Why the ease of Internet use may disrupt the patient physician relationship and affect the continuity of care

By Dr. Batami Sadan, Co-Founder and Board Member, Vaica, chair of the Israeli Association for Medical Informatics

Patients and health consumers are increasingly using the Internet to learn about general health matters, self-diagnose as well as get advice about their specific problems.  Is this a good thing or a bad thing? I’d argue it’s not so clear cut and that we should consider ways to improve the practice of online medicine as it appears to be here to stay. Let’s explore.

Often times, patients submit questions to Ask-the-Doctor (AtD) services. Here, the patient-physician relationship differs from traditional medical practice. There is no preexisting relationship. It is the patient who reaches out blindly not knowing who will answer their questions. Some of these services use texts as their sole means of communication AND there is no follow-up by the physician who considers themselves NOT to be responsible for the patient’s actions or condition following an inquiry. The patient is left stranded with his own knowledge and perceived understanding of the information received from Ask the Doctor.

With this type of result, why do patients continue to do this? Studies such as this (published by JAMA Intern Med) that compare e-visits to actual physician office visits and this (published by Telemed J E Health) about characteristics of patients who seek care via e-visits report to have found ample reasons why patients seek advice from AtD forums. These include: convenient access, anonymity, doctor visit costs, a busy family doctor, discontent with their doctor, difficulty to find time to visit a doctor or seeking a second opinion.

Time recently published an article describing how going to the doctor is rapidly changing. It was written that according to data and analysis company IHS Markit, by 2020 there could be an estimated 45.6 million virtual consultations performed in the U.S. It also notes that telemedicine in health care increased from about 54% in 2014 to 71% in 2017.

How can we harness information technology to improve the continuity of medical care in our fragmented healthcare services?

We all know the importance of the continuity of care. It encompasses quality of patient care over time and how an individual’s healthcare journey is connected across healthcare events and providers. Continuity of care is the product of patients and healthcare professionals working together to produce coherent, connected, and consistent care. A positive therapeutic relationship is defined as a patient’s adherence to treatment, satisfaction with care, and favorable treatment response. The question here is: What should be done to create the same results but within an online relationship or are patients doomed to shotgun medicine?

Bridging Two Worlds

First, to ensure quality and prevent errors, it’s important that consultations, with places like Ask the Doctor, be recorded in the patient’s health record and that all members of a patient’s care team have access to the up-to-date information. 

That said, as care fragmentation increases, maybe we should also start thinking outside the box by utilizing patient support programs to keep the medical documentation up to date.  This would be especially useful for chronically ill patients. Having access to information and educational material would certainly help these patients to be more involved in their health situation.  In addition, easy to use technology that supports a patient’s medication adherence activity and empowers them in their own care, could also be crucial in the quest for continuity of care in the fragmented world in which we live.