point somebody ends up taking the path of least resistance. Like avoiding communication and seeking out answers on the internet.

A path that perhaps provides short-term relief but eventually pretty much leads to more speculation, uncertainty, anxiety.

 (Image: Makz on Flickr)

I’m not saying the internet is evil. Of course not. I’m a huge advocate of patient empowerment and e-patients. And online research and tools most certainly can help inform patient decisions, as well as provide a certain level of community and emotional support.

I just, at times, become wary of curiosity unchecked. I hope that no matter what they discover in their research – no matter how busy and efficiency-obsessed health care workers may look on a particular day – that patients will continue to feel comfortable discussing their online findings with us.

To give a related example, this brings to mind my recent post on Twitter + Group Medical Visits. There, several readers brought up the utility of a physician being aware of Twitter trending topics within the group between visits, so that they can be further discussed at the next Group Visit with input from a medical professional. So while it’s excellent to have more conversation overall, I hope that internet conversations will not be disjoint from in-person conversations between doctor and patient.

Ask the question.

If the description of your prescribed drug in a paper from Medline is making you feel nervous, speak up. If your email list of fellow (insert condition here) patients stumbles upon an interesting concern, let us know.

It’s really not “patient empowerment” if you feel powerless.

I thought it was about time to write a post about the woes of doctor-patient email.

Last week, a friend was having some issues with his phone, so his family doctor’s office couldn’t get in touch to inform him of the date of his specialist’s appointment. He didn’t know about the trouble until he popped in for a visit, which was when his doctor asked him – if he didn’t hear by a certain date – to call the specialist himself.

A good solution to the problem, but I couldn’t help wondering why email wasn’t an option. I mean, practices routinely collect our emails now, but I still don’t see them used very often. What if my friend kept having phone issues? What if he forgot to call?

Later, after the appointment had been worked out, he told me that the specialist ended up sending him an email with instructions on how to prepare for the procedure. This was appreciated, and got us both thinking about what exactly are the barriers to doctor-patient email.

What counts as private info? How do other providers deal with this around the world?

Let’s look at what’s out there.

(more…)

Update (Jan. 15th, 2010): Thanks to Dr. Vartabedian (@Doctor_V) for featuring this campaign on his blog 33charts!

Here it is: I snapped a photo of the Privacy-In-Practice posters that University Health Network (UHN) has posted in its hospitals.

Looks like “Facebook, Twitter or blogs” are the big shots here. Do you think there are any other popular social media avenues that deserve to be listed as well?

For more information, see the post I wrote about seeing these posters for the first time last semester.

Facebook, Twitter, RSS, etc. may have changed the way I communicate, but in some arenas, the mere acknowledgement of social media still moves at a glacial pace. Naturally, I was surprised to see that the local hospitals’ notice boards had been outfitted with colourful new posters. Privacy tips, they were entitled.

The first one I came across went something like this:

Privacy Tip #14

Post wisely…

Cut detail when posting on Facebook, Twitter, or blogs.

Patients can be recognized without their names.

The social media triad grabbed my attention. After all, the other tips were well established truisms on shredding patient information at the end of day and not gossiping about cases in the cafeteria. This was addressing social media explicitly, which to me is an acknowledgement that the institutions are aware of the new technologies and feel some kind of need to rein in early adopters. An important step forward, I think, despite the not-exactly-rah-rah tone, because a time without rules is an exciting time, but it’s also a dangerous time.

I don’t need to tell you why privacy is one of the major minefields in medicine 2.0.

It’s clear that lines need to be drawn, though no one knows quite where. Many health care bloggers post with excellent objectives: to share their love of medicine, to discuss new technology, to give a public voice to physicians in the health care reform debate – in general, to give participatory power to the reader in the form of shared information. But who are the readers and what will they do with the information? Really, the only control the blogger has over the spread is to censor himself in the first place.

(more…)

“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?

(more…)