Monday, April 30, 2012

Collaborators: your providers, technology and you

[a shorter, modified version of this article was published in the KQED "State of Health" blog

Not very long ago a patient’s medical chart was considered proprietary information belonging to healthcare providers. Today, technology is catalyzing a major change in the relationship between providers and patients.

More patients have access to their data now that medical records are increasingly electronic. And more of them want access: patients who were told they could read their charts were 11 percent more likely to be “very satisfied” with their hospital experience in one survey. 

Does your doctor care?

To be sure, healthcare providers have a financial incentive to guide patients toward becoming more active managers of their own health: new Medicare reimbursement strategies will hold providers accountable for encouraging patient engagement.

But it is emerging technology that shapes much of the change. The responsibility to accrue and report data no longer rests solely on the provider. Patients may use mobile apps to keep track of blood sugar levels and lab results arrive in their’ email. So what does the emerging doctor-patient relationship look like?

“Patients, when they come to the doctor seeking health care, aren’t necessarily looking for 'raw data' – they have already looked it up online. Instead, they are looking for meaning,” wrote Bay Area family physician Dr Robert Rowley. Rowley is also medical director of electronic medical record company Practice Fusion.

“The role that physicians play is shifting… (to) somewhat of a coach; a trusted advisor,” he said in a recent interview.  A patient may want to discuss their medication, for example, if new or dangerous side effects were recently reported in the news. In a situation like that “my role is more of an interpreter,” Rowley said in an interview.

Best Practice

Rowley believes that the best care he can deliver today includes helping patients sort through and understand the “chaotic array of overwhelming data” as it relates to each individual’s health. After doing a web search on their diagnosis, he said, “a patient will say ‘help me understand this; help me find meaning.’”

A recent study demonstrates the effect a personal doctor-patient exchange can have – not just on patients’ experience, but on their health outcomes. Los Angeles cardiac patients who had the opportunity to see their heart scans -- clogged arteries and all -- were more likely to undertake cardiovascular risk reduction measures such as taking losing weight.

What's a doctor to Do?

With findings like these the image of the didactic, authoritative physician is giving way to that of a coach or even a collaborator, albeit one with domain expertise in health science. The authors of a recent NEJM editorial Goal-Oriented Patient Care wrote “The clinician needs to explain what is possible and negotiate potentially achievable goals with the patient. Then the clinician should provide a treatment plan, encouragement, and advocacy to help the patient…” 

When patients are in acute distress — perhaps unconscious or incapacitated after an accident —treatment may still start without much input from the patient. But the situation is very different for patients with chronic conditions. In those cases, because patients control their diet and decide whether or not to take their medication, they largely control their own health outcome. 

Because more patients are living longer with chronic disease and because of changing financial incentives, the new face of care is definitely more personal. “Through a better understanding of the patient’s story, we can begin to see how we can truly help patients,” wrote family physician John Krueger in his oft-cited editorial The Patient Will See You Now. (Journal of Participatory Medicine, December 28, 2011)

In an April 9 interview, orthopedic surgeon and new media enthusiast Howard Luks said he tells physicians “this is about relationships. I tell them that this is about stories. We treat patients. We don’t treat x-rays or MRI findings.” Luks is is associate professor of orthopedic surgery at New York Medical College.

But technology has a substantial influence on how the relationship changes, as with the cardiac patients who committed to taking their medication not because the doctor prescribed it, but after because the doctor showed them their clogged arteries.  Luks said

Patients are researching online. They’re researching and diagnosing themselves through WebMD and then they’re searching for physicians who have expertise in that particular area.

Physicians are starting to realize that it helps us regain or recapture those relationships that older physicians had with their patients. They knew their patients…They knew their patients had a recent baby, or that they just bought a new house, that they moved, or they got a new job, or got a puppy, or whatever. Having a relationship with your patient in that respect for some is special and meaningful.

Much of that information is shared now via social media, and the rarely reticent Luks said it’s imperative to get involved. He tells physicians “If you choose not to engage (with new media), then I feel that is to ignore your own relevance as a healthcare practitioner.”

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