What is laisser-faire but an orthodoxy? The most tyrannous and disastrous of all the orthodoxies, since it forbids you even to learn. — Bernard Shaw, The Doctor’s Dilemma, Preface, “The Technical Problem” (1911)
David Cravit, Zoomer enthusiast and author of The New Old: How Boomers are Changing Everything… Again recently addressed a room full of information technology and medical professionals at Cancer Care Ontario’s 2008 Cancer Leadership Forum. His presentation examined how boomers are going to change the traditional health care models because, according to Cravit, we have entered the era of the patient as a consumer. Cravit prefaced his talk with a disclaimer and explained that his presentation would be descriptive, not prescriptive.
As a marketing executive, a big part of Cravit’s work has been to identify emerging trends and to predict how they will be reflected in consumer behaviour. He cautioned the audience that the aim of his presentation was not to make a case for any particular type of health care system (two-tier/one-tier, public/private) or to ascertain whether patients were sufficiently competent to make major medical decisions for themselves.
He argued that the traditional patient model is being replaced by the emerging model of patients as consumers who may respect their doctor and the health care system, but ultimately see themselves as the directors of their own health project. This consumer will be proactive in looking for alternatives and best outcomes, and will ultimately be unwilling to accept bad outcomes without checking all the options. The internet, he said, is enabling this. According to a 2005 Comscore study, the internet is the preferred medium through which people access health information; 80% of internet users have searched for health information. Ultimately, people will cease to see their doctors as godlike and begin to think of them as one of many service suppliers.
Pointing to the emergence of websites offering custom medical solutions and services such as medical tourism and designer body parts, Cravit listed the ways in which this process is already under way and how it is made possible by the online experience. After all, he said, the online experience conditions consumers to expect speed, convenience and customization, the ability to comparison shop, to dialogue with other consumers and providers and instantly access comprehensive information. The impact of these aggregated expectations has already been seen in the way consumers approach financial services, travel, retail—why not healthcare?
The sentiment that the internet would revolutionize traditional health care was echoed by the next presenter, Sir Muir Gray, Chief Knowledge Officer of the National Health Service and author of The Resourceful Patient. Dr. Gray supports a patient’s right to some degree of self-management and he has put forward the thesis that patients should have free access to high quality information about their health. Patient self-management, with its untapped potential, is the driving force behind websites such as http://e-patients.net/, a collaborative information project based on a term coined by Tom Ferguson to describe individuals who are “equipped, enabled, empowered and engaged in their health care decisions”. Ferguson imagined health care as “an equal partnership between e-patients and health professionals and systems that support them”.