UpToDate has been a long-trusted resources for physicians that relies on evidence-based medicine to create a thorough picture of a topic. In addition, each article is peer-reviewed by experts in that field to add credibility to the information. This has made UpToDate an invaluable clinical resource for many physicians (including me), spanning many disciplines and settings.
Recently, UpToDate added patient-level information, hoping to help bridge the gap between patients and physicians by providing information that leads to better decision making with the patient in the process with the physician, and not on the outside of the process. They refer to this approach as “shared decision making”.
At the recent Health 2.0 conference in Boston, UpToDate was the premier example of “Information Therapy” because of it’s evidence-based medicine approach to it’s content. UpToDate is available to physicians by subscription, to patients free for the patient-level information and also by subscription for the physician-level content.
I had a chance to talk with UpToDate’s Editor-In-Chief Denise Basow, MD, at Health 2.0 to learn about UpToDate’s patient information channel and to gain a better understanding of her view of ‘shared decision making’ and how it impacts care. Here are the highlights of our chat:
Before your last debate, Dr. Holt was very critical of UpToDate…stating: “UpToDate is out of date before it even hits the web browsers.” Others, argued it required a great amount of health literacy to be useful. Thoughts on that?
As for the health literacy issue: “We’re not after every consumer”.
As for being “out of date”, the information is as current as the published studies allow and are constantly being re-evaluated.
Do you feel you provide too much information?
“People with serious illness become literate in their disease so no.”
What do you mean when you talk about ‘shared decision making’?
“Shared decision making enables consumers to be part of the information doctors have to get most of what we have to offer. This allows us to do what we’re good at.”
Are practicing doctors comfortable with this, too?
“Docs wants patients to be informed correctly with information they trust. Patients trust this (UpToDate’s) information because it is given to them by a trusted doctor.”
“Patients are going to look things up. Better to come from the doctor.”
How does UpToDate help with ‘shared decision making’? What makes it work?
“Patients are reassured that they are getting high quality information that doctors trust. This is where the doctors go.”
How do you feel about on-line communities?
“There are times when observational data are useful – communities can do that.”
My final thoughts
I have always been impressed with UpToDate’s physician-level information and find their online patient-level information equally reliable and well written, without giving too much information. Dr. Basow’s comment that the site is not for every consumer (patient), is accurate and needs to be kept in mind by health care providers when making recommendations to patients for online health resources. The information is written for the highly health literate consumer as illustrated by the Influenza online information page using terms such as “antiviral”, “sinusitis” and other medical terms. UpToDate’s patient-level information is going to meet the needs of many patients, but not all, for this reason.
Physicians and health care providers should remind themselves that savvy, highly educated patients are not physicians so interpreting physician-level information from any source without the clinical experience to support it will pose a challenge and could lead to misinterpretation of a medical situation and anxiety. This makes me incredibly cautious about the use of UpToDate’s physician-level information for any patient. Except in a rare situation, it really is unnecessary.
At Health 2.0 one of the best quotes about health information of all kids was that it always boils down to “the right information for the right patient at the right time”. UpToDate can accomplish this for a big slice of our population. Our job as health care providers is identifying the people in that slice so we can help the others find an equally reliable health resource that meets their online information needs.
As Mark Twain said "Be careful about reading health books. You may die of a misprint". The problem is applying general information to individual patients. After all is said and done, the best advice you can get is from your own doctor who knows and examined you. Access is often a problem but newer technologies including HIPAA compliant online email services such as housedoc.us or medem can fascilitate such communications. There is really no reason for anyone not to use them, especially since some allow the physician to charge for their own line sesrvices.