Are Patients Becoming Day Traders?

Let me say first that I am a practicing primary care doctor who is very much focused on patient centered care. Though I cannot go back to being a patient who is unaware about what a doctor does, the terminology she uses, or what the importance of certain test results are, I can empathize with the overwhelming amounts of information, challenges, and stressors patients and families can have in navigating the healthcare system to get the right care. This is the reason I wrote my book.

However, over the past few months I’ve noticed a particularly disturbing trend. Patients are not consulting doctors for advice, but rather demanding testing to force diagnoses which are not even remote possibilities. A little knowledge can be dangerous particularly in the context of little to no clinical experience. Where many patients are today are where medical students are at the end of their second year – lots of book knowledge but little to no real world experience.

More patients are becoming the day traders of the boom. Everyone has a hot stock tip, only now it is “be sure to ask your doctor for this test” or “ask for this medication because it is the only one that works”. Everyone is an expert with his own suggestion on what should be done. If a medical expert, like a doctor, weighs in and does not agree, then there is a set of patients and doctors who begin to argue that these doctors are out of touch or arrogant.


I certainly agree that many doctors frown upon their patients doing research online. I disagree with my colleagues. I’m all for patients being partners in their health as long as when they research they also go to reputable websites, like the Mayo Clinic or Kaiser Permanente, and also give equal weight to my medical advice. Ultimately, patients should be more knowledgeable about their health and engage not only with doctors, but with family and friends as health does not begin with doctors, but in households and communities. However, today’s world is increasingly polarized due to the ability to gather information and find opinions of like minded people quickly and easily. A patient researching information can unwittingly blind themselves into believing that a medication, a treatment, a test, or a diagnosis is the only one that explains their symptoms.

Many of the patients who Google their symptoms, do cursory research, and are so convinced that they have a particular problem and need a particular solution are the group I worry about the most. They want to see a specialist for a problem adequately handled in primary care. They want a branded medication when a generic medication works equally as well. They want CT scans and MRIs for migraine headaches or sprained ankles when a generation ago, doctors and patients believed diagnoses based on common sense. They decline vaccinations for preventable illnesses like pertussis, whooping cough, because they are healthy and don’t want “chemicals” even though the state they live in had the worst outbreak of pertussis since 1955.

With more Americans paying for their health insurance through higher copays for doctor visits, medications, imaging, and treatment, it is understandable that they want more information and are seeking it. What is particularly troubling, however, is much like the day traders of years ago, many are bypassing experts for some advice and consultation. Indeed a decade ago many ridiculed financial guru Warren Buffet for failing to understanding the new world and being a dinosaur. Principles of the past no longer applied. (Of course, financials principles remained – you do need to make money to be an ongoing company). As a front line doctor, I’m seeing the same phenomenon in health care. Doctors still clinch the right diagnoses by talking to and then examining patients. Skipping directly to lab work or imaging often gets the wrong answer. Sometimes there is no test or imaging study that can get the diagnosis. Yet somehow if asked, patients retort I don’t have money to see you, I’d rather spend the money on the test or medication, so can you order it?

Like the day traders of a decade ago, these individuals have the illusion of control or mastery. Only later do they discover when the results are normal and the problem remains that being an expert and having the ability to take in information, process it, and then come up with a plan is harder than it looks. (Dr. Lisa Sanders, whose New York Times series Diagnosis was the inspiration for the television show House, M.D., has excellent patient cases which challenge the public on getting the right diagnosis).

That is not to say that there are not patients who are indeed experts. The individuals who are leading the empowered patient movement often know a lot about their diagnoses and treatment options and have mutual respect from their doctors. Enlightened doctors realize that they cannot know it all. I would hope and believe that empowered patients also recognize this inherent problem in themselves as they also cannot know it all either. It is the rich discussion and collaboration which occurs when both groups are on relatively equal footing in terms of knowledge that the answers, solutions, and treatment plans are far better than if only one side or the other led the conversation. Those patient experts probably can and have identified their condition when they read it in Dr. Sander’s column.

Who would have guessed that the day traders of the past would now appear as patients? Funny and sad how history repeats itself. The difference is unlike money the stakes are significantly higher when it comes to health.

Not sure what to do when you have a problem? It’s ok to research online, but then have an open mind when talking to your doctor. If your doctor does not want to listen, then find another one. Be sure, however, as you research and listen, that you do not become a day trader. Indeed, if not done correctly the consumer driven health care movement has the potential to be equally as problematic as the retirement planning and investing movement a decade ago.

Davis Liu, MD, is a practicing board-certified family physician and author of the book, “Stay Healthy, Live Longer, Spend Wisely – Making Intelligent Choices in America’s Healthcare System.” Follow him at his blog, Saving Money and Surviving the Healthcare Crisis or on Twitter, davisliumd. This piece was initially featured on Health 2.0′s sister blog, The Health Care Blog.

2 Responses to Are Patients Becoming Day Traders?

  1. Sherry Reynolds @cascadia says:

    Dr Liu insightful post highlights some of the challenges that patients face as they are increasingly being asked to act like health care consumers in a system driven more by money then by outcomes - as well as the opportunity to include them as co-creators of their own health.

    Perhaps instead of viewing them as “day traders” we look at them as investors in a health care system where they don’t have equal access to capital or information but are trying to invest their limited resources based on the very powerful economic forces that are appealing to them.

    It is easy to identify the few patients who are over-educated and/or simply scared and forget that the real problem lies in the vast majority of patients who only get the correct care half the time, those that forget 80% of everything their are told when they leave their visit and get the rest wrong half the time. The 1/3 who don’t get an RX filled, patients in systems that only allow 8 minutes for a chronic condition or the 20% who lack any access at all to ongoing care. (Does Dr Liu see those at Kaiser?)

    Rather then looking at the “day traders” of health care as a problem they just might be a symptom of a much deeper systemic problem of treating health care like any other commodity compounded by the very typical Western value of self determination?

    • I would agree that the phenomenon of patients being day traders is not what they want but is in fact an increasingly reality due to how the healthcare system is structured in the US with more cost shifting via higher deductibles and copays.

      I would also note that members at Kaiser Permanente are not in the same group as most Americans in that the vast majority get the correct care nearly all the time, have access to their electronic medical record 24/7 via, and an integrated health care system where doctors, staff, health plan, and hospitals work together to keep them healthy.

      As noted from the link above - “Of the 37 clinical measures in this report card, Kaiser Permanente has the top score in 29 of them,” said Robert Pearl, MD, executive director and CEO of The Permanente Medical Group. “We provide care that is coordinated and technologically advanced — and we are having a dramatic impact on our members’ health. We have lowered the chances of our members dying from heart disease 30 percent below the community around us, reduced mortality for patients admitted with sepsis by 50 percent, and dramatically decreased the risk of our members dying from cancer compared to the rest of the nation.”

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