Published 1/1/2008
Thomas K. Fehring, MD

Give them what they need, not what they ask for

Cyberchondriacs are a new breed of patients

Pushing open that examination room door has never been harder. Behind it is likely to be an informed medical consumer replete with newspaper articles and Internet downloads concerning his or her particular complaint. The Information Age has added a variable in medical care that none of us learned about in medical school. The Internet, with its unfiltered medical advice, has become part of nearly every medical encounter. Direct-to-consumer marketing has also fueled the development of a new type of patient.

A shifting paradigm
At one time, physicians were viewed as respected, learned individuals who held all the medical secrets. Whether called a medicine man, a healer, or a physician, he or she was the authority on physical well being.

Now, such authority is being questioned during almost every patient encounter. Armed with a little knowledge gleaned from a recent television commercial or the Internet, the patient is occasionally perceived by the physician as confrontational.

But physicians should not be threatened by this new approach. Patients are only doing what we would do when buying a new car or computer. They are just trying to find out what is best for them medically just as we would try to find the best commodity. Most patients realize that, underneath all those downloads and clippings, they are not really and fully informed about medical issues, just as we aren’t when we show up buying a commodity armed with the latest issue of Consumer Report.

As physicians, we must recognize that—like it or not—the patient care paradigm has changed. This type of medical encounter won’t go away. Physicians need to learn how to embrace it and then, to defuse it. We should see it as an opportunity to present concisely our fund of knowledge on the subject. That is all patients want—a knowledgeable, compassionate healer. Their little bits of information are just their way of testing us to see if we are keeping up with the latest trends in medicine.

But don’t get trapped
We should not, however, fall into the trap of letting patients influence our decision-making process. Although patients may insist that they should have a vote in decision making, their knowledge is, for the most part, very limited. The physician, not the patient, went to medical school, labored through residency, attended continuing medical education courses, and read countless journals. In addition, as physicians, we have spent many years at the school of medical experience. In doing so, we have accumulated a wealth of knowledge no patient can ever accrue simply by surfing the Internet.

Thomas K. Fehring, MD, is a member of the Hip and Knee Center at Orthocarolina in Charlotte, N.C.

Armed with these years of experience, we must recognize that we are the arbitrators of orthopaedic knowledge for our patients. We can distinguish hype from hope. It is our obligation to do so without letting market pressures influence our decisions.

I recently asked a colleague why he performed an unproven new surgical technique with a new implant. I was shocked when he told me that he did so “because the patient asked for it.”

“Because the patient asked for it” is not an appropriate reason to perform a specific procedure or an excuse to use a specific implant. Unfortunately, this response is far too common in orthopaedics. Responding to a patient’s uneducated wishes may also lead to unexpected complications. We must not succumb to industry’s latest marketing strategy—direct-to-consumer advertising.

By marketing directly to the patient, industry now has engaged millions of new manufacturer representatives—our patients—who call on us every day in the exam room. But there is an appropriate response, one that every parent understands.

Appropriate responses
Sometimes the hardest thing a parent must do to a child is to just say “no.” Physicians must have the strength to do the same thing in the exam room. In the long run, patients will respect us for it just as children eventually respect their parents for setting limits.

As orthopaedic surgeons, we are the arbitrators of orthopaedic knowledge. We alone can distinguish true innovations with lasting benefits to patients from mere marketing innovations that have no staying power.

Finally, treat your patient as the veteran scrub nurse treated you when you were a fledgling surgeon. She gave you what you needed, not what you asked for.