CAN TMI (too much information) BE A BAD THING FOR HEALTHCARE?

I can “hear” the groans right now wafting through cyberspace.  Here is an old school doctor bemoaning the “new patient” who is internet savvy and has done their homework. I must be one of those physicians who fears patient awareness and  their ability to come armed with reams of information by which they can mold and control their own healthcare decisions.  I am probably one of those who decry patient self-determination and their ability to possess ALL of their medical records.  

Well actually that is not entirely true. I do recommend my patients do their homework, their “due diligence” so to speak when it comes to their own health.  They are their own best advocate. But what has become a difficulty for me and my patients is exactly how to deal with the enormous volume of information which patients can obtain. I am concerned by what seems to be an almost adversarial approach that some patients now take towards physicans.

 One particular source of information has been generated by big Pharma in an attempt to bypass physicians go directly to consumers.  Ironically, I find that this practice has actually backfired to some extent.  Let me share one particular situation which I am attempting to deal with at the moment.  I am a gastroenterologist and I treat (among other conditions) Crohn’s disease.  This can be a very difficult, disabling condition with a variety of very unpleasant manifestations.  One of most horrific are fistulas.  They are “tracts” that can drain a mucus/pus like material from openings in the skin.  Unfortunately they often occur around the anus and genitourinary tract.  

One of the breakthrough treatments are drugs known as anti-TNFs.  Now I don’t want to expand in detail about exactly how they work and the brand names which many of you would recognize from TV and magazine ads.  Essentially they are very powerful with “potentially” serious side effects effecting the immune system.  On the other hand they can be tremendously beneficial for some patients with Crohn’s and other autoimmune diseases.  They problem is that the TV commercials are SO explicit in the risks and potential devasting consequences of bad reactions that even I would be loathe to try them.

 This has happened with my one young female patient with Crohn’s disease and perianal fistua who is reluctant to try this medication.  Ironically, she is willing to try an alternative drug which is chemically almost identical to the first but which does not advertize on TV and for which she is unaware of the same potential side effects.  And by the way, her insurance company will only pay for the one she is afraid to take.  So now my difficulty is to try to “sell” her on the necessity of trying the drug she is afraid to take.  And she is afraid because of TMI and her unwillingness (so far) to trust the experience and opinion of a physician.  I desperately want her to try the drug and have tried to communicate to her that thousands of patients have used it without difficulty or complication. And we can closely monitor in case issues arise.

In effect what I am calling for is a reasonable balance between information gleaned from a wide variety of sources, some of which are of questionable veracity, and guidance from a physician who really does have the patient’s best interest at heart as well as decades of experience and hopefully some wisdom as well.  An informed patient and a wise physician can, indeed, be on the same page. 

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