Meeting Summary by Dr. Kim Bercovitz
Dr. Evans’ insightful, engaging, and frequently humorous talk provided an overview of the paradigm changes that are taking place in today’s health and society. Illustrating his words with a multi-faceted slide show, Dr. Evans covered three key areas: Chronic Disease Management, E-Health, and Patient Stories.
[You can view Dr. Evan’s slides here.]
Chronic Disease Management
Much of the initiatives currently being undertaken by government are directed at chronic disease management and prevention. For example, the government will be investing $11 million into the management of paediatric obesity. Dr. Evans noted the need for more focus on patient lifestyle—and the inter-relationship of lifestyle "upstream" behaviours such as physical activity, smoking, diet, and stress, as risk factors underlying the disease rather than focusing only on the disease itself.
He also noted a need for:
- Primary care re-design involving an inter-professional team approach.
- Tailored, versus generic, marketing campaigns.
- Electronic health records and knowledge management.
E-Health
Patients are increasingly turning to the Internet for medical advice—even for a diagnosis—before consulting their physician. The percentage of adults seeking health information over the Internet has increased significantly over the last decade. In 2007, 80% of adults were online information seekers compared to 28% in 1998 (New York Times, August 17, 2007), and 60 million Americans are actively engaged in blogs. "Dr. Google" has become the most powerful member of the health care team. He is available 24/7, with no wait time, and has unlimited time for patients who are seeking information to help them manage their acute and chronic conditions.
Another fascinating trend that is evolving outside of medicine is the proliferation of blogs and social networking sites such as patientslikeme.com. These are designed to help patients find and support other patients with similar health conditions through the sharing of experiences, talking to and learning from one another. Social networks not only provide social benefits, including reduced isolation, but are also huge predictors of health outcomes. For example, having a confidant is associated with a 25% reduction in mortality risk (BMC Geriatrics 2007, 7: 19).
Patient Stories
While evidence-based data are central to medicine, stories trump data and relationships trump stories. Health care is turning to the role of story telling as a powerful forum for communicating patient experiences, particularly when they are embedded in a trusting relationship (e.g. peer-to-peer or patient-to-clinician). The medical field needs to do a better job of telling and listening to the stories of health care. Dr. Evans’ Health Media Lab is using videography to document and communicate patient stories. Media is a powerful tool for not only getting the evidence "out there," but also taking that evidence to a new experiential and emotional level.
The information explosion is not without its challenges:
- Patients are faced with increased choices for medical decision-making and limited time to follow through with recommended interventions. Physicians have limited time during the medical consult to help patients interpret or demystify Internet health information. How does one manage knowledge? Suzanne Miller’s typology of "blunters" (patients who trust and defer to physicians for medical facts and advice and under stress actively resist learning more) versus "monitors" (information savvy patients who under stress "spin out on the glut of information") could be helpful for physicians to identify patients in terms of their information-seeking nature.
- Health information is not readily and easily understood by those with low literacy (i.e. individuals with lower levels of education, recent immigrants for whom English is a second language, and seniors). Patients with low literacy have worse health outcomes. Hence, interventions that are sensitive to literacy levels are needed.
- Online communities and support groups provide a tremendous source of information and social support for patients. Yet there are some concerns about misinformation or managing conflicting information. Should social networking sites be expert or peer moderated, or both? At what point would it behoove medical experts to intervene, particularly when ethically sensitive information is disclosed? What is the role of a health care "coach" to help patients navigate through the morass of information and our complex health care system?
- In order for medical/health information to be valuable, it must be: Useful, Desirable, Accessible, Credible, Findable, and Usable.
Dr. Evans concluded his talk with some "doctor’s advice," using a bicycle tire as a metaphor for stress management. He advised us to have enough stress in our lives—our tires should be pumped up with enough pressure to keep us moving. On the other hand, if we have too much pressure and hit a little bump, we explode. The same bicycle tire analogy might be used for navigating the morass of today’s health information.
About the author:
Kim Bercovitz, Ph.D. is President of The Research Doctor Inc. and Assistant Professor in the Department of Public Health Sciences at the University of Toronto. Kim can be reached at kim@theresearchdoctor.com or (905) 597-4581.