3 Reasons For Becoming More Patient-Centered

Health care professionals are a cynical lot.   We joke about the “fad or buzz word of the month”…usually some vague concept heralded by the powers on high.   Our job is to promote the idea…knowing full well that the “next big thing” is probably right around the corner.

Take “Patient-Centered”…it sure feels like a buzz word.   I suspect most hospital and physician executives, and their ad agency partners, would agree.  But this time things are very different.

Why Hospitals and Physicians Should Get Serious About Patient-Centered Care

Reason #1 – Patients Are Starting To Discover That Their Doctors & Hospitals Are Not Nearly As Good As They Should Be

Little Toto pulling the curtain back on the great and powerful Oz

“Pay no attention to that man behind the curtain.” This line comes from the Wizard of Oz where little Toto (the dog, duh) rips the curtain back to show the great and powerful Oz is merely an old medicine show marketer from Kansas.  (Ouch).

The analogy is a good one.  Patients across the U.S., and other countries, are “doing a Toto” as they pull back the curtains on doctors and hospitals only to learn that they are often not getting the quality of care they expected.

People every day hear about some story that undermines their confidence in the health care system.  Doctor Smith at XYZ hospital amputated the wrong limb again, Sally down the street was given the wrong medication, Mr. Patel’s opinion was ignored by his doctor, and so on.  Unlike years past when such stories were infrequent and seemed to occur in some other city… stories now appear daily, occur in my city, and are instantly shared with people around the world via the internet.

Reason #2 – Patient-Centered Care Is The Right Thing To Do…Plus It’s Not That Hard

I think most would agree that today’s health care system is still very provider-driven.  That means that the care that is delivered, how it is delivered, who delivers it, and how outcomes are measured are all defined from the providers’ perspective (physicians, hospitals and payers ).   Patient-centered care simply means looking at these same issues but from the perspective of individual patients.   Notice nowhere here did I  equate patient-centered care with smile training, customer service training or pianos in attractive lobbies.  Patient-centered care means involving patients in the planning, delivery and evaluation of health care where it really counts in terms of outcomes, patient adherence, cost reduction and fewer re-hospitalizations.

Being patient-centered is like doing a market research study and then implementing the findings.  Patient-centered care does not give absolute control to patients…it simply invites them into the party and gives them a place at the table.  As providers, we don’t do a good job of listening to patients.  We do an even worse job when it comes to acting on what patients tell us they want.

Reason #3 – Patient-Centered Care Will Make Any Hospital Or Doctor Stand Out From The Crowd

Like a beautiful rainbow, patients and providers will recognize patient-centered care when they see it.   Like rainbows, example of patient-centered care are few and far between…but here are some tell-tale signs:

• Providers and patients know each others’ names
• Patients’ opinions are actively sought, listened to and honored where possible (and no, having a suggestion box, patient satisfaction survey or mission statement do not constitute being patient-centered – if you think they are then you aren’t patient-centered).
• Patients tell you that their doctors and other team members really listened to what they had to say (again if you think satisfaction surveys qualify you aren’t there yet).
• Patients are treated as the most important member of their health care team and taught how they can best contribute to the team’s success.
• Providers feel that their patients are actively involved in their own care.
• You see a significant improvement in patient health status, adherence, engagement, level of utilization and patient/provider experience.

If these aren’t good enough reasons to give Patient Centered Care another look at your organization then just think about this.  Beginning in 2013, 30% of hospital Medicare reimburse will be determined based upon patient experience.  Eventually commercial payers will follow suit.

As more patients “do a Toto” on your doctors, hospitals and other providers, are you ready for what they will find?

Five Myths About Empowered Patients Or E-Patients

Irrational exuberance was a term once used to describe the stock market before the last crash.  It also seems an apt description for much of the talk these days about empowered health consumers.

To be sure, patients today have unprecedented access to health information.  Patient decision-support tool can be found on just about every provider, payer and self-insured employer website.  Consumers can go to any number of websites to find quality data about hospitals, physicians and health plans.  Personal health records (PHRs) promise to make our personal health data portable for meaning that all our treating physicians will be “singing off the same song sheet.”

That’s what the industry experts tell us.  But what’s really going on?  Here I will describe what I see as the top 5 myths about empowered health consumers.

Myth #1 – All Patients Are Empowered or Becoming Empowered

Since pre-internet days (early 1990s), health behavior research has shown that about one third of adults desire above average health, one third are satisfied with average health, and one third don’t care one way or another.   Not surprisingly there is a direct correlation between one’s health aspirations and the degree to which one engages in activities typically associated with “empowerment, i.e., health information- seeking, exercise and good nutrition, and so on.   For example, people who place a low priority on health related activities for example often have an external locus of control.  This means that they don’t believe they can do anything to change their health destiny.

Using health information-seeking as a proxy for empowerment, it does not appear that people are significantly more inclined to seek health information today than they did during pre-internet days.

Myth #2 – Most Patients Choose To Be Empowered

Are patient empowered because they want to be or because they are forced to be out of necessity?  It is noteworthy that much of the research on patient empowerment comes from research pioneered by the National Cancer Institute.   This suggests a causal relationship between one’s condition (cancer) and how one reacts to it (information-seeking).  This trend subsequently spread from cancer care to all health care as physicians started to increasingly delegate health responsibilities to patients…without asking them, telling them or teaching them how to engage in these responsibilities.   Just ask any primary care physician involved in a medical home conversion.  Anecdotal evidence suggests that a good number of patients, when told of their new personal health responsibilities, respond by tell the doctor that “that’s your job.”

To be sure, a fair number of patients have become quite competent at managing their own health.  But it would be a mistake to assume that everyone is equally predisposed or capable of doing so.

Myth #3 – Health Information-Seeking Equal Empowerment  

Almost 80% of adults go online to seek health information according to the Pew Institute.   There is a tacit assumption in health care that information- seeking is synonymous with empowerment.  Yet information alone is not enough to change a person’s health behaviors, i.e., make them empowered, according to leading health care experts like Thomas Bodenheimer, MD, self care management guru Kate Lorig, and others.  Factors such as the person’s skills, self confidence and knowledge of how to navigate the health system are also important pre-requisites of behavior change.

It is worth noting that for some people; too much information can be disempowering resulting in too many choices and decisions.

Myth #4 – An Empowered Patient Trumps The Doctor

Nothing shuts down an empowered patient any faster than a physician who is short on time and communicates with patients using a physician-directed communications style (versus patient-centered).   As it is, the medical exam process does not afford patient much of an opportunity to speak without interruption.  As such most patients, including empowered patients, ask very few important questions.

Anecdotal evidence suggests that the longer one waits in the office to see the doctor, patients are moved to ask fewer questions in the interest of the doctor’s time.

Myth # 5 – Empowered Patient Are At Odds With Their Doctor

Empowered or not, patients and their doctors disagree on a fair number of important issues including reason for the visit, diagnosis, treatment options, amount of information desired, communication preferences and so on.  So disagreements are probably not the cause of the impression that being empowered equates to be obnoxious.   Rather the trick for the most empowered among us is to be able to disagree without being disagreeable.

That’s my opinion…what’s your?

Sources:

Wilkins, S. et al. A New Perspective on Consumer Health Web Use: “Valuegraphic” Profile of Health Information Seekers. Managed Care Quarterly. Vol 9, No. 2, 2001.

Bodenheimer, T. A 63-Year-Old Man With Multiple Cardiovascular Risk Factors and Poor Adherence to Treatment Plans.  JAMA. 2007;298(17):2048-2055.