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The challenge of the networked patient

Jason Berek-Lewis Creator, Healthy Startups 
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The rise of social media presents a number of challenges for the health care industry, none more so than the emergence of the networked patient. As the ground breaking The Cluetrain Manifesto (published in 2000!) notes, the networked market breeds smarter consumers who are better organised, able to source better information and support from each other than from vendors.

As The Cluetrain Manifesto observes in thesis 9 "These networked conversations are enabling powerful new forms of social organization and knowledge exchange to emerge."

We are seeing the formation of new patient networks across social media platforms such as Facebook, Twitter, Ning, as well as across the blogosphere. These networks are enabling people, across geographical, social, cultural and economic boundaries, to share information about their conditions, their treatment, their recovery and ongoing care. Social networks are, just as The Cluetrain Manifesto suggests, breeding smarter patients.

As patients become smarter their expectations around their health care changes. Smart patients are not docile and accepting of every word the doctor speaks. My late grandmother trusted her general practitioner so intrinsically that she ignored her stomach pains on his advice: those pains turned out to be caused by a tumour. My grandmother died in 1993. In 2011 no patient would acquiesce to their doctor's advice in the same way.

Smart patients expect and demand better care. They expect access to the best doctor because they will have already researched whether their general practitioner, family doctor, physician, surgeon, oncologist is the best. They may have visited sites like www.ratemds.com or www.healthgrades.com or www.mydr.com.au to read about the experiences other patients have had with certain physicians. The patient will have already made up their mind about the doctor, and whether to trust that doctor and act on their advice before the consultation.

Networked patients have different expectations around access to health care and advice that exceed the traditional medical appointment in a doctor's rooms. Patients want to see their doctors active on social networks. Soon it will be common place to contact your doctor over Twitter, Facebook or a health specific social network. The ethical minefield this presents is treacherous indeed.

As I stated above, access will no longer revolve around fixed appointment times. Rather than coming in to discuss pathology test results, patients will expect these results be emailed, tweeted or DMed to them over Facebook before they come in to see the doctor. When the patient does come to see the doctor about the results, they will have already researched and interepreted the findings. This presents significant challenges to the traditional authority vested in medical practitioners.

As notions of access change, and patients demand the ability to text, tweet and network with their health care provider outside the traditional care setting, patient expectations around health care outcomes will increase. 'Miracle' stories of cures or significant improvements in conditions after unorthodox treatments, stories that are spread virally on social networks, will also add to pressure on medical practitioners. Patients will not be concerned about the validity of information on social networks because the information will be passed to them via trusted sources (without the patient necessarily knowing the point of origin for the information).

The other challenge presented by the rise of networked and informed patients is the source of the information the patient relies on to influence the care outcome provided by their doctor. There are millions of websites where patients can access health care information and the quality and evidence base behind this content differs from site to site. People implicitly trust their digital social network and are more likely to believe and act upon information sent to them from a Facebook contact. Examples of patients turning up to consults demanding a specific drug based on information provided by a "friend" will become more common.

Networked patients do present real challenges to doctors, and more widely to hospitals, pharmaceutical providers and even governments as patients organise to build coalitions for political change around health care funding or regulation. There is no point complaining abvout it or longing for the good old days when patients were "dumb".

The future is already here. Markets (the term used by The Cluetrain Manifesto) or networked patients are not going away and the challenges they present will only grow as markets get smarter... Or, you could look at it this way: networked patients present an unparalleled opportunity. Doctors will be able to engage in informed discussion with patients around their care. Patients will be more proactive in managing their own care. I feverently belive this will lead to better health outcomes for smarter patients. 

I'd love to hear from doctors, nurses, specialists, interested observers. What's your take on the networked patient? 

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