1. Consumer Perspectives on Health Care John Brill, MD, MPH April 2008

2. Case 1: April 29 th, 2008 You get a call from the daughter of an 87- year old patient with CHF and atrial fibrillation. She has heard that there is a recall on Digitek, which he is on. She wants to know if she should stop it.

3. Case 2: April 21 st, 2008 A patient saying that she wants to start Cymbalta, which she saw advertised on TV.

4. Case 3: 4/28/08 Email from your niece, who is getting married this weekend “Hi John, I have a favor to ask -- and please know that if you say no, it's all right! But, recently I have been inundated with honeymoon UTI stories. We're going to Mexico, and, obviously, they do have doctors in Mexico, but we're a little worried about me getting an infection and not being able to get to a clinic as easily as we could here. I hate to ask, but I'm transitioning between doctors here, so I don't really have one who I think would call it in without seeing me... and we've hit crunch time, since I move home to Oshkosh on Sunday. So, would you be willing to call in a prescription for an antibiotic for me that we could take with us, in case I do get a UTI? Thanks!!!”

5. Case 4 JS ONLINE TUESDAY, April 29, 2008JS ONLINE By Susanne RustSusanne Rust E-MAIL Woman with rubella rode Freeway Flyer

6. Consumer Health Information Goals: 1.Become aware of sources of health information 2.Develop strategies for evaluating health news stories 3.Use health information resources to your advantage

7. Why Should You Care? 1.Appear informed 2.Save patients from harm 3.Might get asked socially

8. Consumer Health Information Sources Internet Print People Radio, TV Pamphlets, brochures etc Presentations

11. Trust and Sources of Health Information The Impact of the Internet and Its Implications for Health Care Providers: Findings From the First Health Information National Trends Survey Arch Intern Med. 2005;165:2618-2624. Bradford W. Hesse, PhD; David E. Nelson, MD, MPH; Gary L. Kreps, PhD; Robert T. Croyle, PhD; Neeraj K. Arora, PhD; Barbara K. Rimer, PhD; Kasisomayajula Viswanath, PhD Bradford W. Hesse, PhD; David E. Nelson, MD, MPH; Gary L. Kreps, PhD; Robert T. Croyle, PhD; Neeraj K. Arora, PhD; Barbara K. Rimer, PhD; Kasisomayajula Viswanath, PhD 64% looked for health info online in 2003 Physicians still most trusted source 64% looked online before consulting Doc

12. What are patients hearing/seeing? Internet ‘Top Health Stories’ Browse magazines

13. Case 1 You get a call from the daughter of an 87- year old patient with CHF and atrial fibrillation. She has heard that there is a recall on Digitek, which he is on. She wants to know if she should stop it.

14. Media Alert of Rx Danger Digitek, Vytorin, Heparin, Avandia Is it real? Does it apply to your patient? How significant is it? What alternatives are available?

15. Case 2 A patient saying that she wants to start Cymbalta, which she saw advertised on TV.

16. Direct to Consumer Advertising Explore patient thought process, ie. Is she depressed? If appropriate condition, what are options? –Non-Rx treatment –Rx desired med –Rx alternative –Offer to research/explore further

17. Case 3: Email from your niece, who is getting married this weekend “Hi John, I have a favor to ask -- and please know that if you say no, it's all right! But, recently I have been inundated with honeymoon UTI stories. We're going to Mexico, and, obviously, they do have doctors in Mexico, but we're a little worried about me getting an infection and not being able to get to a clinic as easily as we could here. I hate to ask, but I'm transitioning between doctors here, so I don't really have one who I think would call it in without seeing me... and we've hit crunch time, since I move home to Oshkosh on Sunday. So, would you be willing to call in a prescription for an antibiotic for me that we could take with us, in case I do get a UTI? Thanks!!!”

18. ‘WISDOM’ Acknowledge what’s true Try to educate about what’s not Refer to good sources

19. "Top Ten" Most Useful Websites For Health Consumers: by The Medical Library Association Cancer.gov Centers for Disease Control and Prevention (CDC) familydoctor.org : Eng/Span, pt ed handoutsfamilydoctor.org healthfinder® : taxpayer fundedhealthfinder HIV InSite Kidshealth® : user friendly, storiesKidshealth Mayo Clinic : extensive disease libraryMayo Clinic MEDEM: medical societies; iHealth RecordMEDEM: MedlinePlus (English | Spanish)EnglishSpanish NOAH: New York Online Access to Health: model for communityNOAH: New York Online Access to Health

20. Case 4 JS ONLINE TUESDAY, April 29, 2008JS ONLINE By Susanne RustSusanne Rust E-MAIL Woman with rubella rode Freeway Flyer

21. Health Insight http://www.health-insight.harvard.edu/ 10 Questions & Reasons for Asking (Click here for PDF file of the guide) (Click here for PDF file of the guide) 1. What is the message? 1. What is the message? Get past the presentation to the facts. 2. Is the source reliable? 2. Is the source reliable? Think about the quality of the information. Information comes from many sources, good and bad. 3. How strong is the evidence overall? 3. How strong is the evidence overall? Understand how this information fits in with other evidence. 4. Does this information matter? 4. Does this information matter? Determine whether the information changes your thinking and leads you to respond. 5. What do the numbers mean? 5. What do the numbers mean? Remember that understanding the importance of a risk requires that you understand the numbers. 6. How does this risk compare to others? 6. How does this risk compare to others? Put the risk into context. 7. What actions can be taken to reduce risk? 7. What actions can be taken to reduce risk? Identify the actions you can take to improve your health. 8. What are the trade-offs? 8. What are the trade-offs? Make sure you can live with the trade-offs associated with different actions. 9. What else do I need to know? 9. What else do I need to know? Focus on identifying the information that would help you make a better decision. 10. Where can I get more information? 10. Where can I get more information? Find the information you need to make a better decision.