As our health systems slowly (and quite often reluctantly) become aware of the importance of listening to patients, and the growing evidence base to support the fact that engaged patients get better health outcomes, I want to make the case for developing a partnership model between patients and doctors.
Before I discuss why I think this is critical to a sustainable health system, I wanted to start by defining what an engaged patient is…
An Engaged (or sometimes we use the word empowered) Patient is a health consumer who participates fully in his or her medical care.
An engaged patient is somebody who takes personal responsibility for their own health outcomes. Somebody who has a voice in their own care, and exercises choice where that is appropriate. Somebody who speaks up for themselves, or for those that they are caring for. “Nothing about me, without me” as ePatient Dave’s mantra goes.
Engaged Patients see themselves as equal partners with their doctors in the healthcare process. Engaged Patients gather information about medical conditions that impact them and their families, using digital tools in coping with medical conditions.
Now, of course I recognise that not all patients are engaged patients – far from it. Some patients will never be engaged. And many patients with poorer social determinants of health struggle with engagement, by definition.
But I also think that we need to see engagement as a relative concept. Patient engagement is ultimately about improving patient heath behaviours and literacy, relative to where those things sit today. It’s about shifting people up the behavioural and health literacy curve.
With that said, I want to share a few thoughts on the need for a shift towards a partnership model between patient and health provider.
- I want to acknowledge that great doctors have been working in partnership with their patients for years. The best practice isn’t always new practice. Sometimes it’s about rediscovering things that we did better in the past. Unfortunately, however, there aren’t enough great doctors, and most doctors still don’t practice this way. Paternalism in medicine is still rife, and as a patient I could share many, many examples of this.
- The need to move towards a partnership model is exacerbated by the fact that our digital age has led to an explosion in the rate of publication of medical knowledge. Approximately 800,000 scholarly medical articles were published in 2014 alone. It’s literally not possible for doctors to be across even a fraction of the new developments and knowledge in medicine. Doctors must work hand-in-hand with highly motivated, but unqualified, patients to guide that motivation in appropriate directions.
- As I’ve written before, the internet has driven the democratisation of medical knowledge – so much so that I believe we are now in “the healthcare reformation”. In this environment, none of us has a monopoly on knowledge. In the face of health systems that are often struggling under the burden of disease, particularly chronic disease, and fighting for sustainability, we need to mobilise all the resources at our disposal. By empowering, activating, educating and informing patients, we have the ability to take some of the pressure off our health systems.
I’m with ePatient Dave (the original engaged patient from the US) when he says – “patients are the most under-used resource in the health system”. Moving to a model of partnership between patient and health provider is not an optional extra for our health systems, but critical to long term efficiency and sustainability.
A successful partnership with a patient begins when a clinician is prepared to move away from paternalism and say “You know what, I don’t know. Let’s work this out together”.