When I was in India recently, I spent time with one of my relatives. While I was there, he came down with a minor cold, and walked to the doctor’s office just down the road. I stayed at home until he came back. When he did return, he had with him a packet of various pills all mixed together. None of them were labeled, nor did they come with a set of instructions. He didn’t know what any of them were, just that his doctor gave them, so he took them.
A week later, I found myself talking to the servant that had come to clean our apartment. Her son had been ill for sometime, and I knew something about the condition from which he had been suffering, because someone had explained to me earlier. Yet when I talked to her soon after she had come back from meeting with her son’s physician, the way she tried to explain his condition to me struck me as completely inaccurate, given the condition in question.
In other instances, I have seen relatives sitting in the doctor’s office. Oftentimes they don’t say anything, and don’t ask anything, instead simply nodding in agreement. Yet when they were out of the office, the questions and doubts start flying. Usually the condition in question remained nebulous even after the appointment, or the procedures were not explained fully. Other times, they would take a decidedly cynical stance when it came to evaluating the doctor’s suggestions, believing that they were more interested in extorting as much money as possible instead of actually treating the condition.
To my eyes, at least in developed countries, patients seem to be more empowered in the context of the doctor-patient relationship. In the ideal scenario, the patient and doctor work together for a solution, with the patient actively engaging the doctor with questions and concerns, and the doctor giving the due attention and compassion. The patient may also have access to additional information through the internet.
Yet in developing countries, including India, many patients still to cling strongly to the doctor-patient hierarchy. What the doctor says, goes, in most cases. In areas with dense populations, few physicians, or a combination of the two, giving the patient the time they deserve can be a formidable task. Among those with less education, a lack of basic medical literacy can further complicate matters.
I recently attended NYMCSPAD (New York Medical College Student Physician Awareness Day). The theme for the day was Social Media in Medicine. All of the speakers–who are very active in social media applied in healthcare and medical education–discussed their personal experiences using social media, as well as advice on how to effectively use social media. One of the points that really stuck out is that patients who continue to ascribe to the “traditional” doctor-patient hierarchy are likely to be left behind. I thought back to my relatives and other people I know who are still content being passive, and not actively taking charge of their care.
There is no denying that social media has taken hold globally. Its value as a tool for patient education and empowerment is slowly being realized in the United States as well as in other countries. Patients, in many cases, vet their doctors by searching for them on social media sites to learn more about them and what they do. Social media is also being embraced in developing countries among physicians, medical students, and public health workers alike. However, I still believe there is still more work to be done to promote patient empowerment in those countries.
The doctor-patient hierarchy–though in many cases a cultural mainstay especially in developing countries–presents a very real barrier when it comes to tightening and improving the healthcare system. According to the World Health Organization, patient empowerment can allow for a more efficient use of resources. Poor medical literacy is another barrier that makes patient empowerment that much difficult among patients who are unsure about the particulars of their own health. While for many in developed countries, information is quite literally at one’s fingertips thanks to smart phones, the same is not necessarily true for the majority of people in developing nations.
While the knee-jerk reflex for many is to develop an app that can be used on smart phones, it doesn’t solve the whole problem, especially considering that smart phones aren’t as pervasive a presence in most of the world as they are here. In India, there are about 20 million smart phones available, but given that there are just over a billion people in India, it represents a very small percentage of the population. However, there are over 900 million cell phones in use. Similar trends are true for other developing nations, with cell phones being available to at least 50% of the population in many cases. Cheap cell phones are often readily available to the majority of the population. I have often observed the very poorest toting a cell phone.
Facebook, Twitter, and other social media platforms are all useful in their own right. Among social media tools, Twitter seems particularly well suited as a way to improve medical literacy and increase patient empowerment in developing countries. While most users use Twitter through Twitter apps and clients on their smart phones and computers, even those with cell phones can send and receive tweets. Before I got my first smart phone back in 2009, I used my regular cell phone to tweet.
So who would these patients tweet or follow? Doctors, medical organizations, medical schools, and other research institutions are just a few that come to mind. The issue with developing nations on the whole is elevating the patient so that they are on an equal playing field with their doctors. They need to feel like they can ask questions of their healthcare providers, that they can trust these providers, and be well-informed about their health and any prescribed treatment. While part of this can be solved by trying to impress upon the patient that the doctor is a partner in their healthcare, part of it can also be solved by improving the patient’s medical literacy.
Medical literacy has been of particular interest to me ever since I took a class on immigrant health for my public health program. A lack of medical literacy can contribute to a whole litany of problems, including early deaths. The issue in many developing countries is not only the lack of medical literacy but the lack of literacy in general. Combining this with the fact that many still cling to preconceived notions and superstitions can further complicate things. Here, the use of a non-written medium, such as Youtube, can be used to effectively transmit information about various aspects of healthcare. The use of video allows for not only circumventing text entirely, but easily adapting the content to the local languages and cultures. Given the likely poor access to technology in poorer communities, the onus is on physicians and public health officials to make this information available to them.
This is something I have thought about for a while, but revisited with renewed interest after attending NYMCSPAD. Do you know of programs currently utilizing these and other approaches that have been conducted to date? What are they? Do you have any other thoughts on how to promote patient empowerment in these regions? Comment away!