As a primary care doctor in San Francisco and Silicon Valley, I have been searching for the holy grail of patient engagement for over 15 years. My journey began with alpha-numeric pager and a medical degree. I shared my pager number with my patients along with a pledge to call them back within 15-minutes, 24-hours a day. My communications evolved into email and texting, with the predicate that by enhancing communication, I could carefully guide my patients down the byzantine corridors of healthcare – with a high probability we could avoid mistakes – if they would agree to share the ownership of their treatment plan. My life’s work has been where the rubber meets the road; where doctors interface with patients: office, hospital, home or smartphone.
Technology has washed over almost every industry and transformed it, radically. Healthcare is on the precipice of destiny. The wave is here.
Over the past three decades healthcare has lurched from one existential crisis to another; often manifested by an acronym solution: HMO, ACO, PCMH, P4P, PQRS; each a valiant attempt to reign in costs and solve for aligning incentives. However, we can’t have hospitals, doctors, health systems and payers accountable to healthy outcomes if the 300,000,000 people (patients) are not paramount to the equation.
If you haven’t been paying close attention, ‘patient engagement’ is a white-hot topic in healthcare these days. It wasn’t sexy 5 years ago. In fact, at the keynote speech at HIMSS 13 (the national Health IT conference), it was announced that the “The blockbuster drug of the 21st century is Patient Engagement”.
A recent report from the Commonwealth Fund places the US last amongst developing nations in healthcare. For self-loathing Americans, Christmas couldn’t have come earlier. Raptures of ecstasy were oozing from pores of self-satisfying righteous indignation.
Anyway that, and the shakiness of the metrics for another time.
For now I will focus on one of the conclusions. In analyzing the Britain’s high score on the management of chronic conditions the authors attributed this care coordination to the widespread adoption of health information technology.
That’s like someone saying Chinese food is tasty because chopsticks are widely used.
Sigh! Like quants so fastidious about decimal points they’ve missed the overall point.
Where do I begin?
I’ll start with Mesozoic era, i.e. before health IT was thrust upon Britain’s general practitioners (GPs). Then you had GPs and specialists. In Britain GPs are not optional ornaments for the mantelpiece that you pick up from Ikea when you feel like.
No, they are rather compulsory. Everyone needs to be registered with a GP. Ok, you don’t get fined if you don’t have one, but if you want a referral to a cardiologist you need to see your GP which means you must have one to see in the first place.
Read my lips: no GP, no cardiologist.
If your cardiologist thinks there is nothing wrong with your heart and your problems are supratentorial for which you need to see a shrink, then he must write a letter to your GP asking that he might consider referring you to the psychiatrist. The specialist can’t send you directly to another specialist, bypassing your GP.
Most physicians agree that we have an ethical obligation to help educate our patients about what’s going on with their health, but what does that look like in a world overwhelmed with digital health information? And how do we budget appropriate time when we’re already struggling to balance shorter appointment times, more documentation requirements and busier clinic schedules?
It’s estimated that 72 percent of patients get a majority of their health information online. With an abundance of biased and incorrect information on the internet, our responsibility as physicians has evolved from simply teaching patients about their health conditions to now include educating patients on where and how to find and identify reliable health information.
This premise goes back to why I use social media. We have a responsibility to share, or at the very least be cognizant of, reliable health information in the realm where our patients seek it. In the olden days that looked like an exam room; today it looks like a Google search.
Here are four ways to efficiently help ensure patients have the resources they need to find reliable health information, despite cramped clinic visits and time constraints.
- Ask: How can you possibly know where patients find their information if you don’t ask? I have patients come in with birth plans all the time and quite frequently they’ve printed them out from a website with little-to-no additional research into the (often very specific) things they’ve requested. You can’t possibly know or understand their views unless you ask.
- Take 2: I understand how limited our time is. I’m a resident with a busy clinic and short, often over-booked appointment slots, but taking two minutes to discuss reliable health information with your patients has great potential for improving patient care and decreasing un-needed visits and calls.
- Prep: Have pre-written, condition-specific information for your patients and include curated links to additional reliable information for those who may want it. It’s as simple as a “dot-phrase” on most major EMR systems or a copy/paste file you can quickly email or print.
- Encourage: Encourage your patients to take control of their health by being informed. Encourage them to ask questions and explain things back to you, so you’re certain they have a grasp on it. Encourage them to share what they’ve learned in their searches.
Danielle Jones, MD is a a fellow of The American Resident Project, where this post first appeared. Danielle went to college at Texas A&M University (Gig ‘Em Aggies!) and completed her medical school at Texas Tech. Dr. Jones is interested in fertility medicine, social media and health technology. Currently, Dr. Jones is an Ob/Gyn resident in Texas, where she lives with her husband, twin baby girls and three crazy dogs