The Challenge of Educating Patients Through All of the Noise

With the adoption of the Affordable Care Act (ACA) a few months ago, the U.S. healthcare system is now serving the needs of more patients.  The hopes for this changing of the guard is that we will finally see an improvement in overall health outcomes in our country.  Derailing expensive, chronic diseases has been a focus of healthcare for years, but it’s now the center of attention.  This is also a monumental task as difficult as any that we’ve struggled with in modern medicine, but how can we expect to see an improvement in patient health outcomes with an increasing workload that limits the time health professionals can spend with a patient?  One small step that we must take to curb the human and financial cost of the burden of disease is to provide our patients with useful tools to make healthier choices in between physician office visits.

Lifestyle factors are largely responsible for the diabetes and obesity trends in the United States.  It is such a challenge because of the diverse variables that lead to an individual’s daily choices of food, exercise, and sleep.  In the 20 minutes that I have with a patient who I know would benefit from lifestyle change, how am I supposed to inspire them to change their daily habits as a means of investing in a healthier future?  Not only is there the issue of time constraints, but also when you dig a little deeper, you will find that many patients report social barriers to exercise and healthy dietary choices that range from unsafe neighborhoods to long commutes to toxic relationships.

On the other hand, for those patients who are inspired, there is a wealth of information available to them, including podcasts, magazine editorials, Internet blogs, and the evening news - but  navigating medical science is a tricky business.  Fifty years ago, publishing a medical science article implied that esteemed peers had reviewed the methods and conclusions of your investigation.  Nowadays, however, anybody can publish advice through a variety of media, and this is both the beauty and curse of the digital age.  

The reality is that, unless you have a Ph.D. in a field related to medical science, you likely were not formally trained in interpreting medical research.  Even medical doctors struggle to draw accurate conclusions from clinical studies, as they have four short years to acquire the clinical skills, learn medical science, and develop bedside manner before they set off into the world as a Doctor of Medicine.   As such, there is little time to cram additional training into the busy schedule of a medical student for the purpose of interpreting the results of clinical trials.

As a result of the difficulty for the average Joe to access (and understand) medical science and peer-reviewed journal articles, the Internet offers a means to interface patients with contemporary medical literature.  Unfortunately, the barriers to this knowledge have fostered a digital environment in which just about anybody with a laptop may play the role of “doctor” online, and this can be very confusing for patients.  This system opens up a patient’s access to information that might guide their lifestyle change, but there is no regulation of the material published on the various blogs claiming to offer the “best advice for your medical malady.” This has the potential to become very dangerous.

Having said that, there are a variety of bloggers who are actually putting out useful information online, like Chris Masterjohn,  Paul Jaminet, and Chris Kresser.  The reason I find these resources so favorable is that they condense important information accurately into terms that can easily be understood by anyone interested in taking steps to modify their lifestyle.  This is important because, as I have mentioned, even highly trained professionals are not great at interpreting medical literature.  Even if an especially clever patient did decide to take on the monumental task of scanning PubMed for studies related to their specific complaints, an annual subscription to the Journal of the American Medical Association (JAMA), one of the most commonly-cited medical journals, costs $125 alone, and there are hundreds of other journals just like this.  It’s unreasonable to demand that our patients be experts in interpreting this information.  

As a healthcare professional, I want to maximize patient literacy.  Unfortunately, I don’t have the time required to help a patient fully realize lasting lifestyle change as a means of managing their health issues, so it’s important that I’m able to point them in the right direction when they come to me for advice to prevent or manage a chronic disease or to lose weight.  Health coaching has been shown to improve health outcomes, but coaches alike need responsible resources to turn to in generating advice for these patients.

The digital age has improved access to information, but the quality of information available to patients seems to be suffering as a large number of health bloggers focus more on quantity rather than quality.  It seems that for every 500-word, well-researched and revised article, there are 10 others parroting information that isn’t backed by strong science. Finding a solution to this muddying of the waters will not be easy, but it is certainly possible with the help of physicians and other health professionals. The experts need to be heard.

Nathan Riley, MD's picture

Nathan Riley, MD


Nathan Riley, MD is a resident OB/GYN at Kaiser Permanente in Los Angeles and co-owner of Sweat & Butter, a health coaching company in Pittsburgh, PA. He writes about food, movement, sleep, relationships, and stress in order to bridge the gap between his patients, evolutionary theory, and clinical evidence. You can follow him on Twitter @BeyondtheMD and connect with him on Google+.

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