Digital health philosopher and nuviun strategic advisor John Nosta teams up with nuviun’s Senior Content Editor and 30-year nurse Sue Montgomery to provide their unique perspectives on healthcare’s two-party system.
It was a great topic when first published November 4, 2014, and has only gained traction since.
The Democratization of Medicine. It sounds like a lofty ideal, but it’s a discussion that’s gaining momentum in healthcare systems around the world. A recent WebMD/Medscape survey added fuel to the conversation, assessing the “Democratization of Medicine and Impact of Technology on the Patient-Physician Relationship.” During his recent Health 2.0 keynote address, Dr. Eric Topol discussed the findings and implications of the results. Dr. Topol is a leading authority in the fields of genomics and digital medicine, who serves as both Editor-in-Chief of Medscape and Chief Academic Officer of Scripps Health.
Here, digital health philosopher and nuviun strategic advisor John Nosta teams up with nuviun’s Senior Content Editor and 30-year nurse Sue Montgomery to provide their unique perspectives on the two-party system.
John Nosta—Defining the Two-Party System
We all know the drill—patient empowerment. And for that matter, it’s physician empowerment too. And the recent keynote address at Health 2.0 by my friend and teacher Eric Topol seems to support this idea. The recent WebMD/Medscape survey of 1,102 patients and 1,406 healthcare professionals (including 827 physicians) that Dr. Topol references paints a portrait of democracy, or at least a republic. We spoke recently and he put it this way:
“The results were quite interesting—it is one of the first large surveys that asked doctors and consumers the same questions! There is a significant gap in the willingness of consumers, compared with doctors, to embrace new technology, and especially a gap on who owns the data and the right to see it (such as office notes). But I’d say the gap is not as big as many would have projected. Maybe a sign of improvement?”
Dr. Eric Topol
I would agree, the results are interesting and patients and doctors might be aligned regarding an observation on care or technology. But the path to getting to that conclusion might be very different for someone in a white lab coat versus someone on an exam table. Part of what we’re seeing is a bit of a two-party system—the patient and the physician (ok, healthcare provider). And while both of these stakeholders are important drivers, it might be somewhat of a mistake to consider both of these groups the same. A monolithic approach makes little sense—from a strategic, marketing or clinical perspective. And it’s not going to work.
Some of the data that I found compelling was around the willingness for both patients and physicians to embrace technology:
- Consumers (84%) and doctors (69%) embrace technology to enhance and aide the diagnostic process.
- Patients (64%) and physicians (63%) agree that the smartphone can be a useful diagnostic tool in regard to blood tests.
I certainly find it interesting and important that both patient and clinician are converging on a similar number, but I wonder—why? Convenience might be the key driver for a patient and diagnostic accuracy might be what drives the doctor. Getting to the point—via a different path—is exactly my point. And we need to understand that different things often drive differences in “political parties.” While having the overall interest of its constituents in mind, these two parties (doctors and patients) are very frequently different. After all, the Democracy really isn’t a democracy after all, but a republic—a government where we elect representatives who make decisions for us. And this notion sounds very similar to our current healthcare system where we defer a decision to the doctor—a more informed party.
Now, my implication isn’t that doctors are always more informed than patients or caregivers. Nor is the submission to an authoritative party the best route. But as technological revolution grows exponentially, concepts and ideas may not just become simplified by the lens of a super-computer. These decisions may become more complicated and the role of the techno-guru (whoever that may be) may become increasingly valuable. And a simple “show of hands” as an arbiter of clinical care might just not be the best idea.
What worries me most is that we might end up like the United States government. And I’m not talking healthcare, but that actual political system. While the two-party system has set a benchmark of government, the conflicting voices—driven by conflicting needs and issues—have ended the dialogue and seized into gridlock. Doctors can dig in. Patients can demand their rights and data. And what we have left is the stalled revolution of digital health. Sometimes, this worries me…
Sue Montgomery—Defining the Other Two-Party System
The survey data is certainly interesting, and I also worry about similarities to a two-party system. However, my concern isn’t so much about gridlock, but about Big Healthcare taking over the rights of patients, just as Big Government takes over the rights of its citizens.
