Defining a New Doctor-Patient Relationship
Daniel Palestrant, MD, Chief Executive Officer and Founder, Par8o; previously Chief Executive Officer and Founder, Sermo; member, POZEN Digital Advisory Board
Once upon a time, the only way to acquire the knowledge of medicine was through years of scholarly study, followed by an indentured servitude in the form of some sort of apprenticeship or residency. Start to finish, it was about eight years. Indeed, the Latin translation of the word “doctor” is in fact “teacher,” as the cycle of teaching and learning was a central feature of the profession. Today, however, our access to information is not quite so circuitous, arduous or time-consuming. A layperson can access vast quantities of healthcare information with little effort and almost no cost. This near-instantaneous access to information would appear to erode one of the key “asymmetries” in the doctor-patient relationship, as a patient is now able to easily gain access to the collective world knowledge of their condition prior to their first encounter with the physician.
However, the body of knowledge acquired by a healthcare provider over years of experience is vastly different from that acquired by a single foray onto the Internet. The key difference is context. Context is what allows us to weigh various pieces of information, understand their overall importance, but perhaps most importantly, the relative importance to that patient with that particular circumstance. Unfortunately, context also appears to be the most prone to subjective pressures, especially when the inquirer is the patient themselves or the loved one of a patient. Subjective truths can differentiate cold facts from perceived truths and are the gray area of healthcare that largely dictates the variation in treatment paths. In the future, those subjective truths will increasingly become the battle zone between the forces who wish to influence the patient's journey. Ironically, those forces are not the doctor vs. patient but rather the doctor and collectively all the other forces, often commercial, that are trying to influence the patient. With patients now able to access vast quantities of information independent of the physician, the successful doctor needs to evolve into a new role, as a partner to the patient in understanding information rather than a gatekeeper to that information.
For physicians, who can imagine no other role other than a paternalistic gatekeeper of information, the future will be very challenging because the information asymmetry – and, with it, the perceived power – is gone. However, for those physicians who can literally join the patient on their side of the table, the future is bright. The explosion in treatment choices and information available make a physician's experience and ability to provide context more valuable than ever. Likewise, a physician has the experience to be able to provide a counter-weight to the subjective truths that often can be the differentiator between a path of least resistance and one that might have tougher near-term choices but ultimately a better long-term outcome. On a very personal level for physicians, this means relying less upon the rote memorization and recall of information and more the relationship building and bedside manners that are so often overlooked in the clinical arena.
In this “new world order”, industry will need to pick its role very, very carefully. As patients and consumers seek out information online, industry will not be able to resist the urge to cater to this demand, nor should they. However, industry will need to learn from their prior experience with direct-to-consumer advertising, where the opportunity to appeal directly to consumers came at the expense of alienating healthcare providers. This time, industry will have a much broader set of tools, including the entire social media medium, to establish two-way channels of communication with consumers that need to educate without embellishing information and inform the consumer without undermining the healthcare provider. A provider's perception of any given piece of information coming from industry will be flavored as much by whether the information is respectful of the provider's role as by the accuracy of the information itself. This requires a new type of communication where industry communicates to patients in concert with providers rather than in competition. Newer companies, such as POZEN, are at an advantage because they can begin with a customer-centric approach interacting with providers when, where and how they want to be communicated with, compared with larger companies that have an already-established protocol for communicating with providers. By any measure, all parties are in for a period of changing and evolving roles during which the opportunities are at least as great as the challenges.
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