Correcting Information Asymmetry for patients

Consumer reports is invaluable tool for the purchase of almost anything.

Anytime I am considering a major purchase like a car, or perhaps expensive electronics, I always by temporary access to consumerreports.org. While the Consumer Reports magazine can be interesting to browse, the website is even more valuable. You can access any recent product review done for the magazine in an instant.

The problem that consumer reports addresses is “information asymmetry“.

Consider going to the car lot to buy a car and then comparing two similar car models. Both of the new cars cost about the same amount of money. Both of the cars have the same essential features. Which brand of car should I buy?

The problem here is that there is an asymmetry of information. The car sales man knows much more about the performance of these brands of cars than I do. So there is a danger that he will recommend the worse of the two cars, which he will have over-priced. If I trust the car salesman, I might be doing what is best for him, not best for me. Even if the salesman is honest, he might be making his recommendation based on what the needs of the average car buyer. To the degree that I am different from the average car buyer, my needs might be different.

Consumer reports helps to reduce this asymmetry. I can learn about how the cars perform from an objective source. I might end up taking the car salesman’s recommendation… I might not. My decision will be based on -my priorities- which can be very divergent from both a typical customers and from the salesman’s interests.

This kind of information asymmetry is even more pronounced in healthcare. I could learn what a car salesman knows about cars in about a month of diligent study. But to understand what a doctor does I would have to study for years. If I am trying to make a decision like “Should I have this surgery” I am at the mercy of the doctors much-greater information position. The Surgeon might be recommending surgery because that would generate income. He also might be recommending surgery because he is assuming that my priorities are the same as the “typical patient”.

Rectifying this information deficient for as a patient is much more difficult, because the resources available to patients are often problematic.

The information on WebMD is probably accurate as far as it goes, but it is dumbed-down. You can always spot information that might not go deep enough on the web, because it always ends with “ask your doctor about…”. That is the least helpful thing to say here. It means “This is actually a much more complicated issue, but we are not going to give you any more information, instead go ask the car salesman (the doctor)!”. It is the doctor that I am trying to evaluate here!

Wikipedia has much more accurate information that goes much deeper, but its articles are of sporadic quality (usually very high, sometimes very low… which one are you reading now?) and it may not be updated with the latest information on its more esoteric articles. It was not never intended to be relied upon for medical information that changes very very rapidly.

My boss and collaborator at the Cautious Patient Foundation Dr. Cari Oliver has just written a detailed blog post where she details how patients can use at service called uptodate.com to get around this problem. This service is intended for doctors, but they have recently allowed temporary access rates so that patients can access a topic or two and not pay the expensive yearly access fee. Of course, this service is aimed at doctors. It might be a little over your head. But it is better to have access to accurate, recent information about the risks and benefits of different procedures, from a disinterested third party authority that is too complex than not to have it all!

This type of recommendation excites me as a technologist passionate about social change! This is a classic example of using information to make patients more powerful!!

-FT

2 thoughts on “Correcting Information Asymmetry for patients”

  1. While I would agree that information asymmetry is an issue, the problem of getting to meaningful, accurate, understandable information is a faceted problem. People need to be able to make informed decisions, but there is a balance of how much information can be consumed and processed that varies by individual. People need to be able to get to a decision and feel as comfortable as possible that they have made the right decision before taking action. This almost requires that there be some limits to information – bounded rationality – which seems at odds with complete information symmetry. It also requires having some information levels that are “dumbed down.” Information has to be digestible to make sense and be useful, so there should be levels of explanation that are accessible to different levels of domain knowledge – from neophyte to expert insider. That’s why it is important to have something like a Web MD that can give a broad overview and is a trusted resource. The failing of Web MD is not the level of information they provide, it is that they fail to give points of access to information that would require deeper levels of understanding – which I believe is your point. Additionally, I think their veracity may be suspect because they have numerous ads on the site. You are also correct that wikipedia is a fairly unreliable source. People need a medical information clearinghouse – an it’s a huge need as a majority of searches involve medical topics. Sadly, I don’t see that happening anytime soon.

  2. Fred, I totally agree about the problem of information asymmetry in the health space. This is why we started CureTogether.com, which is a more patient-friendly, and definitely not dumbed-down interface to the kind of data you need to check your doctor’s logic.
    Daniel

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