Friday, January 02, 2015


In my reading, in between all the other "rubbish" that I am doing, I came across this very interesting article about Medicine in the future. Of course, this thought provoking article is by non other than Dr Eric Topol. In his younger days, he was a learned Cardiologist ( often, a rather controversial one ). But in his senior years, he has taken on a role of senior physician mentor, and where medicine is going as we head deeper into the 21st Century. I must say that I agree with many of his thoughts and in particular, this article on " Doctor let go!" No he is not writing about terminating care in a critically ill patient or "NFR ( Not for Resus.) situation.
Doctor let go, challenges us doctors to let go of some of the sacrosanct areas of medicine, that we all hold so dear to, from our undergraduate days. There are 3 important areas to let go. Even if you do not want to let go, the patient will make you let go.

1. That doctors know best about my health. Doctors use to think that when patients visit them, the doctor does all the examinations ( tests ) and tell the patient the data. In this day and age, that is not necessary any more. There is a growing trend of " Patient Generated Data ( PGD ). Good examples are home BP monitoring, glucometer readings, exercise monitoring, weight monitoring, etc etc. Patients have learned to handle these facts, and also learn to understand them.  If you care to teach them, fine, if not, they will just "google" and search the "net". Doctors no longer have the monopoly of patient data and information. Doctors must learn to empower patients, share management strategies with patients, thereby getting better cooperations, complaince and better outcomes. Keeping patients in the dark is no longer an option. Doctors "must let go" of the monopoly to their knowledge about a patient. He must be prepared to discuss using PGD.

2. This is the I want what I want when I want in century, or "IWWIWWIW" century. This is the age of instant culture. I want an opinion now. I want to see you now. I want it at my convenience, not at yoyr ( doctor's ) convenience. This will be further enhance by telemedicine, so that patients can do a virtual consultation, without a physical consultation. Even in my small practice, I see more and more of these. Patients have my email, and they will email me complaints and lab  reports and ECGs. So doctors, you "must let go" of your convenience.

3. The third is most clear cut. Doctors "must let go" of the privacy of the patients case notes. The case notes is about the patient, is paid for by the patient, so it belongs to the patient. Sure, doctors can keep a copy, but when requested, doctors must allow patient to have a copy. Either you do it willingly and nicely, or you allow the patient to insist, with all the other consequences to you. Hospitals can have their recods, you can have yours, but when requested, patients also have a right to their revords. So becareful what you write there.

Interesting ideas. I believe that these issues will get more prominence as we move further into this decade.
                               HAPPY NEW YEAR 2015
                               to you and all your love ones too.


Musafir Melayu said...

Happy New Year Doctor!

Winston Yap said...

Doc, your're right!
I can't agree more!
In fact, I do a lot of surfing on the Internet regarding health matters.
And I always have a lot of questions to ask any doctor that I consulted.
So much so that many do not like it!
Just recently, my wife was diagnosed as having hypertension.
The systolic was quite some way above normal while the diastolic was below normal.
Normal is 120/80.
She was prescribed with Lofral 5.
This brought down the systolic pressure to normal but it also lowers the diastolic to the range of sixties.
I found out from the Inetenet that this is called Isolated Systolic Hypertension which mainly affected elderly female patients.
I mentioned this to the doctor but he didn't make any comment.
I also understand that newer drugs can lower the systolic part without lowering the diastolic part as well.
Is there such medication?
I also think that doctors, especially those who would like to render help to the public can band together to have a website to advise them or to give a second opinion regarding medical matters.
Thank you.