“e-Patient Dave” deBronkartTwitter: @ePatientDavefacebook.com/ePatientDaveLinkedIn.com/in/ePatientDavedave@epatientdave.com

The patient of the future: empowered and engaged

$39.95 baby contact

2006

Me? An indicator of the future??

• Who’s getting online:– 1989: Me (CompuServe sysop)– 2009: 83% of US adults (Pew)

• Who’s romancing online:– 1999: I met my wife (Match.com)– 2009: One in eight weddings

in the U.S. met online– 2011: One in five couples

met online

Classic Stage IV, Grade 4

Renal Cell Carcinoma

Illustration on the drug company’s

web site

Median Survival:24 weeks

How can this be??

Because of the Web, patients can connect to information and each other

Observation:We perform better

when we’re informed better.

Corollary:It’s perverse to keep someone in the dark

then say they’re ignorant.

The old (1871): Oliver Wendell Holmes

“Your patient has no more right to all the truth you know than he has to all the medicine in your saddle-bags. He should get only just so much as is good for him.”

Paternalistic caring

“No, honey –you don’t know what you need.”

“I’ll take care of you.”

Sensible – up to a point

“I’ll decide for you.”

When does autonomy become appropriate?

Observation:When assets digitize,

things change fast.

Source: @Asymco

Current information-powered e-patient reality:

Hugo Campos andDana Lewis

Hugo Campos wants his ICD data

#OpenAPS & @DanaMLewis(Open Source Artificial Pancreas System)

Many “loopers” are better controlledthan people with a working pancreas

My weight loss, enabled (not “caused”) by apps:

My providers can’t see this in their computers!

OpenNotes

What happens when patients see

their doctors’ notes?

OpenNotes

• 99% of patients wanted to continue

• 17-26% of docs preferred not to…– But when given the chance to stop, none did

• 85-89% of patients said availability of open notes would influence their choice of providers and health plans

“My patients aren’t like that.”

“They aren’t asking for this.”

Objection:

“E” is not a new idea

• Doctor Spock’s Baby and Child Care (1946)

• Our Bodies, Ourselves (1973)

“We weren’t encouraged to ask questions, but to depend on the so-called experts,”Hawley told Women’s eNews.

“We didn’t have the information we needed, so we decided to find it on our own.”

The old (1871): Oliver Wendell Holmes

“Your patient has no more right to all the truth you know than he has to all the medicine in your saddle-bags. He should get only just so much as is good for him.”

“A new scientific truth does not triumph by convincing its opponentsand making them see the light,

Max Planck Nobel Prize, 1918

“A new scientific truth does not triumph by convincing its opponentsand making them see the light, but rather because its opponents eventually die,

Max Planck Nobel Prize, 1918

“A new scientific truth does not triumph by convincing its opponentsand making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.”

Max Planck Nobel Prize, 1918

“e-Patient Dave” deBronkartTwitter: @ePatientDavefacebook.com/ePatientDaveLinkedIn.com/in/ePatientDavedave@epatientdave.com

The patient of the arriving future:

empowered and engaged