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Medical Uncertainty & Patient Engagement

Medical Lessons From The Trenches

medical uncertainty in face of anxious woman patientSo I got the lab results for that colonoscopy exam I discussed in last week’s post (see “Navigating Medical Uncertainty – Disease, Un-ease & Uncertainty“). And while they weren’t a completely clean bill of health, they could have been much worse as well.

Having gone on the record about this in order to explore our collective discomfort with our medical care and the disease process generally, I feel obliged to report the results – as well as the process of delivering them. They both reflect on matters I discuss at length in Our Healthcare Sucks. And we don’t always get the opportunity to share how our own experiences reinforce or refute what we’ve written. So here goes.

First off, let me say that the doctor, nurses and other providers I encountered were top notch. This was at one of the oldest “Accountable Care Organizations” in America – having grown from a staff model HMO back when managed care meant, well, managed care. And it’s proper management of our medical care that’s so sorely lacking in American healthcare.

So I expected quality care – and that’s what I got.

But the failure to inform me as quickly as possible of my results – in an organization that’s more advanced in its use of electronic medical records than most – shows how far we still have to go to realize truly patient-centric medical care.

Improving Communications

My letter arrived by “snail mail” six days after my colonoscopy. Not too shabby, I guess, but it was dated two days after the procedure.

That means it could have been digitally delivered in two days instead of six. That’s three times as long as it needed to take to communicate lab results after a medical procedure that left me with a highly uncertain, and a potentially deadly, prognosis. We can hardly claim to have achieved patient-centered medical care with patient’s so late in learning their own test results.

This represents part of that 51% efficiency rating our healthcare system earns that I discuss in Our Healthcare Sucks.

Now, a couple of qualifications are in order here. I checked my online health portal only after receiving my letter in the mail and found a copy WAS posted in my online medical record. Because I was told it would take a week or more before I’d know my test results, i hadn’t bothered to log in sooner. As a result, I can’t be certain when it was posted in my online record.

So you could argue I was remiss in not checking my online portal more diligently while waiting. You might also suggest that someone who just decried “our need for speed” and quick answers has no business complaining now about such a delay.

But I’d beg to differ on both counts – and the reasons bear on the respective roles of patients and their providers in their medical care. I’ll take this to the next level for that reason.

A Cultural Turnaround Is Needed

Even if the letter informing me of my test results had been posted online on the day it was dated, wouldn’t a simple automated email telling me to check my health portal for new information make sense? This is especially so as we’re still transitioning to an era of electronic medical records and many patients are still not fully acclimated – and some will never be.

If nothing else, we’ve learned by now that patients need to be prodded with reminders and that doing so results in better patient compliance and improved results. And much of that can be automated, so there’s really little excuse for not taking additional steps to more efficiently inform and involve patients in their own medical care. At the very least, patients should be told to check their online medical portal – if their provider offers one – so they bear the responsibility for failing to do so.

As for how this comports with my earlier “need for speed” critique, there’s a big difference between wanting timely notice of test results about your current medical condition – which may very well be ambiguous – and expecting quick and definitive answers for all your medical problems.

This isn’t about expectations, reasonable or unreasonable. It’s about efficiency – or rather inefficiency – in this case, of communications.

Providers simply need to become much more proactive in their attempts to engage patients in their own medical care if we expect any success with that effort.

I can hear the protest now about how it’s up to patients to take more responsibility for their healthcare. And I agree with that assessment. But getting there from where we’ve been all these years – a paternalistic and passive-patient medical culture – won’t just happen overnight.

You don’t just pass the ball to the new kid on the team and expect him or her to score without any training or practice in how the game is played.

Turnarounds Cost Money

Patient education takes time and effort. And, yes, it will cost money.

We have to decide whether it’s a worthwhile investment or not. Given the enormous amounts of money being wasted in our healthcare today, there shouldn’t be any doubt that empowering patients to better comply with their treatment regimens – and to challenge them when needed – may be the only true path out of our conundrum of no longer being able to afford our bloated healthcare system.

