Share the post "What do you already know before you consult your patients?"
I tried this experiment today- given only a person’s name and address from a phone book what can you find out about them from the internet?
Location and state of home: Using Google street view I can see where the person I selected lives, or at least what her home looked like in May 2014. The house is a bungalow with a double garage, the garden is unkempt, and litter is strewn on an overgrown lawn. The fence with the neighbours is in a poor state of repair and has pieces of junk leaning against it. There are multiple old cars in the driveways or on the grassed areas of all the homes along the street; this suggests that there are many youngsters over the age of 18 living nearby. The neighbour’s bin, which is on the kerbside, is full to overflowing, so it looks like the photo was taken on bin day. There are no children’s toys in the garden or on the lawn or anywhere in neighbouring yards. I can see a car on the driveway and Google has not blacked out the number plate. It is a new but cheap and small hatch back. At least one neighbouring home has a ‘for rent’ sign outside it. From Google earth I can see that none of the homes in the immediate neighbourhood have a swimming pool and that this home occupies most of the plot on which it has been constructed. From Google maps I can work out that she lives 10 minutes drive away from a doctors clinic, 11 minutes from the largest shopping centre, 7 minutes from the railway station (39 minute walk), 6 minutes from various fast food outlets and 15 minutes walk from the leisure centre. The house is not within a short stroll to any major amenities; there are no shops or cafes nearby. There are no bus stops on the street.
From Realestate.com.au I can see that this home sold for over $300,000 in 2011 and that it occupies 500 square meters of land. The estate agent described it thus:
A good sized home with 4 bedrooms, 3 separate living areas, a huge kitchen meals area complete with bench space, 5 hotplates and dishwasher as well as wall oven. Ducted heating, reverse cycle air con, 2 bathrooms (ensuite to master) and a 2 car carport as well as a large driveway complete this house. Catching a train to work? Well, you are only 5 minute drive to the town CBD and station. Schools and buses are nearby and petrol station around the corner for your fuel, milk and bread will give you convenience plus.
I can see inside the house and note that there is Jacuzzi in the back yard. The real estate site tells me that families with adult children occupy one in five properties in this area and that one in ten people living here are retirees. According to domain.com.au sixty nine percent of home locally are owner-occupiers and the average age of people here is 40-59. If this person has a mortgage they are likely to be paying just under $600 per month or if renting $350 per week. Manufacturing is the largest employer in the area. As this person is female, she may be a widow or a divorcee.
Facebook: I also note on Facebook that there is someone by the name of this person from this town. I couldn’t be sure if this is the same person. It is unlikely as the person on Facebook looks quite young and the vintage of the name is more likely to be of a person in their 40s. Google didn’t have any information on this person and this suggests she doesn’t hold a senior position in employment locally and hasn’t been in the news for any reason.
Would any of this information help in a consultation with this person as a patient?
What I already know leads me to suppose that this person is working, probably locally and has a modest income. She probably lives with other adults, possibly her children and moved into the home in 2011 when the property was sold. Given the poor state of the garden it is likely the home is rented. In addition from her medical records I will know her age, her occupation, her current medications and any significant past medical history. That’s even before I set eyes on her.
The information above will be of limited value if she presents with a minor self-limiting illness, except that she may be very keen to get a medical certificate because she will not want to risk losing her job. She probably has a modest income and may be at risk of work related stress. She may also find it difficult to attend the clinic during office hours unless she works close to the clinic. This is unlikely. If in middle age she has a chronic illness and she requires to attend the clinic regularly or she needs to go to a gym four times a week then her address is going to be a significant risk factor. Secondly the cost of medications and the availability of quality food may be a challenge to an individual living in this location. Matters would be worse if she can’t drive for any reason. Some research our team has just completed suggests that people who are at increased risk from the adverse consequences of diabetes, and possibly other chronic conditions, tend to live in close proximity to one another. Therefore if my computer was to alert me, in addition, that this address is in such a hot spot area, then the information I have freely gathered from the internet and from my own clinic records before I see her may offer useful insights into my patient’s circumstances. It may be that we would have to work hard to find someway to help her cope with the rigors of a demanding medical problem should it exist. Of course all of this is speculation, the best thing I can do is to ascertain the whole truth by giving her my undivided attention when she attends. Nonetheless if I didn’t have to spend a lot of time playing detective I would be much better placed to understand her needs.
Picture by Duncan Hull