Patients engagement: what does the buzzword mean
Patients engagement is almost a buzzword. But the meaning varies depending on which side of healthcare system you belong to. The fundamental reason is that patients and physicians have similar but not identical goals.
The task of the physician is to dismiss a patient in a stable condition in compliance with clinical norms and compensation plans. For example, if one’s haemoglobin is low, it should be treated with ferrous sulfate or other iron containing medications. Similarly, if the glucose concentration in the patient ‘s blood is above the norm, a patient will receive the increased dosage of insulin. This does not necessarily mean the person should be healthy, but the results of corporal examination are meeting the approved norms. So, home you go!
Patients have only one goal, and this is to get rid of the illness, whatever it takes. Hence, they are immediately stepping into the care process after getting a preliminary diagnosis.
Normally they start with surfing social networks and online sites to verify diagnosis. Such efforts are not without reason. Diagnostic errors or a failure to provide an accurate and timely explanation of the patient’s health problems or communicate this explanation to the patient affect approximately 5% of adults in outpatient settings each year in high-income countries. Over half of these errors had a potential for severe harm. Therefore, six out of ten Europeans go online when looking for health information. 90% of the survey Europeans said that the Internet helped them to improve their knowledge about health-related topics.
Medical establishment, however, is much more sceptical about patients going online. While “84 percent of patients (according to the Medscape survey) think that technology should be used by patients to assist in the diagnostic process, only 69 percent of doctors thought it was a good idea.”
In reality, medical professionals are not as much against patients going online, e.g., populating data into EHR, but against going online independently without the senior guidance.
Thus, in 2012 Sweden launched an eHealth patient portal, which allows patients to access their medical records over the Internet. However, medical community was strongly opposing the initiative. The conclusion runs that negative attitude of physicians towards PHR (patient’s health record) was mostly explained by the changing positions between the physicians and the patient: the latter can drive the process, which reduces the physician´s ability to guide the patient.
Patients are keen to discover innovative methods of therapy. They naively presume that their life and health are worth the benefits of modern science and technology, thus ready to promote their advancements.
A survey of 2,125 PatientsLikeMe members showed that 94% would be willing to share their data to help doctors improve care and 92% would be willing to share to help researchers learn more about their disease.
Healthcare innovations are also promoted through consumer technology. Think about a portable mobile ECG from AliveCor that can measure one´s ECG 24 hours under the normal conditions, Sonde Health smart phones with biomarkers that analyse voice pitch and harmonics to identify ranges of disease including cardio failure, depression, cognitive impairment or Parkinson’s disease. Avalanche of smart garments, jewelry, watches are waiting to be used to assist ubiquitous diagnostics.
Doctors, on the contrary, tend to stick to conservative methods out of pragmatic reasons.
Thus, according to Pew Internet & American Life Project study “nearly one in three doctors said they withheld medical treatment from patients if the services weren’t covered by health insurance”.
No surprise that noncompliance is growing. Patients simply do not believe that they are getting the best medication treatment. Thus, according to Medscape surveys, 50% of patients fail to take their medications as their doctors direct.
Patients attempt to discuss with the physician their health issues sharing skepticism and concerns. But instead of an indifferent professional, they prefer a friendly interlocutor. Chances, however, are slim.
A study in the Annals of Internal Medicine found that patients were allowed to finish their “opening statement of concerns” in only 23 percent of doctors’ visits. A more recent analysis found patients speak for an average of only 12 seconds before being interrupted by resident physicians.
Doctors are usually reluctant to be engaged in informal conversations with patients, especially when the case is complex, under the pretext that others are urgently waiting for their assistance.
One of the honest statements: “When it comes to rare conditions, most doctors don’t have a clue as to what they are dealing with because they have never encountered or studied this particular case”. So why to give patients information that can provoke more questions to which there is no answers?
If patients are not getting enough response from their physicians they turn to the second opinion.
A study discovers that “nearly 9 in 10 people who go for a second opinion after seeing a doctor are likely to leave with a refined or new diagnosis from what they were first told”.
Another survey conducted using records of patients referred to the Mayo Clinic’s General Internal Medicine Division over a two-year period, “ultimately found that when consulting a second opinion, the physician only confirmed the original diagnosis 12 percent of the time. Among those with updated diagnoses, 66% received a refined or redefined diagnosis, while 21% were diagnosed with something completely different than what their first physician concluded.”
With such a divergence of medical opinions whom shall a patient trust? More and more people are seeking advices from their peer patients visiting social networks.
Indeed, a survey of 1,060 U.S. adults by PricewaterhouseCoopers on healthcare and social media showed that 42% of consumers have used social media to access health-related consumer reviews (e.g. of treatments or physicians). Nearly 25% have posted about their health experience, and 20% have joined a health forum or community.
Patients are already fully engaged in healthcare. Medical establishment, however, tends to ignore their efforts largely because those are independent initiatives. Let us not forget that the Latin word for “doctor” is “docere” meaning “to teach”. Will a teacher allow a pupil to undermine his role?
So why at all physicians give themselves a burden to discuss with patients their health conditions? The main goal of a physician in involving patients in the process of care is to obtain his\her consent and formal signature and thus to delegate responsibilities.
However, field of medicine is still largely the realm of opinions driven rather by administrative or financial reasons than hard facts, which adds a big subjective component to a seemingly scientific discipline. This fact alone may cast doubts about the scientific correctness of doctors´ decisions.