More than twice as many patients as physicians are embracing the use of new digital technologies to self-diagnose medical conditions on their own. On the other hand, 91 percent of doctors are concerned about giving patients access to their detailed electronic health records, anticipating patients will feel anxious about the results; only 34 percent of consumers are concerned about anxiety-due-to-EHR-exposure.
Welcome to the digital health chasm, that gap between what consumers want out of digital health and what doctors believe patients can handle at this stage in EHR adoption in doctors' offices and in patients' lives.
I have the video of Jack Nicholson's general in A Few Good Men asserting, "You can't handle the truth!" And yet... patients told the WebMD survey of consumer-users that indeed, they look forward to examining physicians notes about them, using smartphones for blood analysis and using their personal smartphones for submitting information to their doctors about suspicion skin problems, heart rates and ear examination. Furthermore, over half of consumers believe they – not their doctors – own their medical records.
The WebMD survey polled 1,102 random WebMD users and the Medscape Digital Technology Survey polled 1,406 clinicians who are active on Medscape in August 2014. Only physicians' responses (N=827) were included in the reported survey results discussed here. The larger Medscape sample also included nurse practitioners, nurses, physician assistants and med students.
I spoke one-on-one with Dr. Eric Topol on September 18, 2014, the week before the survey was released, and his reply to the survey from the physician point of view is that physicians' responses were "better" than he thought they would be with respect to their embrace of consumers using digital health tools. Dr. Topol is editor-in-chief of Medscape, the most popular physician-facing online portal for medical information.
Medicine is still a paternalistic culture, Dr. Topol explained to me, with many doctors sharing with patients only what they think is appropriate. That paternalism in medicine is an ethos prevalent "over millennia, not just recent times," he said. "We have to get over that. Patients have a right [to their personal health information]: it's their body, their health, they paid for it [health care services]. And they have to have access to everything," Dr. Topol believes. Clearly, he's switched out his paternalistic white lab coat for one that more about shared decision-making.
In this context, we discussed the Open Notes project sponsored by the Robert Wood Johnson Foundation, which found that once physicians opened their "kimono" of patient notes in the EHR, doctors became comfortable with the outcomes of patients getting more engaged in their health – driving better outcomes and more shared decision-making between doctor and patient. In the survey, 89 percent of patients say they have a right to see all of the notes the doctor writes after visits or projects, but only 64 percent of doctors say patients have a right to see "all" of them. On the other hand, only 11 percent of consumers say doctors should share "only" what they think is appropriate. Here's another vote for the "patients can handle the truth" mantra.
The data point about who owns the medical record is also important to call out: "patients think they own it, and doctors think they own it," Dr. Topol noted. "The patient should own the records and we are not there yet by any means. There's a lot of work to do." His new book The Patient Will See You Now, due out by the end of the year, will deal with this issue about the democratization of the medical encounter. "We can accelerate things. I am optimistic this will happen sooner rather than later," Dr. Topol expects.
Health Populi's Hot Points: One area of broad agreement in the WebMD/Medscape surveys regards price/cost transparency. Dr. Topol said he was "stunned" by this agreement, thinking that doctors would be resistant to the idea of transparency. "They weren't," he admitted, seeing "a nice concordance there" that he didn't expect at all. "Traditionally, doctors don't want anything to do with prices and want to practice the best medicine but don't care what it costs."
I chimed in that in this era of growing high-deductible health plans, patients are increasingly responsible for first-dollar health spending until the point they reach their deductible – which is getting higher every health plan-year. More patients are asking doctors about prices for brand-name versus generic drugs and about procedures before scheduling them. So the new physician workflow is already challenged by such conversations, and more doctors have to become health economists along with being brilliant diagnosticians and behavior change agents.
In this regard, most physicians (56 percent) said they were prepared to compete on the basis of price. Such is this new era of the democratization of medicine.
This post originally appeared on Jane Sarasohn-Kahn's Health Populi blog on September 26, 2014.