Patient empowerment and the use of Internet Steinar Pedersen

Ottawa Charter (WHO 1986) The idea of a process that enables people to ”increase control over, and to improve, their health” (Information therapy)

Patients and level of care Persons per month Level of care 2 University hospital 13 Local hospital 150 GP 500 Self care 85 Symptoms, no treatment 250 No symptoms 1000 Population

Diagnosing the doctor- patient relationship Doctors do more talking than listening. One study found that 72% of the doctors interrupted the patient’s opening statement after an average of 23 seconds. And that doctors failed to elicit 54% of patients’ reasons for wanting a consultation and 45% of their worries. In one study of 20-minute office visits, doctors spent about 1 minute per visit informing patients, but believed they were spending 9 minutes per visit doing so.

Seaman summarizes Doctors tend to perceive illness as a disease process that can be measured and understood through laboratory tests and clinical observations. –To the patient, illness is a disrupted life. Doctor’s tend to focus more on keeping up with the rapid advances in medical science than on trying to understand the patient’s feelings and concerns. –Yet patient satisfaction comes primarily from a sense of being heard and understood. Many doctors do not see the role of physician as listener, but instead view their function as: find it, and fix it. –Yet patients often feel devalued when their illness is reduced to a mechanical process.

So the sharing of health issues with “strangers” may be a symptom of dysfunctional doctor-patient relationships.

The experience of discussing personal problems… …on the Internet …face to face 75 percent find it easier to discuss personal problems in a discussion group online. 46 percent claim they address issues online that they would not discuss otherwise. Source: Kummervold et al. 2001

Who would have guessed that passionate, intimate relationships would be established and maintained through hopelessly clumsy user interfaces like SMS and computers?

Health information and the Internet %

Fox and Rainie (2002) Roughly 80% of the health seekers find the information they need on the Internett

Wanted contact with the doctor Alder

The physicians are today (reluctantly) accommodate patients wanting to interact electronically. But “If you can’t beat them, write them” may be the order of the day.

The new patient role The well informed patient Empowerment From “thank you” to “why” From passive recipient to active participant And they will use the net!!! I’m sorry doctor, but again I have to disagree

Characteristics: The eHealth Consumer 1/3 of the population in Norway Higher education Young adults Higher income Equal use among woman and men

The well-educated and well-off have access to and use the Internet to a much greater extent than those who are less well-educated and who are less well-off

Types of use Discussion forums, self help groups Questions to health personell Information

Internet based self-help for breast cancer operated women

Preliminary results Available when they need it The net group has become their most important resource in their meeting with their own disease Bench marketing of the health care system

Effects on patients’ behaviour towards their doctors N=476 Delayed, altered, or cancelled appointment Scheduled new appointment Attempted to decide own diagnosis Posed more specific questions to their doctor

Effects on health consumers everyday self-care N=476 (2001) Change of diet or other lifestyle related behaviours Experienced anxiety Experienced relief

Heart patients

The Journal of the Norwegian Medical Association Results from a 14 articles meta- analysis show that the death rate is reduced with 30 %

The main feature of the Internet is said to be its accessibility and interactivity

Key global telecom indicators

Phone vs Internet In the UK, the Samaritans report that although only 20% of telephone callers report suicidal feelings, this number increases to around 50% of contacts. This phenomenon appears particularly relevant for those who feel stigmatised, shameful, and/or suffer from low self-esteem.

The use of Internet

Summary Knowledge is power, sharing is wisdom