Tuesday, March 10, 2009

Helping Patients Partner with Docs for Better Health

Don't get me wrong, I'm 100% for patients taking responsibility for their own health care and helping them do it. There is a lot being written nowadays about patient empowerment, patient's using the internet to do their own health care research, and promotions for systems like ours which encourage on line communication with medical professionals.

I've recently been talking with patient advocates who rightly articulate the failiings of the medical system in helping patients better manage their own health. And, to be sure, there are forces at work that make it difficult for the patient who wants to be more active, ask questions, and "be in charge" of their own health care.

But there is another side to the story. As a physician in practice for many years, there just simply aren't many patients yet who know what this picture looks like, and many others who simply don't want to, or are unable to, do it.

Realistically, in order to "take charge" of one's own health, one needs to be educated, internet savvy, have good communication skills and a high level of focus and determination. That defines about 5% or less of my patient population. The others seem either to desire or require a more paternalistic caregiving approach. But, maybe its just a blind spot in me!

Clearly, we can continue to advocate for this, and can work to make it easier for more patients to do it. But, in the meantime, patient empowerment and self management will continue to be a movement that tiptoes around the fringes of medicine.

Among other things, we need a national network of physicians who are able to communicate online with their patients and be reimbursed for that so that the patient can do some of their own research and check back for guidance and direction from time to time without having to wade through the morass of office visits each time they need to discuss or verify a medical issue with their doctor.

Your comments and dissenting opinions are always welcome.


Anonymous said...

Patient empowerment tiptoes at the fringe of medicine for the most common conditions.

But for a growing percentage of patients suffering from rare disorders active engagement in their care is now the norm and considered essential, not a luxury. Most of the innovation will keep on coming from the long tail of medicine for a while, until the main population really understand the value of being educated and engaged.

Dr. Val said...

The Surgeon General determined that the average American understands health information at a 6th grade level. The sad truth is that health literacy is poor for many - and good care requires assistance from medical professionals. I agree that there should be "lifeguards in the Internet swimming pool." It's not paternalism, it's just the reality of where people are. It would be wonderful if docs could be compensated to help people online. We may get there one day. eDoc is ahead of the curve!

Anonymous said...

I have mixed feelings about your post. On the one hand, I am tired of everyone saying, "Ma'am, you have to be more proactive in your care" when sometimes, the 'proactive' seems to entail doing their job for them. On the other, I do want to be as informed as I can and often research my issues. Then the credibility issue comes into question. When searching online, how do I know what to discard and what to take seriously? And yes, it is good that there is a place that can help you weed out the chaff, but who will pay this proposed compensation to docs? Will you bill that questioner's insurance? I foresee questions trickling to nothing if this happens. We would have to give way too much info online. And to be honest, if questions cost, I'm not asking. Professionals should be compensated, but who will pay?

Charles Smith, MD said...

Gilles: Agree, but even many of those patients who have rare diseases are not sufficiently educated, or have the necessary tools, not to mention a "with it" doc, to help them.
Dr. Val: Thanks. We're going to keep at it, trying to stay ahead of the curve.
Anonymous: You raise key questions that our "system" must answer. Clearly, it isn't going to happen for free, so someone will have to pay. I think it makes sense to have this be a component of health insurance and have evisits compensated just like office visits.

thanks to all for leaving comments

Kevin Kruse said...

Dr. Smith, given the coming "silver tsunami" and reduction in primary care providers or service people MUST become empowered patients. Paternalistic Dr. Welby can't exist and pay his (or her) bills. AND 100% agree that to be an e-patient requires knowledge and skills most don't yet have. But we can start simple and grow. Just getting all patients to be comfortable asking side effect questions or taking notes in the exam room could help.