Editor’s Note: Henry Wei, MD, is a board-certified internist and a
Clinical Instructor in Medicine at Weill-Cornell Medical College. He is
currently a Senior Medical Director at Aetna, where he leads Clinical
Research & Development for ActiveHealth Management. (The views expressed
here are the author’s alone and do not represent those of his employer.)

Introverts make up about half the population. In any given year, about 7% of
Americans are also suffering from social phobia, a fear of being in public so
great that’s defined in part by a tendency to get in the way of daily life.
What happens to the health care experience for these demographics? If it’s at
best uncomfortable and at worst panic-provoking to venture out into the world,
does it become impossible for some to seek psychiatric care, let alone regular
medical care?

My bet is that the online experience is changing this, and in particular, doing
so for health care interactions. What happens when computers, tablets and
smartphones start to allow patients to communicate with doctors and therapists
in a virtual space? The rise of ubiquitous online connectivity between patients
and their physicians is bringing a new era to those who prefer to interact from
the safety of their own environments. As a result, there’s currently no
shortage of telepsychiatry startups in the current Health IT bubble, among them
BreakThrough, iCouch, Cope Today, and HealthLinkNow. Behind
the safe, bullet-proof glass of, say, an iPhone or iPad with a front-facing
camera, perhaps it becomes easier to think about visiting a mental health
professional. (Parking, at least, is no longer a concern.)

These seemingly innovative startups may owe a lot to Dr. Warner Slack, a
passionate but otherwise mild-mannered forefather to modern medical
informatics. In the 1960s, while still a neurology resident, Dr. Slack was at
the front of the incipient patient empowerment movement. He was also wildly
optimistic about the use of computers in medicine–this, in the pre-PC era. By
the end of that decade, he had developed computer systems that could directly
engage with patients. Already then, he noted in one seminal paper, nearly 50%
of the 275 patients he studied preferred interacting with the machine, while
only 30% preferred interacting with the doctor. Furthermore, a small but
significant contingent indicated that they preferred both!

Dr. Slack’s findings about how people interface with computers to disclose and
explore their health information would go on to be replicated in different
ways. Other researchers, for example, would show that people in emergency rooms
are more likely to disclose sensitive information about domestic violence and
substance abuse to a computer than to a human clinician. Importantly, we see
these behaviors even more strongly today: On social networks such as Facebook
and Twitter people often feel at liberty to not only reveal the mundane, but
also to expose the deepest, most personal aspects of their lives online.

So, as physicians, we may be foolish to believe that our in-person, one-on-one
scheduled ~12 minute way of interacting with patients will last. Increasingly,
that’s a tough sell when compared to a longitudinal, technology-based
engagement with 24/7 access–all with the benefit of being able to solicit more
in-depth information from introverts or social phobia patients in particular.
It might feel heretical to think that a doctor wouldn’t be the person to figure
out, for example, if patients blood pressure medications are ruining their sex
lives. But in good technology, there’s not only a certain non-judgmental facade
of the machine, there are also ways to gather information that aren’t mutually
exclusive with good bedside manner.

I’ll go out on a limb here to suggest that we can no longer accuse medicine of
being a profession of luddites. For approximately, two decades, we’ve seen
doctors claim that poor electronic medical record adoption is due to old timers
“just not getting it.” That excuse is wearing thin.

We’ll need to push together to figure out the right way to adopt the best
models to start using technology not just for keeping records or ordering drugs
or tests, but to interact with patients. To this end, it would behoove
physicians to consider the opportunity for social networking platforms to
elicit deep, meaningful conversations about the patient experience–check out
IAmA posts on Reddit for example.

As Wendy Sue Swanson(@seattlemamadoc) recently stated it, and as I’ll
horribly paraphrase, we can certainly follow defensive guidelines on the use of
social media such as the AMA Policy: Professionalism in the Use of Social
, but what we need are pioneers to help guide us as how to unlock and
unleash the power of these platforms to effect positive change. While the AMA
policy suggests that physicians’ actions online may negatively affect their
reputations, we yearn for a guideline that suggests other physicians’ actions
online may positively affect entire patient populations.

If social platforms Facebook and Twitter played an instrumental role in
fomenting the Arab Spring uprisings, in mobilizing, empowering, shaping
opinions and influencing change, we physicians are perhaps overly conservative
if we still think Twitter is for twits, rather than a revolutionary channel for
public health.

Warner Slack saw much of this in 1968: computer-based, online patient
interactions can be our avenue into richer, more fundamental patient histories.
They don’t replace good doctors–they augment them. And they’re not just fancy
survey tools. To borrow a cue from Harvard medical anthropologist and
sociologist Dr. Arthur Kleinman, it’s the phenomenology–the “what’s at
stake”–that truly matters for patients’ health care lives. Online patient
interactions and social networking platforms are now combining to elicit and
share deeper, more candid, and more sensitive accounts and narratives of
illness and health–a collective, rather than individual, patient phenomenology.
Needless to say, this is about to change medicine as we know it. If physicians
aren’t there to seize the opportunity now, in 2012, shame on us for once again
not taking the lead.

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