Sunday, October 12, 2008

Doctors as learned infomediaries - a better option ?

Doctors are medical knowledge experts, and patients go to doctors so that they can use their specialised knowledge to get the correct diagnosis and the right treatment. The trouble with this traditional model is that there are too few doctors, with the result that doctors often act as bottlenecks. It takes time to get an appointment - and waiting lists can extend for months. Also, doctors tend to guard their specialised knowledge and often refuse to share it. Finally, while good doctors will provide good care, often bad doctors will overtreat for financial reasons. This means that patients are often unhappy with the medial care they receive from their doctors.

Is there a better alternative ?

I think the trick is to use learned infomediaries to provide medical triage, so that simple problems can be handled with self-care; and doctors only need to see patients with complex problems, who require more advanced expertise.

This has many advantages. Access to medical information will be much faster; less expensive; and doctors will not get bored handling mundane "routine " problems.

This is not a new idea, and has been tried before in different avatars. For example, computer scientists have tried to use artificial intelligence to develop expert systems which allow computers to make a diagnosis; and countries have used "primary health care" village workers to reach out to many more people, to provide them with basic healthcare.

The good news is that the internet allows us to reach many more people much more efficiently. Most people will now routinely use the net to research their medical problem - both before going to the doctor; and after wards, to check on his recommendations.

The trouble is that many people are not sophisticated enough to be able to use the net efficiently. They often get lost - or even worse, misled by unreliable websites.

Can we provide a better model ? I think the missing element we need to add is a human being, who will help the patient find the right information. This person could be a nurse; a physician assistant; a medical student; an expert patient; or a retired doctor - all of whom are much less expensive than a doctor !

This expert can help the patient find the correct information - and help them to make sense of it. It also adds an element of humanism to the net, something which can be vitally important when you are ill !

This sort of blending click and mortar model will allow us to provide patients with the best of both worlds - online and offline !

We can use a stepped care approach, in which simple problems can be resolved with the help of these learned infomediaries; and more complex problems can be referred to the doctor.

This approach can help to save time , money and energy. Call centers and medical helplines staffed by nurses already provide such a service in many cities - can't we do a better job and scale this up ?

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