Family Medicine Vital Signs

    By Kyle Bradford Jones

“Patient-centered care” has long been a rallying cry by patient advocates and many health care providers. Indeed, this is a very important notion that is often neglected by many in the health care industry. For those who have ever been a patient, you know how bad this can be, and how frustrating it is for many of those we treat. Finding a doctor you like who takes your insurance, being put on hold when calling to make an appointment, waiting in the waiting room for 45 minutes after filling out the same insurance and HIPAA forms that you have each of the last 10 times you’ve been seen at this clinic, waiting in the exam room for another 10 minutes[1], seeing your doctor for 10-15 minutes so that you have to come back and do it again if you want all of your questions addressed, finding out your test results in a reasonable time with an accompanying explanation, trying to make sense of the multiple medical bills you receive for only one clinic visit—and this all comes only if you actually do have insurance and access to care. These aggravations even come in addition to the experienced illness itself. Unfortunately, patients are often the main ones to get lost in our current system.

Health care in the United States is the least efficient and poorest consumer-centric industry in the developed world. The system has evolved in piece-meal ways to create such a mess of regulation, structure, payment, and care so as to leave the patient in the middle, confused and unsatisfied. No one would design such a system from scratch, but it is not going to change in huge strides anytime in the near future. Patient-centered efforts in recent years have made big strides, for example through expanded patient access to care-team members through electronic medical records, increased focus on assisting individuals to navigate our complex system, and health care entities responding more to patient feedback. But even current efforts to put more emphasis on the patient is done so within the framework of a broken system, leaving the patient in relative anonymity. The irony is deafening!

Working around the edges of how we provide care will not solve the problem; a revolution is coming from patients. Eric Topol, a Cardiologist and author of two fascinating and eye-opening books The Creative Destruction of Medicine  and The Patient Will See You Now, speaks of how technology is being, and needs to be further, leveraged for the patient to get what they need, when they need it. This goes beyond current delivery “breakthroughs”, such as telemedicine for example, but goes to full democratization of medical data where “the patient becomes the Chief Operating Officer (COO)” of their own health and physical information. For example, he talks of smartphone apps that are already in existence that produce and analyze a patient’s cardiac rhythm strip, apps that can run hundreds of routine lab tests with a drop of fluid placed on a phone attachment, and can even digitize breath to detect cancer, all without paying a co-pay or seeing a physician. Such opportunities provide a plethora of do-it-yourself (DIY) possibilities for immediate medical care. Dr Topol also talks of patients having full access to their medical records, to lab results, to genetic information; all of this does, after all, belong to that individual. He speaks of a time when patients will be the repository of their own information, significantly changing the role and definition of primary care going forward.

There are potential safety concerns with many of these opportunities. There are concerns of how people may interpret (eg misinterpret) the results of DIY testing. There are concerns of loss of the physician-patient relationship. There are economic concerns for those working in health care. These are all valid concerns. But there will always be a need for physicians to act as health coaches and assist the patient with necessary treatment decisions.

There is obviously a limit in resources for many such breakthroughs. Not every person has a smartphone. There are not enough medical providers to do a home visit for every individual, or who can quickly respond to the questions that arise from a person’s home laboratory testing. Many patients don’t want to, or simply won’t, take control of their own information. Those health care workers ensconced in the current system will likely fight against any significant change to the status quo. For many, transforming the edges of our care system to increase patient-centeredness may be the best we should shoot for. The mindset of the generation X and millennial generations, however, tends to be more in line with Topol’s vision, and many of them will simply not tolerate receiving care in our current inefficient system.

Change is hard, it always has been and always will be. Physicians will have to leave their comfort zone. Payers will need to be more creative. Health care organizations will have to completely change their mindset and profit-structure. Most won’t like it, but that’s why they call it a revolution. Many will complain that such a dramatic increase in technology will degrade the human aspects of medicine, causing us to compromise the soul of healing. But haven’t we done so already?

[1] The combined 55 minutes of waiting in this example would STILL be better than the average wait time of 62 minutes for a physician in the United States!

Kyle Bradford Jones, MD is a Clinical Instructor in the Univ of Utah Family Medicine Residency. He can be reached on Twitter @kbjones11.  You can read more from him at kylebradfordjones.com.