Dr Michael Brooks, Senior Emergency Medicine Doctor in the NHS, and Chief Medical Officer of PatientSource Limited believes it’s high time we just got on with giving patients access to technologies that help them take control of their health
Ten years ago, I qualified as a medical doctor. Back in medical school, it was made clear to us that medicine was going through a massive cultural shift. Gone were the days of ‘paternalistic’ medicine where doctors would tell patients what the best course of action for treatment was and proceed unless there was a massive objection. Instead, we were taught to practice ‘shared decision making’, where doctors solicit their patient’s opinion and explore all possible options with them, coming to an agreement about the best course of action.
Clip from the 1954 film: Doctor in the House
Paternalistic medicine, at its worst. A scene from Doctor in the House (1954), Group Film Productions Limited
Instead of notions ‘compliance’, which describes how well a patient is following the treatment prescribed for them, we were taught to think in terms of ‘concordance’, which describes how well the doctor’s agenda and patient’s agenda are aligned. It makes complete sense: when I am a patient – and indeed with a chronic condition I do sometimes find myself sitting on the other side of the desk – I want to have a say over what happens to me.
Over the next decade, working in hospitals across the UK and eventually specialising in Emergency Medicine, I came to see how shared decision-making functions in reality. Just like with height and blood pressure, patients come on a spectrum in terms of desired engagement. At one end are patients like me who wish to be fully informed, who want to know everything and want to have weighed up all possible options before picking one, taking into account the doctor’s advice. At the other end, there are patients who would rather the decision be left up to someone else: ‘you’re the doctor, do whatever you think is best’. The art of medicine is tuning in to how much engagement your patient wants to have and providing them with their preferred amount of engagement.
So that’s how we as doctors approach patients when it comes to a consultation. Yet the systems we use to deliver healthcare are frequently stuck in the paternalistic past. Think of when it comes to getting a hospital outpatient appointment: in most areas of the country, you are sent a letter which tells you when you must attend. There’s no dialogue there, it’s the hospital’s decided slot in the hospital’s decided room or nothing. You as a patient may undergo a variety of tests, and often have no direct means to look up your own results, and instead are told only when a doctor is ready for you to receive them. Hospitals across the world make prescription errors on paper medications charts at alarming rates, and frequently hold clinic appointments with the patient notes missing, yet you as a patient have no say in how they prescribe your medications and administrate your records.
Frequently the existence of the least technologically capable patient is used as an excuse not to invest in technologies which would improve patient safety and experience. Take, for example, virtual outpatient clinic appointments by videoconference: each day tens of thousands of patients make trips to hospital to attend appointments where no physical examination or procedure takes place. Some are taken on hospital-funded transport waiting hours for it to take them back home at the end. Many of these visits could be replaced by a secure video-conferencing and electronic medical record platform working on the patient’s tablet or smartphone.
Everybody seems to worry about how Doris, the hypothetical 94-year-old lady with macular degeneration would cope with a telemedicine appointment – a perfectly legitimate concern – but then use that as a basis to justify not offering telemedicine appointments at all: a bad conclusion. What about Tom, the hypothetical 19-year-old diabetic who has to get three buses across town to attend his diabetic review, so tends to skip it?
Instead, we need the same approach to patient engagement when it comes to healthcare services as us doctors have been practising over the last decade in our consultations: we need to give patients the means to be as involved with their care as they would like to be. So yes, that does mean offering online patient-viewable records with the ability for them to discuss and comment on the details, while at the same time allowing those records to be just as useful by healthcare professionals for the patient who never logs in. That does mean offering telemedicine appointments in any situation where physical presence is not required but also keeping face-to-face appointments for those who would prefer something more analogue.
I’ve seen some great technologies emerge over the past decade. We’ve got patient-appointment swapping and scheduling apps like DrDoctor which give patients the power to choose their clinic appointments. There are AI-powered clinical diagnosis assistance platforms like Isabel Healthcare, which can identify likely and important diagnoses based upon symptoms. The teams at Patient Source and Modality have built a cloud-based electronic medical record platform with video-conferencing that just works, allowing a patient and doctor to be brought together with all the information at their fingertips wherever they physically are. Let’s get these innovations helping patients that want them.
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