Doctors fear of knowledgeable patient: new eHealth blocker
Successful outcome of care as well as patient’s relationships with physicians very much depend on the quantity and quality of information that flows between all the participants of therapeutic process. Despite wide spread of Electronic Health Record (EHR) in Europe, there is almost no country with its full adoption which would imply smooth data streaming across care including information exchange between patients, general practitioners (GPs) and specialists.
According to the EU Commission Benchmark deployment eHealth among general practitioners study less than 10% of the respondents claimed that patients ‘remote monitoring and consultancy are available in their practice. Training/education and consultation with other healthcare practitioners are used by 35% and 15% of GPs respectively”.
Apparently, eHealth that is healthcare practice supported by electronic processes and communication – is not yet ubiquitous in medical environment.
Is it only the technical issue (e.g., interoperability infrastructure) that prevents technology adoption in care processes? Or there are also mental barriers deeply rooted in medical culture that impede information sharing between all the participants of care including patients?
Pervasive mythology: patients are too sensitive (ignorant) to participate in care program.
At the dawn of European medicine, the “seclusion” of medical profession was the logical consequence of limited knowledge regarding human physiology and unpredictability of treatment outcomes. “Ars Medica” traditionally was the domain of those who exclusively possess the sacred knowledge of healing. Patients did not belong to this elite and were doomed to endure patiently all manipulations performed upon them. A patient basically had to blindly trust a physician. The less patients knew, the more faith they had.
Through centuries this stereotype has undergone some “modernization”, however it is still entrenched in medical community. Instead of a blunt statement that patients are ignorant by default it is now elegantly argued that they are too sensitive (or medical information is too complex for laymen) to face their health conditions.
Patients’ alleged fears, unwillingness to accept bad news are pushing physicians for additional unnecessary tests and examinations which are expensive and harmful. The logical conclusion derived: physician should filter information patients are receiving for their own benefit.
The advance of Information and Communication Technology (ICT) made health knowledge more accessible stimulating patients’ engagement in healthcare process, one of the triggers of the global healthcare system transformation. However, the old paternalistic mentality is still deeply rooted in medical culture. This perception often tends to block technologies that facilitate information flow between patients and care providers.
Thus according to survey provided by WebMD and Medscape :
“91 percent of US doctors believe that giving patients full access to their detailed electronic medical records could cause anxiety about results while 84 percent felt it would lead to unnecessary requests for more medical tests.”
Another survey conducted by SERMO, a large physician social network, found that the majority of doctors when asked, “Should patients have access to their entire medical record – including MD notes, any audio recordings, etc.?” two-thirds of 2,300 physicians said no. Nearly half of participants agreed that this disclosure should be given on a case-by-case basis. One doctor alluded to the old proverb that “ignorance is bliss” when it comes to telling people about their health. People don’t take bad news well.
“84 percent of patients think that technology should be used by patients to assist in the diagnostic process while only 69 percent of doctors thought it was a good idea.”
“89 percent of patients said they should be allowed to see all the notes their physician takes during a visit, however only 64 percent of doctors are in favor of sharing”.
While the discussion about the level of patients’ engagement in healthcare continues vehemently in media and medical publications, patients have already started with simple but important things such, e.g., doing their “homework” to make medical appointments more efficient.
The study of Nuance Communication among primary care in US, UK and Germany showed that
“68 percent of patients bring a list of questions to their appointment; 39 percent have checked WebMD or an online source in advance of their visit 20 percent are bringing data from outside monitoring devices to share with their physicians. When asked “how engaged do you feel in managing your own health?” 80% of the respondents said that they were “very engaged.”
At the end of the day, it is a patient who ultimately evaluates the quality and the outcome of care with his own health.
A proactive patient can be an invaluable partner in care journey and one of the best gate keepers for medical errors. He or she can track records circulation between various participants of the care process, ensure test results and follow ups, discovering communication gaps that can lead to errors.
“Up to 80 percent of serious medical errors can be attributed to miscommunication among medical staff while transferring patients” according to the Joint Commission, a group that sets safety standards and accredits healthcare organizations.
Typical situation many probably have faced: a nurse is coming with the anticoagulant injection required after the surgery. In 40 minutes enters another one with the same injection. Even worse scenario can happen: insulin injection several nurses in shifts were trying to perform to the same patient. Fortunately, a person was on guard and vehemently objected.
A survey in 7 primary care practices in North Carolina of English – or Spanish – speaking adults showed that 15.6% of surveyed patients responded that a physician had made a mistake, 13.4% reported a wrong diagnosis, 12.5% a wrong treatment.
The discovery of additional unreported errors is hardly welcomed in paternalistic culture. Thus a Canadian study on pediatric hospital admission found “that patients and their families are willing and able to report valid safety concerns, but only less than 3% of those had been identified by the hospitals’ own safety-monitoring program”.
The belief that patients are not capable to fully participate in healthcare process due their “emotional instability” leads to the logical conclusion that information coming from a patient may not be reliable. That explains the skepticism towards Patients Health Records (PHR). According to Medscape survey :
“Patient portals have achieved a high degree of penetrance into clinical practice, with nearly three quarters of physicians reporting their integration at their main practice site. However, the majority of physicians 53% said that they almost never use PHR to communicate with patients.”
Patients, again, have a different view. They reported to have lower availability of patient portals than physicians; however, are significantly more likely to using them.
Just 13% of patients reported “never using” a patient portal; nearly one half reported using a patient portal at least occasionally, and nearly 20% reported using one “almost always” or “always.
The concerns of “desacralization of medicine”, expressed by those who were used to justify authority by wearing the “white robe”, fears of losing influence on patients when the latter fully access their data ”, are unjustified.
Thus, the EHR Patient Impact study showed that those patients who are using EHR can better understand the treatment procedures and thus have more respect towards physicians’ efforts. 78% of the surveyed patients using EHR were satisfied with their doctors compared to 68% who did not.
So, who ultimately has more fears: patients struggling to do their utmost best to engage in care to cope with the disease or those medical professionals who are trying to restrict communication through technologies for the fear of error disclosure and credibility loss?
Patient’s engagement in care process is still a wishful thinking. However, health information accessible via internet, advance of personal health technologies stimulate people to proactively participate in healthcare process.
Patients are often more technical savvy than health providers, more willing to offer their partnership in care journey than health providers to accept it. To certain extent this is understandable: patients are looking for improvements, providers – not to lose what they already got.
Nevertheless, medical professionals should accept that they are dealing now with the new type of patients: more educated, more proactive to manage their health. The trend is sustainable, and it is good so. Just like educated reader can enhance the quality of literature, an educated patient can stimulate health providers to aspire for long life studying for the best outcome of care.
Is it not what we are all willing?