The Inspire Q&A: Inspire talks with Kevin Pho, MD

Dear Inspire Community Members,

We at Inspire are pleased to bring you the latest in a series of Q&A interviews with people we feel are making contributions to helping patients worldwide. We are posting these interviews in a Q&A format in my Journal as a news feature for members of all communities on Inspire.

I recently interviewed Kevin Pho, known widely as the blogger KevinMD. Pho is a member of USA Today’s Board of Contributors. He writes and speaks on topics related to healthcare social media, and his opinion pieces appear in publications such as USA Today, CNN.com, and the New York Times. Pho received his medical degree and completed residency at Boston University School of Medicine. He is board certified in internal medicine and practices primary care in Nashua, NH.

Inspire: Do you think it’s the norm now for patients bringing printouts of health news or information from the Internet to their physicians and expect to talk about those printouts?

Pho: I can say that in general patients are using the Web more to empower themselves. Information now flows two ways. Before, healthcare used to be a more hierarchical, one-way transfer of information, but now, with the power of the Web, more patients are going online and empowering themselves to become better-educated patients.

Inspire: From your perspective, what is the impact of that shift?

Pho: I’ll be honest. Not everyone in the medical profession is happy with that. But whenever I cross the country and tell doctors about this phenomenon, I let them know it’s happening anyway, and we might as well embrace it. The longer it takes for us to embrace it, the bigger the disconnect that we’re going to have with patients, and that’s going to make our jobs harder in the exam room in the end.

Inspire: When you have conversations with fellow physicians who have legitimate criticisms of patients becoming more active in their own treatment, particularly by researching online, how do those conversations usually go?

Pho: I always say, “If patients aren’t going to come to you looking to help interpret health information, they’re going to look elsewhere. They’re going to look further on the Web.” There was a study earlier this year that only 25% of patients going on the Web looking for health information actually checked the source of that information. So I think, as medical professionals it’s our responsibility to interpret what patients find on the Web, make sure it is medically sound, and help them translate it and help patients apply that information to themselves.

Inspire: To be so active and entrenched in healthcare social media probably makes you think sometimes that it is very widespread, but studies show that it’s not widespread yet.

Pho: If you look at social media as it relates to healthcare, just last year the American Medical Association came up with professional guidelines, and hospitals are just now embracing social media and recognizing it as a viable forum to communicate real-time information to patients. And I think in the medical profession we’re still a step behind, so one of my goals when I travel across the country is to convince doctors of the value of social media and to let them know it’s here to stay. So, if I were to use one word, it would be that healthcare social media is in its infancy still.

Inspire: How would you define the term “empowered patient?”

Pho: I would say it would be a patient who is an active participant in their healthcare, and wants to play an active role in the shared decision about their health. I think there are some doctors who fear empowered patients and think that it’s infringing on the traditional doctor-patient relationship. But I think the trend is toward more shared decision-making and having patients being partners in their healthcare. And I think it’s to a physician’s benefit that they recognize that phenomenon.

Inspire: What qualities do effective “e-patients” share?

Pho: I think they’re proactive in their healthcare. They’re inquisitive. They like to ask questions. And they don’t always take what doctors say as the final word. As physicians, we don’t know all the answers. There are a lot of studies that get contradicted. There’s a lot of new information that comes out, and I’ll be honest, there are a lot of things doctors don’t know. So, I think it’s certainly our responsibility to keep up with that information, but patients have a responsibility too to take control of their healthcare and be that partner that really is the epitome of an ideal doctor-patient relationship.

Inspire: You touched there on the responsibility of patients. There’s often discussions about the levels of responsibility that patients should assume in this new paradigm, and the classic tale about patients who don’t follow the agreed-upon treatment protocol, such as diet and exercise, and who then blames the physician for poor health outcomes. How might social media help in improving that hoped-for shared outcome?

Pho: I think it breaks down barriers between doctors and patients. Social media introduces that transparency that was lacking before. Now, whenever I write in my blog, behind the proverbial curtain, patients have a better idea of some of the things physicians are facing. They can understand why we sometimes run an hour late, why we can only spend five to 10 minutes with patients, why we do some of the more unpleasant things that we do. And I think, on the other hand, through social media, doctors can hear from patients as well. Whether it’s comments on my blog, and sometimes I invite patients to write a guest post because I think it’s important for doctors to hear the stories from patients too. A lot of doctors haven’t gone through personally what their patients are going through, so I think it’s important for each party to share that experience, whether it’s a blog, or on Twitter, or Facebook, or on groups like Inspire, I think it’s important that each party hears each other’s perspectives.

Inspire: People are using Yelp and Angie’s List and online customer rating services like those more regularly. Do you see patient-driven online physician rating and hospital rating services becoming more popular?

Pho: Let me take a step back on this, and talk about online physician rating sites in general. I wrote about this topic recently. I get a lot of stories from doctors saying patients wrote negatives reviews about them online, and they want to know what they can do about it. The first thing I tell them is it’s here to stay. Patients want a way, like TripAdvisor, like Yelp, they want a way to know from other people what it’s like to go to a certain doctor or hospital. And, the most convenient user-friendly way to do today are online rating sites. I do think there are some problems with those things.

Inspire: Such as?

Pho: First, a lot of them are anonymous. Some of them don’t allow doctors and hospitals to respond, and frankly, also, not enough patients use them, so a lot of those reviews are skewed. I think the sites can tremendous useful for doctors to receive that kind of feedback and frankly, there are some doctors who need to hear that type of feedback. So, what I tell doctors is that they need to encourage more of their patients to rate them online. There was an article I always cite, that was in the Journal of General Internal Medicine, that showed close to 90% of patient ratings of doctors online are actually positive. So, if you get more and more patients rating doctors online, chances are they’re going to be better what doctors think, because it’s going to present a more accurate picture of what a doctor is like, and some of those outlier negative ratings will just be considered as such.

Inspire: Let me return to the topic of the patient-physician relationship with regard to patient empowerment. When a patient begins an appointment with you saying that she read something online about her health, where does the conversation usually go from there?

Pho: Every conversation is unique, but I always try to let the patient lead and let the patient take charge as to where he or she wants to go with that information. I always ask them what they read online and what they think about it, and if there are any medical inaccuracies I’d certainly give my take on it. And I never discourage patients from researching online. I realize that telling patients to not go online for health information is not a viable option. I’ll give patients tips as to what are reputable sites, to be careful as to what someone is saying on blogs, as they may not be as accurate as a hospital-based or government-based Web site. Certainly everyone is entitled to their own opinion, so if a patient draws a different opinion than I do from an article, I will certainly give my take, but in the end it’s the patient’s ultimate choice as to where they want to take their medical care. I’m here as a guide, and I’m here as a resource.

Inspire: It can’t be easy, particularly in the US system that you work in, to devote enough time to have substantive discussions with patients who bring some amount of online research to appointments.

Pho: It does take time, and the way that doctors are financially incentivized, and the way that our medical system is built is based on 10- to 15-minute office visits, and really is not meant for long conversations. And that’s a shame, and I hope that will change in the next five to 10 years. What I always tell patients is to prioritize their questions and concerns. I think that patients understand that there are cases where I’m not going to be able to address all of their concerns in a single office visit, and there are some issues that deserve their own office visit. Rather than give a rushed version, it’s better to have patients come back and give the issue the time it deserves.

(Please email me at john@inspire.com if you have suggestions for future Inspire Q&As. Feel free to post comments to this interview, and thanks for reading.)

Edited May 8, 2011 at 9:46 pm

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