Get a Second Opinion… Yours

Photo Credit: Erich Ferdinand

The situation: You go to your doctor with a complaint. He gives you a diagnosis, and prescribes a treatment.

But is it the right one?

As much as we’d like medicine to be full of easy answers, in truth getting useful guidance on what to do can be confounding. Not to blame the doctors; they’re often working with incomplete information, and using their instincts and experience to prescribe a course of action. But sometimes, their decision may not be the one you want. And you might want to think about getting a second opinion.

So consider this: Maybe the second opinion you need isn’t from another doctor. Maybe it’s your own.

Here’s why: Many aspects of medical care are highly varied, with different risks, tradeoffs and benefits. Different medications for the same condition — from depression to heart disease — can have very different effects and side effects. Different courses of action — for instance treating chronic back pain with surgery versus physical therapy versus medications — can have dramatically varied recovery periods and response times and outcomes. And while a good doctor will include the patient’s perspective into the decision, he could be missing an essential piece of context that would improve the prospects of care. Really, teasing out these tradeoffs and matching them to the individual patient, is one of the toughest tasks we demand of doctors.

And the thing is, there’s another expert in the room: the person themselves. Unlike the doctor, we spend 24/7/365 with ourselves, and we’re usually pretty aware of how we’re doing. We also know our experiences and preferences in a way that a quick QA with our doctor might not divulge. So making people more a part of the decision process is essential to finding the optimal course of treatment.

Of course this isn’t how most of us think about our role. Sure, we want to have input — but we don’t expect to decide. What’s more, even the best of us could suffer from recall bias, getting our recollections of our symptoms and experience wrong when we look back from days or weeks vantage. And most of us lack the expertise to assess the tradeoffs and dive into the literature. This isn’t about making people their own doctors.

But there are great ways to help people observe their experience, and to create a mirror of their experience that can be a meaningful way to understand what really bothers us about one medication, or what we could truly imagine doing for physical therapy. The Internet is our friend here: It’s easy, nowadays, to find well-designed, helpful tools that let us check in over time with a condition or symptoms. Progressive reporting can help us build an understanding of what we’ve been going through, and what is really bugging us day to day. These could be diary style, where the onus is on the patient to note what’s going on — or better yet, these could be proactive tools (think mobile notifications) that reach out to us and make it easy to enter a few notes on how our medicine is working along the way.

Check-ins aren’t the solution though; yes, they’re a great way to create dashboards without a steering wheel. But we have to have a way to make sense of our experience, to read our log and understand where it points us. The doctor can help, if she’s available. But software can help here, too.

Asking patients to make the call isn’t the right answer for every condition. But the patient’s opinion matters — your opinion matters — and it’s often sitting there, right for the asking. This perspective is especially essential in planning for treatments in so-called symptomatic conditions, those diseases where the individual experience is closely aligned to — or even the same thing as — what a doctor would measure. These conditions are some of the most common ones in medicine, and affect tens of millions of Americans and hundreds of millions worldwide: Depression, chronic pain, fibromyalgia, chronic fatigue, arthritis (all kinds), and many auto-immune conditions.

This kind of self-monitoring is already a significant component of treating diseases and monitoring progress in diabetes and pulmonary conditions like asthma. It should be standard practice in more areas of care.

Right now, getting the patient’s opinion on a course of action is too often done in an ad-hoc, unofficial approach. We need to turn the exception into routine, and to make it easier for patients and doctors alike to systematize how we gather and utilize a person’s opinion about their own care. This is what my company, Iodine, is thinking about everyday, as we aim to help people understand their experiences, and turn them towards meaningful actions. We’re eager to build systems that help people learn from their own experience.

The future is headed here: every industry has been upended by empowered consumers, and mobile technologies make it easier than ever to turn opinions into action. It’s time to make that future happen in medicine, today.


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