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When Patient Communication and Engagement Yields Physician Anxiety

by Sally Ginsburg, MD

Has anyone else noticed that advances in technology have accelerated our lives to warp speed? Feeds from Twitter, instantaneous information from Google and continuous texting keep us up-to-date on just about anything and everything, right down to the nanosecond. The scope of information is infinite, from celebrity gossip to patient communication portals. This is what our children are growing up with, and it’s what we have gotten used to.

Have you recently tried cutting yourself off from electronic information during a workday? I bet not. I wouldn’t be able to. I believe the information that’s literally at our fingertips can increase patient anxiety and physician stress, and is likely to be a factor in the rising cost of health care.

I’m not sure our brains can keep up with it all and I’m not sure they should. Despite the fact that we retrieve all this information voluntarily, doing so drives us to obtain—and want--even more. It is an addiction I see in my patients, their parents and yes, sadly, in myself.

Patients Walk In With Their Own ‘Diagnosis’. Thanks, Google.
I am a full supporter of empowering patients and encouraging everyone to take an active role in managing their own care. Yet I get a nervous twinge in my stomach when parents come to my office with a differential diagnosis for their child's fever—one that is longer and more involved than anything found in the dusty, forgotten textbooks on my shelf. Concerned parents have more detailed information about “zebras” such as Dengue fever than I knew after completing my course in infectious disease.

Fortunately, I can use my laptop, with Epocrates and UpToDate apps, to look things up. Problem is I can’t follow up online nearly as fast as my patients and their families provide me their research on their concern du jour—especially after they’ve spent the prior evening scouring the Internet.

By the time I have listened to their worries, my 15-minute acute visit time is up, I haven't asked some of the questions I need to ask, I haven’t documented much of anything, and I haven’t even examined the patient. I am already running late, and anxiety is high.

This is a problem not exclusive to parents of young children. Many adolescent patients have already read all they need to know about how to cut their wrists to relieve stress, and how to fake out the doctors when they have an eating disorder. (Thank you, Google!) Such are my days in pediatrics in the digital age.

Medical School Didn’t Prepare Me for 21st Century “Episodes of Care”
In our current era of information overload, many patients already “know” what medications they want for a disorder… and will sometimes request "brand name only please." They know what tests need to be ordered because “the Mayo Clinic website said you need to order these, and I want them STAT." They want to make sure they or their children don't have some dreaded, freshly-Googled disease.

This demand for treatment, and search for diagnoses, not only increases health care costs but also boosts the anxiety and stress for me and my colleagues. These 21st century "episodes of care" involve negotiation between the patient and the physician, taking away time we don't have and potentially setting up an adversarial situation that we need to learn to navigate adeptly. No surprise this was not addressed in medical school or residency. At least not in mine.

Patient Anxiety + Physician Stress = Lab Orders
Patients and their parents want answers. They want them fast and they want reassurance—no, they want a guarantee—that they or their children will be okay. Sometimes, my 15-minute visit is spent listening (yes, I get to do this once in a while) to their fears about their child’s symptoms. They have a list of medications they would like to treat this or that ailment, and they “know” the vaccines we administer at well-child visits can cause autism if given in bunches so they want them separated out.

I am stressing out just writing this.

I’ll admit that sometimes I am a bit worried that there might be something about the patient or parent’s concern I should check into. So, I do what many stressed and anxious doctors sometimes do: I order what they want—within reason—so I don’t end up in a confrontation with the patient or a potential legal situation later. Let’s not even get into the high-deductible insurance issues that enter into this.

As caregivers, we walk that tightrope between pleasing parents and patients, and angering them. They all need reassurance and they don't necessarily want mine. They want labs that will tell them definitively that their child doesn't have lymphoma or Lyme disease or whatever their search engine spits out at them. I get it. I have two children and know what it’s like to worry about them. The difference is I raised my children at a time when dial-up was the only way to connect to the Internet, and you could cook an entire meal in the time it took to load a web page. Now you can get the differential diagnosis of an enlarged lymph node on your cell phone while sitting at a red light!

Is this a problem? Is there a solution to the problem? Unless someone out there has a way to manage this instantly available information overload, I suspect health care costs will continue to rise in a manner directly proportional to the level of anxiety in patients… and the stress they bring on their doctors.

It’s no wonder that, at the end of the day, I just want to come home, eat comfort food, and climb into bed with a good book—on my iPad.

Dr. Sally Ginsburg is an athenahealth client and a pediatrician at Pioneer Valley Pediatrics in western Massachusetts.

Dr. Ginsburg is a pediatrician at Pioneer Valley Pediatrics.

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