In Health Care… Fear Sells

Author: Howard J. Luks, MD- Posted in: Orthopedic Social Media, Sports Medicine 8 Comments

I have had the seeds for this blog post sewing for a while… then this post in the NY Times, by Virginia Heffernan cinched it…. and a new post was born.

Every time I am asked to give a lecture on Social Media and Health Care or provide a guest post on the subject of Physicians and Social Media I am asked to address why I believe physicians should engage in social media and what  role they could play.?

A simple Google search perhaps yields the number one reason I feel physicians should be engaged in social media. Content creation.

 

A Google search within my own specialty for an anterior cruciate ligament tear, produces  a search page with results dominated by commercial medical entities.  Many of these entities, such as WebMD, are simply on the web to make a profit… and a lot of the information available on these sites, simply put, scares patients into action…. or *pushes* them to click through to purchase an item they likely do not need.  In corporate america… that is a success story.  For scared, anxious patients — I would not call that a success.

 

What role does fear have in healthcare delivery?

WE all know that fear is not a particularly strong motivator in general. Many patients smoke, yet they are very well aware of the side effects. A significant percentage of the population is obese, yet they are aware of the side effects. Many of you will head to Burger King or McDonald’s today with a clear understanding of the fact that you are about to consume a 1400 cal hamburger. We all know that we should eat more fruits and vegetables, less fatty foods, we all know that we should exercise regularly and basically make more healthy behavioral choices in our life. But the fear of lung cancer, diabetes, and cardiovascular diseases does not seem to influence our behavior.

 

On the contrary, hype or fear online appears to *sell* healthcare very well.

Contrast the information you can find on the website of the Mayo Clinic with the information seen on WebMD.   Information on the Mayo Clinic’s website is written in any noninflammatory, straightforward manner designed to educate, and not to sell. The content is not surrounded by flashy ads (some google ads do appear), and you are not forced to click through a number of pages to drive revenue.  The information on WebMD’s site, where the user needs to click through a number of pages to finally arrive at a destination finds information which can appear more inflammatory,  perhaps more stress inducing, and the content is entirely surrounded by flashy ads to sell you(although their disclaimer states otherwise) medications or products that have been linked to your search term.

Fear in the physician’s office setting…

I personally see this play out on a daily basis in my office when I am rendering second opinions. It is unfortunately not unusual for patients to try to schedule an emergency visit for a second opinion because they’ve been told that there cartilage tear in their knee was an emergency— so they scheduled the surgery (motivated by fear and mis-information) and now need an “emergency second opinion”.

An emergency cartilage tear, really!?

 

—So to jump back and address my lead-in statement—

Fear in Medical Practice

I feel that the majority of physicians are giving their patients proper advice and proper recommendations based on the available literature and scientific research. Imagine if all these physicians were creating useful, non-hysterical, actionable content and publishing it on the World Wide Web. Perhaps their SEO strategies would not match those of a WebMD, but there would be a whole lot more useful information online to allow patients to properly educate themselves about their disease and enable them to make informed decisions without a background of fear motivated by a drive for commercial profit.

I run a very active surgical practice in the suburbs of New York. I see well over 100 patients a week with various painful orthopedic conditions. A patient with a painful cartilage tear or end-stage osteoarthritis who is not satisfied with their quality of life, and the patient has been told that they stand a reasonable chance of obtaining pain relief with nonsurgical or surgical modalities— can be guided through a shared decision-making process in a calm effective manner without the need for fear to play any role in in this decision-making. It works. It benefits patients. Patients make informed decisions…. and the patient trusts the physician and welcomes them as a member of their care team.

When you are searching online for information regarding a condition that has recently arisen, or a diagnosis you have recently been given… You need to be very well aware of the source of the information that you are reading. Is this a for-profit entity? Is this a commercial entity driven by advertising revenue? Is this predominantly a web-based entity driven by click throughs and SEO to drive their advertising revenues.— Or are you on a site where you learned something useful and the site did not possess a conversion page, ads popping up all around you, and the site does not judge its success by the number of drugs or devices that you click through to.

