The $100 question about patient empowerment

by Devin Gross

Here’s a question. It’s not a 5¢ or $5 question that anybody can solve on their own without much thought or effort. It’s a $100 ask-an-expert or think-about-it-for-a-second question.

What’s the point of patient empowerment?

Much of the current discussion of empowerment deals with patients who for one reason or another have had to fight for their care. CNN’s Elizabeth Cohen opens her book, The Empowered Patient, with a moving personal story of her panicked battle to keep her child from having an unneeded spinal tap. Here on KevinMD.com, an article titled All patients will soon become e-patients, contained the quote, “But, I’m not a ‘regular’ patient. I’m pissed and I want answers. That’s where all those ‘e’s’ come from.”

The message from most discussions on the topic is that only the squeaky wheel gets the grease; only patients who are willing to get ‘pissed’ can get the answers and the care they need.

To put it simply, this message is not the whole story.

Patient empowerment is not about making sure patients get what’s theirs from the healthcare system. It’s about finding solutions to the problems that have plagued healthcare for decades by getting help from the one group that has the most at stake: patients. These problems (miscommunication, poor patient compliance and towering costs) can only be corralled if patients and providers work collaboratively.

This third problem, the cost conundrum, sits in the middle of all discussions about the future of healthcare. Little can be achieved unless we can manage to ‘bend the cost curve.’

Patient empowerment is at the center of this issue. Right now we have the wrong healthcare resources delivering the wrong levels of care. Everybody talks about the ER. Many patients ignore symptoms, get no preventative care and then get treatment in the ER for twice the hassle and a 100 times the cost of a visit to a general practitioner. Often these patients are portrayed negatively.  But the issue is broader. Every day patients, including those who are diligent and attentive, go to their provider to get weighed or to have some extremely basic service that could be provided elsewhere more conveniently and much more cheaply.

We don’t need to have our most expensive resources, real people who spent years at medical school and even more years in residency preparing for the cutting edge of medicine—we don’t need them answering $5 questions and performing 5¢ tasks. We can save the $100 questions for doctors and empower patients through better communication to answer the easiest questions on their own. We can offer tools for empowered patients to get more involved in their care.

The result will be better outcomes, cheaper care and more satisfaction for physicians and patients alike.

We can’t solve the lasting problems of healthcare without patients. And patients can’t get involved unless we give them the tools to help in a constructive way. That is the point of patient empowerment. And it’s worth far more than $100.

Devin Gross is CEO of Emmi Solutions and blogs at Engaging The Patient.com.

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  • SarahW

    This sounds suspiciously like having new barriers between Primary care physicians and patients, i.e., nurse-practicioners or health aids. Perhaps I read too much between the lines here.

    If only there were some way to involve patients in payment for basic care…
    #HSA

    • http://www.talktoyourunconscious.wordpress.com BobBapaso

      Yes, every patient with an HSA is empowered.

  • http://www.egoscue.comwww.egoscueportland.wordpress.com Matt Whitehead

    The thing that we forget in healthcare is the patient knows more about their health than anyone in the entire world. Until doctors and all other healthcare providers believe this fact, the way the healthcare system treats patients will not change. Because this country (and most westernized countries) have believed this for a long time, patients are dis-empowered. They are led to believe that their body and health is too complicated for them to possibly understand and they have to go see an ‘expert’ to diagnose what is wrong with them and ‘prescribe’ some treatment. This has created patients that don’t trust their own knowledge, understanding, and intuition which would give them answers to 75% of the health questions/problems they have. An example is someone is short of breath. They run to their doctor to get ‘checked out’ and are told nothing serious is wrong but you do have high blood pressure, high cholesterol, are pre-diabetic, overweight, and have asthma. The patient is given several medications, told to eat healthier, and exercise more. If the patient would have been empowered to trust their own intuition they would have realized that they have been eating too much junk food and stopped their daily walks 5 years ago. If they would start eating healthier food and walking daily again all the symptoms would disappear in 6 months. No need for a doctors appointment or medication and the patients health would be drastically better than in the first scenario where the patient would take the drugs (thinking that’s fixing the problem but it’s really only helping the symptoms not the cause) and never change their habits. This is where 75% of healthcare money is spent and it is 100% avoidable by empowering people to trust themselves again and when they do they will happily take responsibility for their health which changes everything!

