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  Digital Doctoring 101:
Top 10 Tips for Type 1 Cyberdocs

As more and more providers and patients begin to communicate online, a clinician's 'screenside manner' may soon become an essential medical tradeskill. Guidelines for Type 2 provider-patient e-mail (electronic communications between doc-providers and their patients) are already becoming well-established (see 'Danny's Clinical Use of E-mail Page' in this issue). But some Net-savvy docs may choose to offer Type 1 coach-consultant services as well. We asked veteran online health producers Alan and Cheryl Greene of the award-winning pediatric site drgreene.com what advice they would give to aspiring Type 1 cyberdocs--and boiled their comments down to the following guidelines.

1. There's no better way to learn about online health.

Offering Type 1 doc-consultant services will put you at the epicenter of the online health revolution. You'll learn so much about the new, net-savvy health consumer, including many things that you would probably never learn in the clinic. People want in-depth explanations ("Don’t just tell us what to do--we want to understand."). And they want convenience. ("We don’t want to have to take time off from work and sit in a waiting room to get a few moments of your time. We want our questions answered in the middle of the night when we're dealing with the problem."). And in addition to explanations, they want a personal, empathic connection. Additional benefits for providers: Some of the patients you help online will become your Type 2 patients. And the things you learn as a coach-consultant should be very good for your medical career.

2. If you do it right, you'll be flooded.

We put up our site expecting a trickle of interest. Instead, we got a fire hose, a flood. We were surprised by the numbers, the geographic spread, the passion, and the intimacy of the questions we get. So think carefully about what you hope to offer, and watch your visitor feedback to evaluate how you're doing. Your visitors will expect a lot and will let you know in no uncertain terms if you disappoint their expectations.

3. Don't try to do it all.

Better to do a few things well than to offer a site that's a carbon copy of a hundred others. Personalize your site, pursue your special interests and abilities, and to focus on the areas in which you have the most to offer. A targeted audience of sophisticated self-helpers for a limited range of concerns will help you deepen your own understanding of these chosen areas.

4. Don't try to keep your visitors 'inside the walls' of your own site.

Send people to the best resources you know for their concerns. Don’t try to trap them inside the walls of your own Web site. There's no faster way to lose a visitor's trust.

5. Be clear about what you're offering.

Will you answer all e-mailed queries or only selected questions? Will you respond to all visitors or only those from your local area? You can set things up however you wish, so set reasonable limits, establish a clearly-stated policy on how you will respond, and follow through on the commitments you make.

6. Don't try to do online with Type 1 patients what you would do with Type 2 patients in the clinic.

There are lots of things you routinely do in the clinic that you shouldn't try to do within a Type 1 doctor-patient relationship. Don't try to diagnose your visitors' medical problems online. Don't prescribe online for Type 1 patients. And above all else, don't try to tell your Type 1 visitors what to do. Answer their questions, share your knowledge, point them to the best resources, and leave the final decisions up to them.

7. Work cooperatively with your visitors' local Type 2 doc-providers.

Encourage your visitors to use your services as a supplement to enrich and expand their relationships with their current Type 2 docs. And be careful not to jump to any hasty conclusions about the care they provide. And if you hear from patients who are upset with their local providers, remember that you are hearing only one side of the story.

8. Work cooperatively with your visitors' online support groups.

Be supportive of your visitors' relationships with their online support communities. Such groups can provide their members with invaluable support and information. Establish good relationships with the best online support communities and patient-helpers in your areas of interest. Offer to serve as a consultant to online communities, and when you do, beware of medical arrogance: be real, be yourself, and be willing to serve as just another member of a group working together for the common good.

9. Think before you type.

Remember that there are real people on the other side of your computer screen. Use the same kind of language you would when e-mailing a friend--vivid, everyday, informal, respectful language. Don't make any assumptions. If someone says "My son has measles, what do I do?" don’t assume that this is the actual diagnosis. You can't know that. And always remember, "First, do no harm." In some cases it may be best not to share certain types of information, e.g. when a depressed person asks, "How much Valium would it take to kill someone?"

10. Let your end-users teach you how to be a good Type 1 Coach-Consultant.

The ultimate payoff for Type 1 cyberdocs is the realization that our patients really *are* our best and most devoted teachers. You'll learn things from patients online that you'll never learn in the clinic. Above all else, our Type 1 patients have taught us that the secret of caring for the patient lies in caring for the patient. If you don't think you have something to learn from your e-patients, if you don't really care, or if you're not really interested in making a personal connection with your e-visitors, you may might be happier in another type of practice.


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