October 1998 Bulletin

Patients armed to discuss treatments

Physicians must be ready for knowledgeable consumer

In today's society, patients have access to an overwhelming amount of medical information from medical sites on the Internet and news or talk shows, to newspapers and magazines.

They're also an educated lot, according to the U.S. Census Bureau's 1997 statistics which shows college enrollment at about 9 million students attending four-year schools and nearly 6 million attending two-year schools. The population's income levels have also increased, as well as their product expectations.

"The rising level of expectations in today's society, demands that physicians be ready for a much more knowledgeable consumer," notes Regina E. Herzlinger, professor of business administration at the Harvard University Business School, and author of many articles and books on management control and health care.

"People in this generation want it all. They've reshaped the rest of the economy to get what they want and they're not going to leave you [the medical profession] alone. The most demanding, assertive, narcissistic group of them all are the baby boomers. As they're growing older, about 55, that's when they're starting to really use medical care."

According to Herzlinger, consumers want "convenience" from the healthcare industry in location, hours and care that is "bundled by their needs-not by the specialty of their provider." She adds, "They also want info that helps them help themselves… . If anybody thinks this particular group is not going to get the convenience and info they want, they're fantasizing."

Take the case of a patient who had an enchondroma. Even after seeing a specialist who gave her a diagnosis, this former researcher searched a medical library on the topic and copied articles. Then, she visited Bruce M. Leslie, MD, a hand specialist, and president of the Massachusetts Orthopaedic Association.

"I told her what she had and what my treatment recommendations were," explains Dr. Leslie. "She asked me questions. I answered them. She then made reference to certain articles and pulled out a notebook. I started laughing. It broke the ice.

"I went through the references one by one and told her why I thought one article was better than another, and the articles went back into the notebook and never came out again."

What made their relationship work? "I gained her confidence," says Dr. Leslie. "I didn't dismiss her or say she didn't know what she was talking about. I wasn't intimidated by her research. I gave credibility to what she had done and respected what she did."

According to Daniel D. Federman, MD, an internist and Dean of Medical Education, Harvard School of Medicine, "The questions that patients are able to ask are often more sophisticated than before and the level of explanation, as well as the degree of involvement in the decision-making are both changing. However, at the moment, physicians have to respond to not so much to what the patients want, but to what managed care plans will allow. That I think is more of an issue than patients who are demanding. I don't run into that a lot."

Robert J. Levine, professor of medicine, Yale University, notes, "Patients may come in with more information that is as likely to be accurate as it is to be inaccurate." "It's really important to keep an open mind on the information that is coming in," Herzlinger says. "If it is incorrect information, deal with it. If it is correct, acknowledge it."

According to Levine, this "encourages a substantive conversation" between both parties. "If the patient came in with no information at all, these conversations might be very, very brief or non-existent. It's just as educational for doctors to correct misinformation, as it is for the doctor to provide the correct information in the first place. It's somewhat less efficient [time-wise] though…."

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