Perhaps if the politicians and news media would stop treating us like unenlightened herds of sheep, we’d REALLY make progress.

Dan’s point about e-patients having more or less one health concern and the ability to focus on it is well taken. I feel that the people on my lists are able to focus, to an amazing degree, on their own particular health issue(s). As a result of the desperate need to take control and find a solution, they will research and read every article they can find. I don’t think most physicians have the time to do this.

I think that speaks powerfully to the issue of virtually criminal abuse of physicians’ ability to treat patients in an appropriate manner. The seven-minute appointment, the pre-screening of reasons why you are there (by the assistant), the feeling that you, as a patient, are taking up too much time… I can’t imagine that this is the way most physicians wish to practice medicine. The very concept of needing an entire full-time person – or several – simply to handle insurance issues, is appalling to me. I absolutely agree this need is valid; I am appalled that doctors need this. Our system needs such a huge overhaul, so that doctors can give their patients the time they require.

But getting back to the issue at hand, of the patient who has read numerous articles and goes – prepared – to see the doctor, armed with information. Enter the issue of the hostile physician… “what medical school did YOU go to?” etc. – when someone brings in an article or information that the physician is not familiar with. What I find is true, is that people have an amazing ability to absorb information they theoretically shouldn’t be able to understand, when their lives are at stake.

I am probably a case in point: having avoided biology class completely at all periods of my life, I now find myself reading about cancer cell growth and division and the effects of various chemotherapy agents on them (from a biochemical point of view), and understanding what I am reading. Could I write a textbook on it? Certainly not. But I do understand what I am reading, and the implications of it.

As an example, I just attended the Ovarian Cancer National Alliance annual conference. I am on the board of directors of the organization, so I was also instrumental in organizing aspects of the conference. During this conference we heard speakers from the NIH, CDC, Department of Defense (regarding their cancer research), and many other researchers and physicians speaking about the science of ovarian cancer research and treatment. I can’t say I understood it at the level of the researchers, but I understood it.

By the way, this year we also had Susannah Fox as a speaker, at my suggestion. Of course she was fabulous.

I remember the first conference that OCNA put on – and several since – at which we had researchers discussing their work at a very high level and then every so often, someone who started out with “the ovary is about the size of an almond” and continuing on in such basic language that most of us were wincing. (Note that those speakers were not invited back…)

Anyhow, I think it is far from accurate to think that information overload is an issue for most serious e-patients. I’ve been one for 12 years, and seen such growth in the information available, and in the ease with which it can be found and accessed. I am profoundly grateful for the wealth of information that is now available, and I think that attitude is typical of the e-patients I know.

To expand on the role a bit, when I was discussing this idea of clinician as coach with some medical informatics professionals just after posting my blog entry, one of them opined that another function of the clinician is supplying context. I like this idea as well. It’s a way of harnessing the experience and objectivity of the clinician. There have always been (we all know some) clinicians who do not try to have an encyclopedic knowledge and yet are superb. They naturally emphasize their coaching abilities and bring context to the relationship. They are natural sounding boards, and context providers.

Josh Seidman has talked about the need to “titrate the dosage” of information, just as doctors need to titrate a drug dosage. He has posted a response to this post on his blog, by the way.