But this means a wholesale cultural turnaround – by doctors and patients. And it will be tougher than most turnaround situations where everybody’s trying to achieve the same objective.

Here we have competing interests that will try to stymie progress at every turn. Many are intent on preserving their profitability with the current dysfunctional model of healthcare in America. And they’re the ones with the current financial backing, so you’d have to guess the smart money’s on them.

Turnarounds of this magnitude – facing such political inequity and financial disparity – won’t happen by simply wishing they would. Nor by pointing fingers when they fail to materialize without proper funding, political support, and provider attention.

Real patient engagement will take time, money and a really concerted effort by all involved. That means more than lip service and token initiatives to bolster patient survey results for higher payments (under Obamacare, hospitals will start to see their payments reduced if patient satisfaction surveys aren’t favorable).

Patient Satisfaction Isn’t Patient Engagement 

Let’s hope no one still confuses patient satisfaction with patient engagement. The former will simply preserve current hospital payments rather than reduce costs, while the latter holds promise for long-term cost-savings and a more efficient, effective, and affordable healthcare system.

medical care Patient Recognition Month Poster

Patient Recognition Month Poster (Photo credit: Army Medicine)

Patient satisfaction is relatively easy to produce – and hospitals will be newly-focused on it as Obamacare unfolds.

But real patient engagement in their healthcare is an entirely different undertaking. For one thing, it requires that our doctors – or their designees – spend precious time educating patients about complex medical subjects rather than hospital administrators dreaming up new ways to keep their patients “satisfied”.

With doctors under mounting time pressures as Obamacare expands insurance coverage to 30 million more Americans, this is one tall order. Which means it won’t happen without a major recognition and embrace of it as fundamental to true healthcare reform.

As long as that remains as unlikely as it appears today, meaningful healthcare reform – that may actually gain control of our medical spending – will continue to elude us.

Oh Yeah, My Test Results

I probably shouldn’t end this without closing the loop on the substance of my test results (and i’ll try not to share my not-so-confidential health record beyond this).

Of the eight polyps I mentioned in my prior post on this subject, 5 were normal tissue or benign. The rest were ordinary pre-cancerous adenoma polyps that were fully removed during the colonoscopy.

One of the features about colonoscopy that’s earned it a spot as one of only two screening exams Consumer Reports has found to be of near unequivocal benefit (my term) is the ability to remove any suspect polyps during the procedure. That means it can not only screen for a problem, but actually intervene with treatment that prevents the feared condition from progressing to full-blown cancer.

That’s a huge benefit that makes the uncomfortable, but hardly overwhelming, prep process so worth the effort. When you factor in how minimally disruptive removing polyps is during a colonoscopy compared to the often toxic treatments required should they progress to cancer, it’s a virtual no-brainer.

When polyps like these are found, patients are advised to get a follow-up colonoscopy in three years rather than the five years they might otherwise wait. According to WebMD (“Many Cancer Deaths Prevented By Colonoscopy“), these time frames are based on the assumption that most colon cancers take about ten years to develop.

That doesn’t apply to everyone, however, which is why colonoscopies only reduce cancer deaths – by over half – rather than eliminate them. Everyone’s different and some will develop cancer before their next colonoscopy despite their timely vigilance in following up as prescribed.

But we all live with uncertainty whether we recognize it or not.

And having been spared what may very well have developed into colon cancer had I not made the effort to get the colonoscopy,  it’s certainly a powerful incentive to adopt even more of those healthful lifestyle behaviors I advocate so freely here.

Bottom line: Absent a family history of colon cancer, starting at age 50 it makes eminent sense to have a screening colonoscopy that will substantially reduce your likelihood of dying from this major cause of cancer deaths that are, in many instances, avoidable.

Unfortunately, studies of people with our increasingly dominant form of high-deductible health insurance show that many defer this essential screening because they’re forced to pay for it themselves when their high deductible hasn’t yet been reached.

And that’s not a good omen for our future health – physically or fiscally.

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