Until now I've spoken about the advantages of MEDLINE on the web for physicians, but not about it's impact on the general public.
Today, although the average person believes in the validity of modern medical information, he often questions the decisions that his physician makes using this information, and even the extent of his physician's knowledge.
There are many reasons for this. Unlike earlier Americans, today's citizen has an increasing faith in his ability to understand medical science. This change has occurred gradually over the last 40 years as more and more scientific and, specifically, medical information has proliferated in the popular press.
In the past, it was difficult, for the average person to gain access to detailed medical information. That obstacle disappeared when MEDLINE was placed on the Web. This democratic leveling of the playing field, so to speak, between doctors and their patients is exactly what the government intended.
Vice President Albert Gore stated that one of the main reasons for offering MEDLINE on the Internet was to give American consumers access to timely and accurate information about medicine that might lead to quicker and better treatment for their illnesses. The NLM reinforced that point of view by giving examples of how average citizens had successfully used MEDLINE and Index Medicus to discover effective treatments for themselves and their relatives (NLM, 1997).
Despite these optimistic endorsements, however, some professionals will argue that the average person doesn't understand enough about the technical aspects of medicine to use this new information safely and effectively. That is certainly a realistic concern. It is reasonable to ask what impact increasing access to medical information will have on the treatment of patients and especially on the doctor-patient relationship. Consider, for example, the following scenario:
Sally E. is a professional woman in her late 20s who has been suffering from periods of intense anxiety for several months. Her internist recently prescribed diazepam(Drug information on diazepam) (Valium) for the anxiety, but it was only moderately effective. After a few days, Sally-concerned that she might become addicted to the medication-discontinued it and decided to learn everything she could about her mental problem on her own.
She began research at a local bookstore where she read DSM-IV and several popular books on anxiety. Based on her reading, she concluded that she was suffering from a panic disorder and that there were several treatments available, including behavioral therapy, cognitive therapy and medication. Sally continued her research on the Web, using search programs like Alta Vista and Yahoo to find general information on panic disorders. She also did a MEDLINE search on the pharmacologic treatment of panic disorder. One of her friends, a nurse, helped her understand the drug study reports.
After finishing her research, Sally made an appointment with a psychiatrist. She informed the doctor that her symptoms met the criteria for a panic disorder and requested treatment with a specific selective serotonin-reuptake inhibitor (SSRI). To support her request, she gave the doctor copies of abstracts from several relevant articles about the drug that she had discovered during her MEDLINE search.
Is this a realistic scenario? I believe it is not only realistic but that it will become a common occurrence in the future. It is part of an evolving trend that is demystifying the practice of medicine and radically changing the nature of the doctor-patient relationship. Most physicians realize that there are several modes of treatment for every illness. Many believe that the ultimate decision about which treatment should be used belongs to the patient.Self-help Available
In the past, however, the patient has relied on the physician to provide information about the various appropriate treatments. Now, new self-help books, home medical software, the Internet and MEDLINE mean that more and more patients can find detailed information about their illnesses independently. As a result, many patients have an idea how they wish to be treated before they even see their doctor. They may even know more about the latest medical studies than their physician! One result of this change is that the patient may feel more of a partner in the process of treatment because he or she has had an active role in its choice.
Does this mean that every teenage computer hacker will know more about current medical practice than an overworked physician who finished training 10 years ago and doesn't have time to read all his journals? Of course not; experience counts for a great deal in medicine. Physicians have a responsibility to use their experience to guide patients. Just because a patient has increasing access to medical information and makes a decision about his diagnosis and treatment doesn't mean he is correct. A physician has no obligation to give a patient exactly what he or she wants if it isn't appropriate. At the same time, a physician should be tolerant of a well-informed, outspoken patient who has an appropriate request for treatment. Rather than interpreting the patient's demands as a challenge to his knowledge and competence, a physician should view it as an impetus to learn more about the new medical information resources so he can integrate them into his practice of medicine. MEDLINE on the Web is a good place to begin this process. If Sally's psychiatrist is not familiar with the drug she wants him to prescribe, he should freely admit it, do his own MEDLINE search, and then help her sort out the results.
In 1889, William Osler, M.D., advised graduating medical students at The University of Pennsylvania that they must cultivate a sense of "aequanimitas" or equanimity, especially when confronting the uncertainty of medicine and the credulity of the "ordinary citizen" (Osler, 1947). He might have had some difficulty maintaining his equanimity if patients came into his consulting rooms with detailed medical information and demands for a specific treatment. Nevertheless, despite its superior and patronizing quality, his advice has some value today. We need to realize that the professional role of the physician is shifting to that of an educator, interpreter and guide, as much as a healer. Social changes of this magnitude produce anxiety on all sides. Everyone subject to such change can benefit from a little equanimity.