Monday, November 16, 2009

Not Ready for Prime Time

Well, that was a bust!

I recently posted about my plans to expedite informing men about their prostate biopsy results by using the secure messaging service. Over the last month, I saw 7 men who required prostate biopsies. I told all of them about what I was trying to do, and offered them the choice of a phone call or email notification. Five of the men said either that they didn't have internet access or they didn't feel comfortable using the internet. Of the other 2 men who expressed interest, one of them took the initial step in accessing's system, but never followed through in signing up for the service (which, by the way, is free for a 30-day trial).

Two years ago, I'd tried conducting an online patient satisfaction survey. The response was similarly dismal. It seems that either something is lacking in my approach, or my patients don't find the internet to be a comfortable or accessible resource - which is completely opposite to the message I heard at a conference I attended 2 weeks ago.

The Canadian Institutes of Health Research hosted a conference on the value of social media in communicating the value of health research. Most of the attendees were communications officers for health advocacy groups (e.g., Canadian Lung Association, Multiple Sclerosis Society of Canada). The keynote speaker, Mitch Joel, doesn't work in healthcare, but his message was dead on for anyone who does.

Mitch is involved with digital marketing and new media, and made a very compelling case that not only will most of the population use social media to access health information in the near future, many of them use it now, and can't understand why most healthcare practitioners are so far behind the curve on this. I agree with him. I regularly consult with patients who have already informed themselves about their condition via the internet. Physician-rating sites, like RateMD, let people share their experiences and satisfaction with their doctor. People do seem to be keen on using social media.

But then, I run up against the experience I had with prostate biopsy notifications. Maybe it's because these men are older, and haven't had much exposure to the internet. Maybe it's because many of them are from rural areas, and don't have easy internet access. I asked Mitch for his thoughts on how to proceed. He suggested that I should continue to offer both options to my patients: phone notification or email/secure messaging. This was consistent with his broader message that health advocacy groups should be spending a greater proportion of their marketing budget on developing social media marketing tools for their increasingly net-savvy audience.

His advice to me makes sense: Continue to offer the choice to my patients. But, I think it misses an important point. A big component of notifying men about results was developing the "script" that I would email about whether their biopsy was positive or negative, and if positive, where they could get further prostate cancer information, and when we would be getting together to discuss the matter further. If I were sending this out to a significant number of men who had positive biopsies, my initial time investment in writing the script would be rewarded with time saved later on. But, as it stands now, the time I spent has not paid off (except as a topic for a blog post). I'm reluctant to invest similar effort for any other clinical conditions until I'm more confident that a greater proportion of my patients will find value in the service.

Because I've already created the infrastructure around prostate biopsies, I'll continue to offer men this option. But, it doesn't look like we're ready for any more new-fangled stuff around these parts. Sorry, Mitch.


  1. Originally posted 11/18/09 10:50 AM

    Sounds just too complex for people to be bothered doing ... why not just send an email (wrap up the results in a password protected zip folder).

  2. Originally posted by Dean Brown (West Vancouver) 11/17/09 1:10 PM

    Hi Kishore, As a GP, I'm guessing that these guys want a face-to-face meeting. For many, it's the scariest thing they've ever faced, and the last thing they want is a brief e-mail, or a detached chat on the phone. They want a chance to sit down with the doctor and ask 'but what does it mean'. Good blog, keep it up. Regards.

  3. Originally posted by Greg Pauli 11/17/09 1:12 PM

    Really enjoy your blog. Keep up the good work. Your comments on Nov. 16/09 I find to be very true. I am not sure that the population who most accesses the health care system is computer savvy enough to see it as beneficial. As time passes on it will be a more utilized tool. Dare I say 20 years? Then you can just text message patients but not while they are driving. :)

  4. Originally posted by Steven Lewis (Access Consulting Ltd.) 11/17/09 2:40 PM

    Kishore, I'm not entirely surprised by your responses. Even if the technology is not new, the current proposed application is. The subject matter is serious - biopsy results - so as an icebreaker for a new approach it may not be ideal. But the general thrust is correct - look at this as a PDSA and keep offering the choice. However, as in introducing any new product or service, there has to be some market development and communications, and one expects both early and later adopters. It might also help to soften them up by encouraging the use of these media to book appointments, etc. Once accustomed to using the technology for these kinds of processes, it's a smaller step to use it for more substantive purposes. As for the script, here's where social media can help you. Why should you have to develop your own script? The web has enormous potential as a learning environment and one would hope you could find dozens of scripts that have been tried elsewhere, and even evaluated. Communities of practice can save a lot of labour, and can provide expertise that even the best efforts can't match locally every time.