The paternalistic healthcare system that we’re accustomed to in America is gratefully beginning to change. Digital health technologies are catalyzing this dynamic, and I think some of the survey results are a great reflection of that:
- There is overwhelming support among patients (96%) and physicians (96%) around a patient's right to see their lab and diagnostic test results.
- However, doctors feel that giving patients access to detailed electronic medical records could lead to anxiety about results (91%) and unnecessary requests for medical evaluations (84%), whereas patients feel that this access will allow them to better manage their health (93%).
- Importantly, patients (58%) and doctors (77%) agree that doctors should review test results before sharing with patients.
In the increasingly archaic age of paper records, access to the information that supports patient empowerment was locked away in the seeming vault of the paper chart. But now, digital health applications are allowing easier access for patients to view their own data—to the point at which provider philosophy will soon be the only barrier which stands in the way. Survey results show that the provider dilemma regarding patient access isn’t really about if—but about when and to what.
I have to say that I’m a stubborn and independent consumer of healthcare. My nursing background and experience have a lot to do with that—both in terms of how I view patient autonomy, as well as my comfort level in dealing with healthcare information. It also fuels my empathy for the concerns that providers express.
Several years ago, when I moved from being an employee for most of my working life to becoming an entrepreneur, one of the first challenges I faced was how to handle my family’s healthcare needs. It was a sometimes-daunting-yet-empowering exercise in creativity and independent thought. Do we really need that much coverage? Is that test really necessary? How much will it cost? Is there another way to screen for that? What’s the latest research say?
More than once, I’ve questioned providers about the necessity and cost of additional tests—unwilling to pay for something I wasn’t convinced was necessary. In our health plan, we vote on what we want to cover, and receive health incentive discounts according to specific criteria. I’ve been ordering and purchasing our lab tests through an independent lab and receiving results first for several years. I have to say we’ve gotten some interesting feedback from our providers.
In light of this, I’d take the two-party system a step further, proposing that it’s not just made up of patients and providers, but patients and patients—those who want to be governed, and those who don’t. I think we need to find a way to account for and address this within our healthcare paradigm. Doing so will not only help patients, but providers as well—allowing them to pour the efforts of their limited time and resources into the former, instead of the latter.
We have an entire demographic of patients and consumers like me—who want more autonomy in their healthcare journeys—many of whom are also providers themselves. I’ve taken care of many physicians-and-nurses-turned-patients, and they typically demand and receive a different level of informed and empowered care.
There will always be patients who need more support than others, and are happy to be governed by the paternalism of our healthcare system. But, there are many who prefer a more independent approach. I believe we need to attend to the needs of both. Here too, a monolithic approach won’t work, and can lead to the gridlock that John describes. Physician practices are filled with patients who are apples and oranges, and treating them all as either won’t do.
I’d happily sign a form that releases my provider from any liability associated with giving me full access to my records. Since we’re all human—and I’ve found errors in the past—I’m more-than-willing to be a full-partner in ensuring the accuracy of my own EMR and related care.
There are sound reasons that physicians don’t want to turn the wheel over to patients, but I don’t think it universally applies. We need to sort out who-needs-what and match it to who-gets-what in terms of access and empowerment. For the patients who want to take responsibility for that which they already own—let them. For those who don’t—give them the level of support they desire.
The Commonwealth Fund released an excellent report this month that highlights the ability for digital health technologies to optimize this approach: “A Vision for Using Digital Health Technologies to Empower Consumers and Transform the U.S. Health Care System.” It provides a wonderful overview of a variety of initiatives that are serving to provide the individualized and empowered care that patients want and deserve.
Herein, personalized medicine doesn’t just apply to the field of genomics—but to the two-party system of patients—giving them the level of governance they want and need, as well.
The nuviun blog is intended to contribute to discussion and stimulate debate on important issues in global digital health. The views are solely those of the authors.