Saturday, February 15, 2014

When the expertise of patients is more useful than the expertise of doctors


I have a good friend, who’s trying to do his best to stop smoking , with little success. I suggested he try using e-cigarettes , and I did a lot of research on their efficacy online . We also spoke to his physician, who agreed that e-cigarette should help him, as they have been proven to effective alternative nicotine delivery systems. However, when it came down to the real life nitty gritty practicalities , such as which model to buy, he didn’t have any advise to offer, since he wasn't a smoker himself . He suggested we look for additional resources online , but when I did so, it very hard to find out what the differences between the various models were. The prices ranged from Rs 2000 – Rs 10000 – and it was hard to know whether the more expensive models offered better value for money.

One my patients actually imports e-cigarettes, and he kindly agreed to accompany me to my friend’s house, so he could walk him through his options. After all, just buying the e-cigarette would not help – he would have to use them daily, and changing behavior is the hardest thing in the world to do.

I was very impressed when he started demonstrating the different types of  e- cigarettes and their features to my friend. The key it seems is not so much the e-cigarette itself, but rather the favoured nicotine solution which it uses, to give the user the “nicotine kick”.

My patient used to be a chain smoker himself , and when he found that using e-cigarettes had helped him to kick the habit, he decided to start a company to sell them ! He knew all the ins and outs of the market because he was an actual user himself. Since he had been a smoker himself, he was much more empathetic towards my friend’s plight, and had answers to all his questions about how to manage his cravings and how to make the switch from regular cigarettes to e-cigarettes.

This was extremely valuable information , which we could never have got from any other source. He explained to us that it's not just the hardware of the model which maters – it’s software it uses - the nicotine solution , which is used within the e-cigarettes , and which come in over 1500 flavours and strengths ! There were many different models available , some of which were very classy looking and stylish, so that they were easier to carry, but they had a much smaller capacity and a shorter battery life, which meant that they needed to be refilled and charged more often.

He encouraged my friend to try different models , so that he could see which one suited him the best, because this is the one he was much more likely to actually use in his daily life., My friend had lots of questions – for example, how and why e-cigarettes were better than regular cigarettes ( they do not contain the carcinogenic tar which regular cigarettes do).

Since my patient was using the e-cigarettes daily himself, he could answer all these questions with a lot of confidence . Even better , he was able to empathize with my friend , because he had “ been there , done that “.

What I learned is that while doctors are medical experts, expert patients have much more practical , real-life knowledge and wisdom to share with other patients. We need to tap into their expertise , so we can other patients like them get better medical care . There is no reason why this kind of networking should happen only online through support groups . Doctors themselves can help connect newbies with expert patients, so they can learn from them,.

By listening in on these conversations, not only can doctors learn a lot about the daily difficulties their patients face, they can also learn more about how ingenious some of the solutions which their patients come up with can be. This will help doctors to respect their patients even more !

This kind of networking will save the doctor a lot of time; improve his efficiency ; and help improve patient compliance as well. The good news is that expert patients are very happy to help others – and are quite honoured when their doctor asks them for help ! This can set up a  positive virtuous cycle !

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