Sometime around 1998 in the Texas Medical Center.
DrV: (enters exam room) Hey, How are you? I’m Bryan Vartabedian (extends hand).
Father: (arms crossed, smiling, leaning against wall) Oh I know who you are, Doc. And I know where you went to school, where you’ve lived, if you’ve been sued and a few other things. And I’m fine, by the way.
DrV: Um, Okay. (Shakes hands with father. Looking to child, scruffing his hair). And this must be Caleb.
An odd moment, for sure. When it happened I didn’t know what it was about. After similar encounters I understood. It was about where patients found themselves in the early days of the information revolution. And there was the father who wheeled into the exam room two large boxes of printouts perched on a dolly. Inkjet validation of his role in the decision about his son’s surgery.
These situations illustrate the ‘information show of force,’ a phenomenon that I witnessed in the mid 1990’s when patients assumed the power to search not only their doctors but everything about themselves. After generations of information control by physicians, patients could now see what their doctors could see. And they could see all about their doctors.
The show of force was less about information as much as what it represented: a new role in an old relationship. Like hammers on the Berlin wall, information was the tool that began to break an old model. But understanding information’s power and limitations has its own learning curve. There have been awkward moments. Caleb’s father, for example, wanted desperately to show that he had a card to play.
The information show of force ultimately faded. Now, nearly 15 years later, it seems patients have developed a more mature, sophisticated relationship with their information. Digital natives are now digital moms and patients are more accustomed working with and around data. A new generation of doctors has begun to replace the pre-digital set. And like reception areas, exam table paper and the smell of alcohol wipes, information is part of our healthcare landscape.
I think it’s these small elements in medicine’s transition that help us remember where we’ve come from.
The scenario presented here has been altered/de-identified/fictionalized to protect the dignity/privacy of the patient and parent.
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The future of the doctor-patient relationship. I am in favor of acknowledging the past and encouraging the future when patients aren’t encumbered by heavy medical records or loaded down by scans to share with yet another physician. Wishing the entire healthsystem was digitally up to date? Yes, but I don’t think you’ll find a parent or patient who doesn’t value the care and consideration of a dedicated doctor who can help guide the way.
“I think it’s these small elements in medicine’s transition that help us remember where we’ve come from.”
And will take us where we need to be with health, medicine and consumer/provider relationships in the future.
I think the ‘information show of force’ has been quietly working in the background all along and will continue to be a force in health. Information is the great neutralizer, it creates better health consumers and health providers. Hopefully together this makes for better health all around!
I finished residency and fellowhip in 1982, so my career spans the before-and-after information divide. In the early days of the information explosion, when the Web was just getting going, information seemed to be more of weapon. Like your patient’s father, parents then tended to see possession of that sort of “secret” information as something that leveled the playing field in their interactions with doctors, especially when things turned confrontational or adversarial. These days such information is just . . . information. Something useful to all. It’s a healthy transition, I think.
I’m working on this slow hunch (not my term
that the state of the medical profession hinges on a relationship between information and power. I haven’t done any heavy conceptual lifting other than reading a little of “The Social Transformation of American Medicine” and the other usual suspects.
I was struck by how this post and the one prior address this topic.
Perhaps you care to offer a thought or two?