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Seeds for Change
In a healthcare system that has for so long encouraged patients to be passive, how can putting them at the center of decision making benefit the system as a whole? One advantage is better outcomes. The “National Healthcare Quality Report, 2009,” produced by the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality, states that patient-centered approaches improve patients’ health status, lessen symptom burdens and “can reduce the chance of misdiagnosis due to poor communication.”
In some cases, providers already see the potential value of collaborating with patients on healthcare options. For instance, Miller points out, “Three dozen hospitals and clinics—including Fox Chase Cancer Center, Kaiser Permanente and the UCLA Medical Center, in conjunction with the Foundation for Informed Medical Decision Making—have recently launched clinical demonstration sites with the mission of amplifying the patient’s voice in healthcare decisions. The patients-as-partners model is sometimes referred to as Health 2.0.” Such shared decision making, Miller asserts, could save billions of dollars annually, because studies show that it leads patients to choose conservative and less costly treatment options more often. “For instance,” he continues, “when patients with herniated discs were shown a video explaining that similar outcomes could be expected whether they have surgery or not, rates of spinal surgery at Dartmouth-Hitchcock Medical Center dropped 30 percent.”
Time management is another consideration. As Hallisy, who is a dental practitioner, notes, “A patient who comes in prepared, engaged, aware of his or her symptoms and ready to ask questions makes for a much more timely and efficient office visit.”
“It’s true that the majority of my colleagues consider themselves in the old camp, where it’s up to us to give the orders,” says Charles Smith, a long-time family physician and founder, chairman and medical director of eDocAmerica, a Web-based provider of doctor-consumer consultations online. “My personal view is that the only way patients can obtain an optimum outcome is to take responsibility for their own healthcare. We’re the doctors, but it’s their health, their medication, their lifestyle.”
Some studies show how healthcare consumers already demand change. “Top 10 Health Industry Issues in 2010: Squeezing the Juice Out of Healthcare” from PricewaterhouseCoopers, states, “Patients want better access to care, and jams in the delivery system are prompting them to seek quicker and more convenient treatment outside physicians’ offices and hospitals.”
Such options are not merely on the horizon—they are here, and flourishing, today. In 2009, Merchant Medicine’s “Retail Clinics in the United States” report stated, “Retail health clinics have increased nearly 20-fold since 2005 and are beginning to expand the scope of their services to include management of chronic diseases such as asthma, osteoporosis and diabetes.”
Moreover, Kathryn Gohman, chief executive officer of the Patient Advocate Group in Dallas, Texas, points out, “current media coverage of healthcare issues has resulted in opening new doors. Involvement by large companies such as Wal-Mart, which plans to have 2,000 clinics in its stores in the future, will spur others to new ideas.”
Still, no simple strategy empowers all patients. No obvious steps can magically make every treatment safe and effective for every patient in all scenarios. No technology will prevent all medication errors. Nothing will ever make the Internet or any other means of electronic communication infallible. In fact, medical challenges sweep across every aspect of human health and the role of patients in it. Still, these very challenges set the bar for future healthcare. Although the bar for improved health sits high, life and death literally depend on getting over this obstacle, and it cannot be scaled alone. As Miller says, “In the end, better treatment depends on improved participation from providers and patients.”
Only such improved participation—engaging a wider range of participants, including pharmaceutical companies and regulators—can rebuild the public’s trust in the world’s overall health enterprise.
Molly Knight Raskin contributed to this article.
Patients and their advocates have an unprecedented amount of information sources available to them. The nature and degree of proactive engagement in treatment options among consumers can impact the regulatory, discovery and business aspects of health.
© 2010 Scientific American,
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