January 6, 2014

Is Patient-Centered Health Care Beneficial?

It is somewhat surprising that in today's world, with our smart phones, internet savvy and media hype, when we go to the physician for a check-up many of us tend to sit back, listen and nod in response to a doctor’s advice on our conditions or treatments. This does not sound very participatory, does it? Why does this happen?

It is unfortunate that many patients do not want to be participatory and even more do not want to be empowered. On the other side, many doctors do not want empowered or participatory patients. They have gone to great lengths to confuse patients and continue their overly paternal ways. They claim they are doing what is in the best interest of their patients, but in reality, they often ignore obvious clues and misdiagnose what the patient presents. They insist on talking at the patient and not with the patient.

For a prime example of how poorly these doctors do their medicine, read this blog from Joslin Diabetes Center. Doctors can be idiots at times and as I read this blog, those were my exact thoughts.

Two laws are now stepping in and putting these doctors on notice that they need to provide more to patients. The legislation that mandated doctors to have electronic medical records (EMRs) or (EHRs) electronic health records also mandates them to provide patient portals. This forces doctors (providers) to more actively engage patients by providing them with the capability to electronically view, download and transmit relevant information from their provider’s electronic health records, including lab test results, a list of current medications, and hospital discharge instructions. The legislation also requires that physicians engage in email with patients.

Then we have the latest legislation that mandates and puts the doctors on notice that they must communicate with their patients of earn quality points that will determine their pay structure and incentives. In anticipation of this and the provisions of the first legislation, these physicians have developed new terms to muddy the waters and push back. Meaningful use and patient engagement are the terms these physicians have invented to work their way around these requirements.

If you are one of the patients that have been given access to your EMR, then you know what I say is what happens. When you receive their emails, there are statements as part of your medical appointment that are not happening. Supposedly, you have received a pamphlet or page relating to the purpose of your visit, which you have not received and probably never will receive. Mine were counseling I supposedly received about weight loss and another about concern for the purpose of the doctor visit. All the doctor needs to do is check a box and this is meaningful use when the paper is said to have been given to you.

Communication is definitely lacking, but the physicians can claim patient engagement. The theory behind this patient engagement is that when we have access to our medical information and we are assisted to the point that we understand what our care is all about, we will respond positively to our treatment options and take better care of ourselves. If this communication actually happened, I would be very happy. Instead, I have needed to go to the computer and research to find information about the problem that I saw the doctor to communicate with on the topic.

I will admit that some doctors are actually communicating and rebuilding the doctor-patient trust, but most doctors are not. I have blogged about some of this on 28 and 29 December 2013. Another good blog by Nancy Finn about what is supposed to be happening is a blog you should read and become familiar with because it does explain some items I have not covered in this blog. She does explain patient-centered better than I do and probably because I have not seen patient-centered benefits at this time.

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