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Rapid Responses: Rapid Responses published:
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Medicine 2.0
- Alexandre Gouveia (24 July 2008)
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Web 2.0: Benefits for doctors and students
- Shafqat Inam (27 July 2008)
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I want great care, but not at the expense of a modest practitioner.
- Sukhpal S Gill (28 July 2008)
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Hardly a revolution
- Trisha Greenhalgh (28 July 2008)
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Revolution for doctors and patients
- Graeme Mackenzie (29 July 2008)
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Anonymous opinion is worthless
- Henry Tegner (30 July 2008)
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Alexandre Gouveia, GP Registrar Arcos de Valdevez Health Centre, NHS Portugal
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The new information and communication technologies have started a revolution in Medicine. Although a lot of health professionals thought for many years that only the diagnostic and therapeutic instruments had changed with informatics(imaging techniques e.g.), people get nowadays more surprised by observing the fact that the doctor-patient relationship has step into a new paradigm: patients have access to more health information and therefore became more judicious. This encompasses a new role for healthcare providers and thus brings the concept of Medicine 2.0, theme for discussion at the Medicine 2.0 Conference in Toronto (Canada) next September. Medicine 2.0 mainly focuses on five aspects conceptualized by Dr. Gunter Eysenbach: social networking, apomediation, participation, collaboration and openess. My thoughts are that, as healthcare providers on the 21st century, we need to accompany the changes that emerged with the digital era and Medicine 2.0 might undoubtedly be the solution for the future of healthcare. Competing interests: None declared |
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Shafqat Inam, Medical Student University of New South Wales
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The tools of Web 2.0 are not only valuable for patients, but allow unprecedented opportunities for professional interaction. Virtual conferences allow participants to overcome the tyranny of distance, while collaborative wikis may facilitate the creation of clinical guidelines and research manuscripts. Furthermore Web 2.0 technologies are well placed to complement the widely adopted philosophy of problem based learning. Interactive sites that augment textbooks, forum discussions that facilitate group work, and excellent online "learning sparks" such as podcasts and quizes from major medical journals all add value to traditional medical education. Web 2.0 has arrived, and it is not only patients who can reap its benefits. Competing interests: None declared |
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Sukhpal S Gill, Final Year Medical Student School of Medicine, University of Birmingham, Birmingham, B15 2TT
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There are a number of problems with the concept behind iwantgreatcare.org, and many have already been highlighted by Deborah Cohen’s blog.[1] Considering the website, it is claimed that there are measures in place to identify abuse such as multiple posts by a single person.[2] However, what is to stop a grudge-bearing patient or an overly tempted doctor from logging in as different users and swaying the overall reviews to one side. Indeed as a public health professor from my epidemiology module would say, the results/reviews for each doctor will be greatly biased in that the only those patients who are proficient in the use of the internet will be able to contribute. Perhaps the computer literate population has different expectations of a doctor than those not trained in information technology, notably the elderly patient population. Despite the fact that 96% of the reviews on the website were positive in the first week, I still believe the website will attract a greater number of negative reviews in the long run. I certainly have a tendency to make greater effort when criticising something rather than commending it (as evidenced by this response to the article), and I believe the patient population contributing to the reviews will have similar priorities. Logically this may lead doctors to ask their patients to post good reviews for them, in effect, marketing their skills to the wider (internet) patient population. I think I prefer the old modest practitioner. References: 1. http://blogs.bmj.com/bmj/2008/07/25/deborah-cohen-i-want-great- care/ - accessed 27/07/2008 2. Cross M. How the internet is changing health care. BMJ 2008; 337: a883 ssg467@bham.ac.uk Competing interests: None declared |
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Trisha Greenhalgh, Professor of Primary Health Care University College London
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I decided to use the website 'iwantgreatcare' to identify a good GP in my area. I typed in 'general practice' and my London suburb, and got a list of six doctors (out of some 50 individuals whom I know to be practising as GPs in that area). One of the six is not a GP at all; one left the country five years ago; one is well known to have been the subject of repeated complaints from dissatisfied patients; and one has retired. Not a single one had any 'ratings' listed from patients. On the other hand, I was in Waitrose the other day and heard two people behind me talking. One, who was new to the area, had asked the other to recommend a good GP for a young family. The second individual immediately passed on clear and (I felt) accurate information about which local surgeries gave good care, and named two popular and sympathetic GPs who had an interest in young children. What can we conclude? Perhaps nothing - but an important hypothesis remains to be tested: The bush telegraph is likely to be a better and more up-to-date source of relevant knowledge about 'good doctors' than either web 2 or any official league table yet produced. Competing interests: None declared |
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Graeme Mackenzie, OUT OF HOURS GP NORTH CUMBRIA
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While patient access to information is the cornerstone of the internet, there should be another revolution going on that will change doctors' behaviour. Why struggle to try and remember things when it is easy to access much better information during a consultation? Patients traditionally judge doctors by what they know. Perhaps in future they will judge them by what they admit to not knowing. Access to the internet on my PDA has considerably reduced my anxiety about being a doctor. Just tap in the possible diagnoses and have a quick self taught tutorial during the consultation. Of course done repeatedly you end up remembering the things that you were struggling to before. However it all takes time and that is another story and part of the revolution. Competing interests: None declared |
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Henry Tegner, General practitioner (retired) Chippenham SN15 1HP
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In common with many colleagues, I find that my own details on iwantgreatcare are out of date and inaccurate. That aside, I fail to see any use in such initiatives as this web site. In my 35 years as a general practitioner I received many an accolade from my patients but I have to confess that they meant little to me. On the other hand, on the rarer occasions when I was a recipient of negative criticism that was delivered openly and honestly by the patient, I found that I could and did learn from them. Such instances came about through the in-house practice complaints procedure, and the patients did not hide behind a screen of anonymity. If addressed objectively and sensitively a positive outcome - and a strengthening of the doctor/patient relationship - were the norm. I think I am sufficiently mature not to need sustaining by compliments directed at me by patients. On the other hand, if I have been perceived to have "got it wrong" then I would indeed want to know so that I could be in a position to rectify matters or to clear up misunderstandings. But in my view any opinion given of me by an accuser who choses not to identify her or himself is utterly valueless. For myself, I could not envisage making an uncomplimentary assessment of my own doctor anonymously on iwantgreatcare or any similar web site. I think that I would be cowardly to do so. Besides - to expect "great" care all the time is unrealistic given the constraints and pressure under which doctors work today. Competing interests: None declared |
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