May / June 2009

Editor's Notebook

Define the Relationship

By Susan Carr

My 20-something friend Colby observed recently that her younger brother unwittingly scares away girlfriends by jumping too quickly to the "define the relationship" conversation. I thought of Colby at a conference I attended in April, where the topic of changing roles for physicians and patients infused all proceedings. Rather than scaring people away, interest in "defining the relationship" packed the house.

The conference was organized jointly by Health 2.0 (www.health2con.com) and the Center for Information Therapy (www.ixcenter.org). Health 2.0 is a three-year-old movement that promotes the use of web-based tools, especially online communities and search, by patients, families, clinicians, and organizations, to create content and connections for better care and health. Considered a fringe movement by some, Health 2.0 supporters now include Microsoft, Google, Kasier Permanente, the Mayo Clinic, consumer organizations, and many start-up companies. The Center for Information Therapy (launched in 2001) defines information therapy (Ix®) as the "timely prescription and availability of evidence-based health information to meet individuals' specific needs and support sound decision making. Ix prescriptions are specifically targeted to an individual's needs at a particular moment in care and are delivered as part of the process of care." The two organizations brought 520 attendees together for 2 days in Boston to explore harmonies and differences around some of the principles they share.

Health 2.0 and Ix share the notion of participatory medicine (see PSQH Nov/Dec 2008, pg. 4), which refers to patients taking active roles especially with their caregivers. Whether reading Up-to-Date™ entries forwarded by their physicians, downloading their medical records to Google Health accounts, or contributing data for research through PatientsLikeMe, individuals now are participating more actively in managing their healthcare. We all wish that more people would take responsibility for their own health by making informed, smart choices about diet and exercise. But especially among subgroups of people with chronic conditions or rare diseases, assertive individuals are disrupting traditional roles and challenging their physicians to accept their advice and information, which they are likely to have found online. Further disrupting the status quo, that information may not come from traditional, evidence-based medicine. The most confrontational moment at the conference came when a (non-physician) speaker arrived to debate "What's the Future Role of the Physician?" with a physician. He stepped on stage (with what I took to be a degree of humor) before a huge screen on which his first slide read, "We have come from the Internet to negotiate the terms of your surrender." Cue the uncomfortable "define the relationship" conversation.

Outside the bubble of this lively, provocative conference, I often see safety and quality improvement initiatives that include increasingly active roles for patients. Even if it's only a low-tech sticker on a hospital gown that asks, "Have you washed your hands?," there is opportunity and need for everyone to take more responsibility for improving the safety and quality of healthcare.