A Dialogue at the Public Library about Internet enabled care

I have been working steadily with the excellent Seattle Public Library system to expand our health information offerings into the community. This has included some training on our health information resources, and last week, the first presentation I gave to patrons at my local library, the Montlake Branch, in Seattle, WA.

This branch is brand new, and just added Wi-Fi access. The week I presented, there was a traveling computer lab in the facility, complete with laptops, projector, and wireless network. I went with the ideas I had about what patients might be interested in from a topic of “Leveraging the Internet to Navigate the Health Care System,” based on what I refer to as our “50,000 patient-years” of experience interacting with patients online. The assumptions I made in preparing my presentation were proven wonderfully incorrect from this session. I can’t wait to do more.

What was interesting at the beginning of my talk is a trend I have noticed from talking to other patient groups. When I ask about the ecology of medical care – where most health care is actually delivered (see this link for a nice overview), patients have so far answered correctly that most health care in the United States is delivered by patients to themselves, not in physician’s offices. When I have asked professional audiences, they have tended to answer that most health care is delivered in physician’s offices.

This led to the next revelations. I had come prepared to talk about using patient education resources to look up certain conditions as a way of promoting Information Therapy. However, there were more important information needs than that, like, “how do I find the right doctor for me?” and “How can I judge the cost effectiveness of recommended treatments if I don’t know the cost of the treatments in the exam room?” For the former, we went through the evaluation of physicians in on online provider directory. For the latter, well, this was a bit of a struggle for me.

This was really the tip of the iceberg of several useful pieces of feedback and observations from my time with library staff and patrons. What I realized is that when I think of the “Gemba” (the factory floor) in health care, I am thinking of it incorrectly if I assume that it is the outpatient medical center. As much as I go to the Gemba as I work applying Toyota Management principles to health care, the Gemba of health care is really not a medical facility. It’s patients’ homes, and I am not there as a medical professional, which caused me to reflect.

I thought of the influences in my training concerning being in the community. I remember being told as a first year medical student, “Don’t announce in x public forum that you are a medical student or a physician, because that will change the conversation to one about the deficiencies of the medical profession.” This reminded me that as I give these presentations, I will meet people who have been disappointed by members of my profession and the medical system. I think they need to know that we are here and listening, and that means disregarding the advice I was told in medical school.

I am very thankful and pleased that Seattle Public Library could offer this opportunity to get a little bit closer to the “true Gemba” of health care. There are libraries in every community, and physicians that work near them who could form wonderful collaborations. I would like to keep giving this presentation, on “Leveraging the Internet to Navigate the Health System” outside of the health system, to non-health professionals. Each time I give it, it will get better and more relevant for our customer, which will help the work of the health system be more relevant for our customer, the patient.

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Ted Eytan, MD