The e-patient movement, panacea or barrier to care?

I haven’t really paid much attention to the e-patient movement, but recently it’s become a subject of interest.

I Googled “epatient”, and here’s what I found: “e-Patients are health consumers who use the Internet to gather information about a medical condition of particular interest to them, and who use electronic communication tools in coping with medical conditions The term encompasses both those who seek online guidance for their own ailments and the friends and family members who go online on their behalf. e-Patients report two effects of their online health research: “better health information and services, and different (but not always better) relationships with their doctors.”” This definition comes from Wikipedia. I’m not a big fan of Wikipedia, but in this case it seems appropriate.

Here are some thoughts on the e-patient movement:

• It assumes free time – If you don’t already have a working knowledge of the heathcare system, diagnoses, use of medications, etc, then it can take you quite a bit of time to figure it out. Many families have their hands full trying to make a living and survive in this crazy world without having to worry about whether or not they’re getting proper care.
• Assumes access to information – Information on disease states and treatment options is found online, in journals and books, long discussions with your healthcare provider, etc.
• Assumes intelligence – Is it wrong to assume that the “average” person may not have the skill set necessary to keep up with their own health care? Some of this stuff gets complicated. Healthcare providers spend years in school plus years of training to do this stuff. If the average person can effectively manage their care, why the heck are we spending all this time, energy and money on training doctors, nurses and pharmacists? Shouldn’t the system be designed for the lowest common denominator? This isn’t a shot at those without PhD’s, it’s a legitimate concern. I consider myself a fairly intelligent guy, but I don’t think I’d try to build a nuclear submarine from some manuals and an internet search. Know what I mean?
• Assumes access to not only computers, but the internet – My girls go to school with kids that don’t have a computer at home, much less access to the internet. Don’t even get me started on the idea behind mHealth.
• Creates more silos; those that have the time, energy and resources to make sure they’re getting good care, and those that don’t. Many sick people simply want to be taken care of, and I think that is appropriate. We’re not fixing a car, we’re fixing people.

It’s always good to be an active participant in your care, but it shouldn’t reach a point where the care becomes substandard if you can’t. What if the e-patient becomes the “normal” patient? Will those that can’t manage their own health fall through the cracks and receive worse care? Probably. I’ve already experienced this while working closely with chronically ill family members; some with end-stage diseases. If you stay on top of things you get better care. If not, you receive worse care.

Should we really be developing a system that encourages people to provide their own care because it’s better than the care the system provides, or should we build a system that provides better care for every patient? With available resources we can’t do both. Build a better healthcare system. Think about it.