The rise and rise of patient powerThe rise and rise of patient power

Knowledge society and the interpretation of truth Knowledge society and the interpretation of truth

Wieland Kiess, MD

Hospital for Children and AdolescentsDepartment of Women and Child HealthUniversity of Leipzig, Leipzig, Germany

The rise and rise of patient powerThe rise and rise of patient power

Knowledge society and the interpretation of the truth Knowledge society and the interpretation of the truth

� Internet, medicine and the patient

� Health

� Internet, data banks

- chances and opportunties

- dangers and deficits

� Knowledge and the knowledge society

� Experts and evidence-based medicine

� Service versus enterpreneurship

The rise and rise of patient powerThe rise and rise of patient power

Knowledge society and the interpretation of the truth Knowledge society and the interpretation of the truth

� Internet, medicine and the patient

1. General availability of information

2. Wide array of information sources

3. Era of advertising and manipulation

4. Lack of quality check and control

5. Expert opinion vs. truth vs. evidence

The rise and rise of patient powerThe rise and rise of patient power

Knowledge society and the interpretation of the truth Knowledge society and the interpretation of the truth

� Health - definitions (WHO)

1. Absence of disease

2. Presence of well being

Our expectations, our wishes, our dreams

Hokusai Katsushika (1760-1849) Elf blinde buddhistische Mönche untersuchen einen Elefanten, können sich aber nicht auf eine Definition einigen. Japanische Illustration einer alten Fabel buddhistische Mönche untersuchen einen Elefanten, können sich aber nicht auf eine Definition einigen. Japanische Illustration einer alten Fabel

Individual health definitionsIndividual health definitions

´I am afraid´,

you have cancer´

The rise and rise of patient powerThe rise and rise of patient power

Knowledge society and the interpretation of the truth Knowledge society and the interpretation of the truth

� Internet, data banks

1. chances and opportunties

2. dangers and deficits

Use and abuse

Availability and ability

Relation with societal, cultural, education, and

economic conditions

Hello, does anyone hear me?Hello, does anyone hear me?(MMW –19.01.2006)(MMW –19.01.2006)

The six elements of a structured doctor patient conversation:

• Establish relation• Listen to problem• Allow for emotions• Explore details • Discuss actions to be taken• Summarize

The rise and rise of patient powerThe rise and rise of patient power

Knowledge society and the interpretation of the truth Knowledge society and the interpretation of the truth

� Knowledge and the knowledge society

Why donWhy don’’t we know it all?t we know it all?

Many “Leaks” from research & practiceMany “Leaks” from research & practice

Aware Accept Target Doable Recall Agree Done

ValidResearch

If 80% achieved at each stage then0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 = 0.21

From Evidence to Practice From Evidence to Practice US Paediatricians’ SurveyUS Paediatricians’ Survey

0

20

40

60

80

100

Aware Agree Adopt Adhere

Hepatitis BPertussis

Pathman, Medical Care, 1996: 873-9.

Many “Leaks” from research & practiceMany “Leaks” from research & practice

Aware Accept Target Doable Recall Agree Done

ValidResearch

The rise and rise of patient powerThe rise and rise of patient power

Knowledge society and the interpretation of the truth Knowledge society and the interpretation of the truth

� Experts and evidence-based medicine

Medication Errors

Is bed rest ever helpful?Is bed rest ever helpful?A systematic review of trials*A systematic review of trials*

*Allen, Glasziou, Del Mar. Lancet, 1999

� 10 trials of bed rest after spinal puncture � no change in headache with bed rest

� UK neurology units - 80% still recommend bed rest after lumbar puncture (Serpell M, BMJ 1998)

� …evidence of harm available for 17 years preceding...

The rise and rise of patient powerThe rise and rise of patient power

Knowledge society and the interpretation of the truth Knowledge society and the interpretation of the truth

� Service versus enterpreneurship

1. Florence Nightingale

2. Hospital companies

3. For profit vs. non-profit hospitals

4. The physician as an enterpreneur

5. The physician as an altruistic caring person

Quality management in the health care system

Patient

Doctor

Apotheken

Hospitals

IndustriesNurse

Insurances

Politician

Presse

Administrator

Society

The rise and rise of patient power -The rise and rise of patient power -

Knowledge society and the interpretation of the truth Knowledge society and the interpretation of the truth

Summary

and

Conclusions

Questions are (missed) opportunitiesQuestions are (missed) opportunities

� Most of our questions are NEVER answered

� When answered, the information is likely to be neither the best nor up-to-date

The rise and rise of patient power -The rise and rise of patient power -

Knowledge society and the interpretation of the truth Knowledge society and the interpretation of the truth

´He who does not believe in ´He who does not believe in miracles is not a realistic person´miracles is not a realistic person´ (Ben Gurion)(Ben Gurion)

Thank you for your attention !