Dr. Weeks’ Comment: My practice was always one which empowered the patient through the sharing of knowledge and my refusal to take over or take control but to remain as the expert who advises. It was never “my way or the highway” which is the attitude that so many doctors share with their distressed patients. The patients don’t know that their doctor is constrained to offer only the “standard of care” and is not at liberty to offer innovative medicine until the thought leaders and the insurance companies decide it is reimbursable. Now a giant in medicine (albeit one who was kicked out of the Cleveland Clinic for his independent thoughts) is telling the doctors to let go and empower the patients. Alan Tisdale, a wise professor of medicine, gave me valuable advice almost 30 years ago… “When in doubt, Brad, ask the patient.”
Topol on Medicine in 2015: Letting Go
December 29, 2014
Although we usually ascribe the phrase “letting go” to critical end-of-life decisions, there is another meaning that pertains to how medicine is changing: the end of paternalism. There are several concurrent forces that are taking hold now and that will undoubtedly build momentum in the coming years.
First, let’s consider patient-generated data (PGD). Patients using home blood pressure cuffs or fingerstick glucoses are typical examples of what was available. But that capability is quickly expanding with such new entries as heart rhythm monitoring or ear exams via smartphone attachments.
Not only can patients obtain the data, but there are validated computer algorithms that immediately provide the interpretation. We’ll soon see smart watches that can continuously monitor blood pressure or blood oxygen concentration, and wearable sensors that track hemodynamic metrics such as cardiac output and stroke volume. Furthermore, much of routine lab data has been shown to be assayable through smartphone device attachments. All of this data will be flowing directly to the patient on his or her device and will be contextualized by the person’s real-world experiences and environment. Neither patients nor doctors have ever had such information before. For sure, that’s empowering.
PGD: Addressing the Concern
We in medicine are concerned about this PGD movement. Will the data be accurate or misleading? How will I deal with my patients getting torrential streams of data and sending these to me for guidance? Or will the computer algorithms bombard me with false or unnecessary alarms? These are just some of the relevant questions that will need to be addressed by regulatory oversight and software programming to foster comfort within the medical community.
Second, our culture is rapidly changing because of mobile devices. We are quickly moving to “on-demand” expectations, as reflected by the newfound ability to summon a car or have one’s groceries delivered to the house. So instead of waiting weeks for a doctor’s appointment, the IWWIWWIWI (I want what I want when I want it) mentality is pervading. As a result, the embracement of telemedicine has grown more quickly than anyone might have imagined.
The consulting arm of Deloitte published a report showing that already, in 2014, nearly 1 in 6 office visits switched from physical to virtual. So, beyond patients having medical information flowing directly to their mobile devices, the immediate access to doctors and nurse clinicians has been shown to be remarkably alluring.
It is expected that Congress will be passing new telemedicine laws in 2015 that markedly reduce the barriers currently imposed regarding state-specific regulations. And employers are into this movement because of the marked reduction of costs, reflected by a recent Towers Watson report.
Third, the medical community has historically been the purveyor of all of the medical information, holding the key to patient records. Last month, my Medscape column about ownership of medical records elicited more than 450 comments, which was a record number for all of the posts I have written for Medscape over the years. Many of the comments reflected the persistence of paternalism—”the records are mine since I created them.” But the records are about the patient and were paid for by the patient. Also, they’re now digitized, and it has been well documented that patients do not have a problem handling the information. At the very least, shouldn’t a shared ownership model be operational?
Today only a limited number of health systems provide mobile device access for the patient’s office notes, hospital records, labs, and scans. But in order for health systems and doctors to meet consumer demands, it will be increasingly important to “let go” of this information that each individual is rightfully entitled to. We’re not talking about having to go to an office or hospital and sign a release, and then pay several dollars per page of materials faxed to the patient. That’s old-world medicine, and it’s not just inconvenient and costly—frankly, it’s disrespectful to patients.
For these reasons and many more (which I have drilled down in my new book, The Patient Will See You Now, Basic Books, January 2015), I think we’ll see next year as the beginning of “letting go” in medicine.
As always, I’ll be keen to see your thoughts. We at Medscape are extremely appreciative of your engagement.
Best wishes for a healthy and productive new year,
Eric J. Topol, MD