There are a multitude of patient driven websites which offer phenomenal information for patients. There is no reason in the world why physicians cannot offer their patients similar information, and perhaps even the ability to interact when that physician also chooses to engage in social media. We would all be far better off!

After all,

WE ARE ALL PATIENTS!!

 

image from: http://www.21stcenturymed.org/

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8 Responses to “In Health Care… Fear Sells”

  1. Reply Carrie Swartz says:

    Excellent article. As a gyncologist, I also have seen many patients frantic with fear about their asymptomatic ovarian cyst or fibroids. I try to steer my patients to reputable online sources (I usually recommend http://www.uptodate.com, and while their content isn’t flashy, at least I know it is reliable and evidence based ). I agree, though, the most reputable content is that which we ourselves can generate. Thanks for the great post.

  2. Reply Brenda Bell says:

    It’s not just a matter of creating appropriate content. It’s a matter of explaining to the average patient why certain content is more reliable than others, and teaching him how to read between the hype (this includes the biases in peer-reviewed publications as well). It’s also a matter of keeping up-to-date in what’s going on in your specialty (or in multiple specialties, if you are a general practitioner, family physician, or other primary care provider) in general, and what’s going on with regard to the specific concerns of your patients.

    The flip side of fear that I see online is fear of the practitioner. Fear that if you (and I say “you” specifically because I am not a healthcare provider) post something, it might be inappropriately construed by a patient as medical advice directed at him/her, and that you could be held legally liable. Fear that you might post something that cannot be easily retracted when subsequent research and evidence change best practices and standards of care. Fear that something you post might be abridged, reworked, taken out of context, and reprinted elsewhere.

    What many of us in online patient communities would like to see is active engagement by physician-researchers and social/public-medicine researchers who are interested in pursuing our anecdotal evidence about what works (and what does not work) for us as individuals, fill in pertinent missing data, account for confounders, and use “real-life” evidence to inform both best practices and directions for further study.

  3. Reply Howard J. Luks, MD says:

    Brenda… you are absolutely correct. Unfortunately there are very few physicians engaging online or even producing content (first stage). When I counsel groups who are interested in venturing online, I put forth the concept of a circle of engagement. The first part is that we need content to even begin a discussion. We need to help patients interpret studies and see through the obvious bias that exists in many research studies. We need to listen to patients, incorporate their values and other shared decision making principles in our practice and become comfortable with the engaged or “e”-patient population. Then I describe a situation where the physician becomes comfortable posting online (with proper disclaimers in place) — and if they want to *learn* to interact with others and engage online we start with twitter. Simple, easy to lurk and become comfortable. Then we discuss blogging with an open comment stream and finally we reach a stage where the doc is interested in closing the loop, so to say…. where they are ready to openly engage online on various SM platforms, produce content on a platform that allows for comments or feedback… etc.

  4. Reply Anne Marie Cunningham says:

    It might also be worth directing patients to http://www.tripdatabase.com
    They have a great set of non-commercial patient information leaflets, and other content such as guidelines which are really useful.
    Hope you find it as helpful as I do. If you have suggestions for content I’m sure @jrbtrip would be delighted to hear from you.

    • Reply Howard J. Luks, MD says:

      Thank you… as always I appreciate your advice. Once I figure out where I have my outside links on my new WordPress site I will post your link. It looks very interesting… need to explore the Tilt section! Thx again.

  5. Reply Howard J. Luks, MD says:

    Thanks to Anne Marie Cunningham for (once again) pointing me to remarks by a notable HIT expert and eHealth KOL … John Sharp… his comments re: Prescription for Fear can be found here http://goo.gl/Xl4Ip

  6. Reply Sarah S says:

    hi there everyone, I’m new on here and glad to be a part of the group.

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