The Patient's Role in a 'Patient-Centric' Health Care System

No health care system today or tomorrow is going to work without the patient taking his or her place as an active team member in the health care process.
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Our health care system needs to invite the patient to be more involved in their health care well before we can discuss the patient being centric to their care. As discussed in my last post, there are fundamental institutional challenges that need to be overcome to achieve this objective. Otherwise, "patient-centric" is a nice concept with no chance at reality.

But there's more to it than that. The patient herself has to be a willing participant in her health care process. This is more than simply a financial participant -- it's being an owner and accepting some level of responsibility for her health care. And it's that ownership that patients need to become more comfortable with.

Our health care system has to date been fairly paternalistic. You went to the doctor, you listened to the doctor, you did as the doctor told you -- all because the doctor knew better. You followed directions and didn't assume responsibility for any of the decisions. Before the 1980s, you probably had a family physician who answered all of your questions. He may even have made housecalls.

As managed care emerged, the family physician was re-dubbed the "primary care physician." He was still your family doctor, but now he was also the gatekeeper to the rest of the medical community. The role went largely from focus on the family to focus on the financial implications on the system. You began to question a bit whether your doctor's wisdom was being impacted by some level of financial constraints.

So we all rebelled. We wanted more choice. We wanted to get the gatekeeper more out of the way. Our primary care physician was no longer the solution. He was the problem to efficient system utilization. The patient wanted more options and did not want a gatekeeper.

The system recognized the market opportunity and insurance companies started offering health care plans with greater consumer choice. The HMO (the traditional gatekeeper model) was supplemented with the PPO, the EPO, the POS and other acronyms that allowed the patient to bypass the gatekeeper. We finally had choice.

But with greater choice came added consumer responsibility -- and no one really ever acknowledged that shift. If I was going to bypass my gatekeeper, then who exactly was the keeper of all of my health care information? If I was going to go to five different specialists, then who was responsible for making sure those specialists were all on the same page? And if I was going to seek out medical treatment far and wide, who was responsible for ensuring that my personal health records were complete, accurate and useful?

So we can make all the claims that we want that the system is inefficient, the system is broken and the system is inadequate. And in some respects I would agree. But we created this system and we all need to take greater responsibility for our parts in it.

There are three primary things we need to do as patients and caregivers to assume the added responsibility that a patient-centric health care system will require:

First: Acknowledge that you are indeed responsible for your own health care decisions. Gone are the days of Dr. Marcus Welby. Here are the days of the informed consumer making health care decisions. That might be overwhelming given the lack of a medical degree, but given that you are your own gatekeeper it is incumbent upon you to assume the role. Plus, assuming that anyone else in the system is able to play that role is dangerous to your health.

Second: Make sure you are beyond organized in your approach. Crises happen and few of us plan for health care in advance. This reactive nature needs to change. We should all keep our and our family's information somewhere we can access. More importantly, we need to maintain the integrity of our family's information and we're the only ones who can ensure the histories are properly kept. You'd be amazed how few doctors even know what other doctors are prescribing to the same patient. Not that they're careless, but they have no way to get the information.

Third: Become your own advocate. If you have the responsibility for decision-making, you have the responsibility for advocating for those decisions. No one is going to know more about your or your loved one's situation than you are. This is a highly uncomfortable point for many (not to mention it is uncomfortable for a medical community that often holds on strongly to its paternalistic culture). But there is no more important point to be made. You own it -- no one else does.

There are a myriad of other actions we all need to take. Perhaps I'll write about them in future posts. Simply put, no health care system today or tomorrow is going to work without the patient taking his or her place as an active team member in the health care process. The concept of "patient-centric" is a two-way street, with the system thinking more of the patient and the patient assuming responsibility for their part. If either party isn't willing to play their role, then there's no chance the healthcare system can ever be improved.