From black leather bags to online hashtags: The golden age of #medicine

Think of the classic image of the town physician. Charcoal suit. Probably a vee-neck sweater. Maybe a smooth brown mustache. Definitely a black leather bag. Always a black leather bag.

Inside the black leather bag, a town physician held the mysteries of health, healing, and dying. Visiting patients at their sick bed, the physician would pull up a chair and place the bag on the bed. The patient and their family would stare at the bag, then the physician, then back at the bag. Hopefully, the two could devise an answer—or at least a solution.

We romanticize the black leather bag because we think it represents the golden age of medicine. In the era of the black leather bag, we say medicine was “still about the patient.” Insurance protocols did not dictate de-individualized treatment plans. Co-payments and reimbursement did not impede clinic visits.

But the golden age of medicine was about the physician, too. In fact, maybe it was mostly about the physician. In the golden age, the physician was the sole proprietor of health information. Ailing patients purely trusted their physicians’ knowledge and treatment. No one Googled their symptoms before making an appointment. WebMD did not offer second opinions. The process of healing and the distribution of medical information began and ended with the physician.

The power dynamics have changed. Type “right abdominal pain” into Google, and five diagnoses headline the search page. The social web, only fractions of which are run by physicians, can distribute medical information to patients around the world in a matter of seconds. Patients are more informed: they search for medical information on smartphones and expect personal health information to be wirelessly shared to their home computer. Medicine and health are becoming increasingly mobile, and the patient is the digital center.

If knowledge is power, then patients have more automony than ever before. The physician-patient relationship in the exam room is evolving because patients are more informed outside of it. In fact, the entire digital revolution in medicine has occurred almost entirely outside of clinics and hospitals. In other words, physicians have a prominent absence in medicine’s digital revolution. The challenge to adjust to this new treatment dynamic is what inspires me to be a better physician.

I strive to influence patient care as much outside the hospital as I do inside. For a few hours each week, I sift through international heath news, medical journals, and urology research with Google Reader, a web-based application that retrieves hand-picked media sources. Then, using 140 characters at a time, I curate that content over Twitter. I store the Tweets in an electronic queue, releasing three to five Tweets a day to the Internet. The Tweets highlight topics ranging from current issues in medicine to advances and controversies in urology. Sometimes my audience is only a hundred people. Sometimes it is thousands.

Tweets are useful for communicating a brief idea or forwarding a website, but patients often need more than 140 characters. Web blogs provide physicians with a way to clearly and accurately communicate medical information and decision-making. I maintain a blog and update it at least monthly according to the latest news in urology.My most recent blog dissects the United States Preventative Services Task Force’s (USPSTF) draft recommendation against prostate-specific antigen screening. The mainstream media misses the complexities of prostate cancer screening, diagnosis, and treatment. Blogging allows me to paint fuller, more accurate pictures for patients at any time, in any location, and on any electronic device.

In our increasingly digital world, even blogging is becoming antiquated. The new trend is “virtual clinic visits” on video sites like YouTube, Google+, and Skype. One of the most prominent physicians utilizing this technology is an orthopedic surgeon outside New York City. He posts dozens of short videos on YouTube preparing patients for their clinic visit. He explains what to bring, what to wear, types of physical exams he is likely to perform, and questions he wants patients to ask. All of this makes clinic visits more efficient for the physician; more important, it makes visits more informative—and empowering—for patients.

If medicine is truly about the patient, then this is the golden age of medicine. To deliver patient-centered care, medicine needs to meet patients where they live. Four years from now when I am a fully-trained physician, I will have already developed an online presence that delivers on-call information to my patients. The term “better physician” is relative, especially when you consider patients’ perspectives, but the right knowledge can empower the right patients, and empowered patients always mean better health.

A worldwide infrastructure supports physicians who invite patients as partners in health and medical treatment. I do not carry a black leather bag. Instead, I give the bag to patients, and they carry it in the form of their phone or iPad. I can make house calls at all hours of the day to an endless number of homes. The golden age of medicine is now. I want my patients to experience it.