"Tapping" Apps for Physician Advice: No Waiting Room Necessary
This past week, I stumbled across a fascinating article by Michael Millenson on the Health Care Blog (originally on Forbes.com) that I almost bypassed entirely. Described as a “social media darling”, the article focused on a relatively new health care service called “HealthTap.”
To me, the name “HealthTap” immediately implied an iPhone or other smart phone appplication or “app” like TapFish, a virtual aquarium, or TapFarm – a likely deliberate marketing scheme to tap into (pun intended) the success that apps have had. With apps to calculate the amount of calories you burn, fitness workouts, curing acne, and instant access to WebMD and WebMD Baby, consumers are turning to app downloads for solutions to their health problems. As we all know too well, there’s an app for pretty much everything (and indeed, there is, in fact, a HealthTap app).
I freely admit that I, like many others, don’t think twice about consulting WebMD and the like before my physician for any health questions I may have. The availability and wealth of information and the ease which consumers can obtain it is a powerful attraction and a driving force behind over 9,000 health apps being available in the iTunes store. Like many others, I generally only consult sources that to me appear reputable and from a trustworthy individual or organization.
At first glance then, HealthTap appears to be an applaudable solution to help individuals become more involved in their health care and seek answers to general health questions. HealthTap states that,
We help you better understand your health, make better health decisions, and find the best doctors...We believe that everyone has the right to free, reliable, and independent health information. We also believe that the most trustworthy health information comes from medical experts. Finally, we believe that the best health decisions take into account unbiased expert knowledge, community insights, and relevant data.
Individuals can log on and create an account, either as a physician or as a member. A member can pose a question which any physician that signs up for HealthTap can answer. For each question answered by a physician, he or she is granted points and levels, building his or her “reputation” in HealthTap. Answers can be categorized as “Yes”, “No”, “Maybe”, “Complicated Question”, “Evaluation” and the like.
Because answers are only coming from a physician with supposed knowledge and expertise, not a random individual like with Yahoo Answers, it appears to be more credible and trustworthy. In addition, HealthTap gives you information on physicians active on HealthTap who are in your area and their field or speciality. It may give you their practice location and affiliations as well so you can choose to “follow-up” with a particular physician who answered your question if you so choose, establishing a bona fide physician-patient relationship.
However, there is no way to actually confirm the credentials of the physician answering your question, nor is it clear whether, and to what extent, HealthTap thoroughly checks the credentials of physicians before allowing them to participate (HealthTap does require physicians provide their medical licensing number). And the “reputation” level of a physician answering questions on HealthTap is based not on his or her professional reputation in the community or professional area of expertise, but rather the amount of “agrees” clicked by other physicians who happen to see your answer. The more clicks you get, the more visibility you get from HealthTap. In addition, "Health-Tappy Awards" are given out to physicians based on their answers.
As Millenson also points out, HealthTap also markets itself to physicians as a way to generate new business. Its website states, “Build your reputation while attracting new patients and improving quality of care in an enjoyable and socially impactful way.” Notably, HealthTap also offers certain "elite clubs" with "preferential placement and highlighting of answers" and access to the HealthTap blog to publish articles for the HealthTap audience. It is unclear, however, though just how invitations to or membership in these elite clubs is determined: payment of a membership fee or reaching a certain HealthTap reputation level.
On the one hand, I am fairly optimistic that a majority of physicians truly wish to help empower patients and share their considerable knowledge and expertise simply out of this desire. Sharing this expertise online and through apps is an efficient mechanism to reach a larger group of individuals and communities, potentially affecting broader population health in a positive way. I am also generally supportive of asking and making available answers to general health issues and questions.
On the other hand, I am inclined to also agree somewhat with Millenson that motives may be questionable, as well as in general the reliability and trustworthiness of their answers. As he puts it,
You’re getting a few sentences of free medical advice from a group of random physicians, with reputations attested to by other random physicians, who are taking the time to answer your question for free either because of a desire to generate new business or a desire to help their Fellow Man.
After browsing around HealthTap, and giving it some thought, I almost agree with Millenson that HealthTap and other similar platforms may not be too different from receiving advice from a random stranger on Yahoo Answers or the first page "Googled" to that looks somewhat respectable. While only physicians may provide answers, how do consumers know that the information they receive is accurate and reliable? Is it really possible for physicians to provide advice to an individual whom they have never seen and received only a few sentences describing a general health problem or question with little clinical relevance or clarity? And even if the individual’s question is perfectly clear (which from a random sample of questions I viewed most certainly may not be), can a physician ethically provide reliable and clinically reasonable advice when limited to a 400 word response?
HealthTap isn't the only social media culprit that presents these problems. The recent push for email exchanges between patients, Facebook and Twitter, posting "wiki's" and other informational sources online, blogging and participation in other online health forums all can create similar concerns for the physician-patient relationship, despite the wealth of infomation they can make available almost instantly. For an article touching on a host of other issues presented by physicians increased use of social media platforms, such as malpractice, fraud and abuse, privacy and professional concerns, see Health Care Social Media: How to Engage Online Without Getting In Trouble and its Part II.
Millenson cites a recent post on an internist's dissolutionment with blogging, quoting the physician as follows,
Mostly everyone has either sent or received an email in which the content somehow did not fully convey the point intended. Despite reading, and rereading the message, the intent of the email was never fully apparent. I often felt that my responses were clear and concise, only later to learn that further clarification was required….In the end, the potential back and forth that can occur with email often resulted in the need for an office visit in order to clarify the mess that was created from the original email.
As Millenson goes on to note,
Maybe that’s the point. By consistently providing just enough information to be confusing, HealthTap may hope to provoke a significant number of users into paying to see a participating doctor and, presumably, persuade a significant number of participating doctors into paying HealthTap for that referral. Form follows function.
I can certainly see the benefits and potential that HealthTap and similar health apps and online resources have to help achieve broader patient involvement and understanding in their health care, prompting them to seek care from their physicians and specialists where necessary. These apps, to some extent, may contribute to revolutionizing health care and patient involvement.
On the flip side, however, a site promoting "real physician advice" and "no waiting room" may lead to a false sense of trustworthiness and accuracy and a host of other concerns. A quick "type-and-tap" is not a substitute for real physician evaluation and advice or that physician-patient relationship, and for many, the waiting room just might be the better option.