    • Dennis

      boy do I wish this was true. If the only thing people in this country did was to stop smoking and get rid of their obesity, you wouldn’t need most of the meds/tests that I use daily. As a family physician, what I am telling patients is common sense about what they should do; since they don’t get it, I guess it’s uncommon sense.

  • http://www.pacificpsych.com/ pacificpsych

    I took a look at your site, and noticed that the list of experts about communication at EMMI solutions omitted one little specialty…

    • jp

      care to share which one???

      • http://www.pacificpsych.com/ pacificpsych

        Hint: the answer is in my moniker. :)

        Thought it entertaining that on a site devoted to improving communication with patients, out of all the specialties, mystery specialty X was left out. Gave me one of those ‘shake your head in disbelief LOLs’. If you know what I mean.

        http://www.emmisolutions.com/medical_experts.html

  • http://secondbasedispatch.com Jackie Fox

    Good stuff. I couldn’t agree more that the “squeaky wheel” message is not the whole story, beyond which it’s a message I don’t necessarily agree with.

    Check out Doc Rob’s take on the cost aspects on his fine Musings of a Distractible Mind blog.

    http://distractible.org/2010/09/24/caring/

  • http://www.davisliumd.blogspot.com Davis Liu, MD

    This post illustrates correctly that there must be much more to the empowered patient movement. It’s about patient engagement.

    And it will take more than simply shifting costs with higher deductibles, copays, and HSAs.

    http://davisliumd.blogspot.com/2010/09/empowered-patient-is-this-what.html

  • http://somebodyhealme.dianalee.net Diana Lee

    I’m definitely not an angry patient, but I do expect cooperation and team work from my care providers. I offer the same to them and do a lot of work to educate myself and do what is within my power to improve my health. It need not be a confrontational relationship on either side, I think.

  • http://patients.about.com Trisha Torrey

    Devin, I would disagree with you that angry patients drive empowerment. I would agree that most of us patient empowerment experts got our start based on a horrible or frustrating experience, but for those of us who have become professionals in this “space” it has become a passion to help others get the care they need.

    Elizabeth Cohen started her campaign after her daughter was mistreated. Dave deBronkart never did have a bad experience. I was misdiagnosed with a cancer I didn’t have – but today would tell you it was the best thing that ever happened to me. It gave me purpose in my life.

    My book, You Bet Your Life! The 10 Mistakes Every Patient Makes (How to Fix Them to Get the Health Care You Deserve) isn’t about anger or being aggressive – it’s about tools to help patients get the best of a broken system. My About.com patient empowerment website, http://patients.about.com is also about providing tools, and helping people take responsibility for the care they need, seek and deserve.

    What I appreciate most about your post is the statement that patients MUST be involved in helping to fix the system. Too often we are invisible, or undervalued.

    If it wasn’t for patients, there would be no need for a healthcare system to begin with. We can play a key role in system improvement.

    Trisha Torrey
    Every Patient’s Advocate

  • http://www.BocaConciergeDoc.com Steven Reznick MD FACP

    I disagree wholeheartedly and respectfully with the concept of only bringing the tough stuff to the doctor and getting the other questions answered by ” less expensive ” alternatives. Each opportunity you have with a patient for a simple problem or a more complex one is an opportunity to get to know your patient and what makes them thrive. You get to know what causes them worry and anxiety and why if you take the time to delve into it. Over time it gives you a frame of reference and knowledge to pick up subtle changes in health earlier. The more you divert the doctor patient interaction the more you interfere with this process. You can bring your car into the shop for a quick computerized evaluation of its performance with the tough stuff assigned to the master mechanic. Human being are complex and as they age this approach does not yet work.

    • jp

      Dr Rez. hit the nail on the head again. As a GP w/12 years exp. in primary care, I sincerely hope Mr. Gross’ “solutions” are not going to be implemented.

  • http://secondbasedispatch.com Jackie Fox

    Without patients, doctors wouldn’t have jobs. Without doctors, patients wouldn’t get care. We need each other. And we need to treat each other with mutual respect.

    I swear, I’m not on his payroll or related to him, but here’s another great post from Doc Rob on “what is a patient.”

    http://distractible.org/2010/10/05/what-is-a-patient/