“As adults, we own a number of complex processes,” such as who we marry, our careers, whether and when to buy a house, have kids, and so on, said Dr. Peter Edelstein, chief medical officer and vice president for Elsevier, the world’s leading publisher of scientific and medical content. “Health is the only thing we own in life that we voluntarily give over to others.”
Edelstein, a surgeon and author, says patient engagement has three phases with “engagement” coming first, “education” the easiest and “empowerment” the most important.
“People engage when they believe the potential benefits outweigh the risks or burdens of participation,” Edelstein said. A heart patient can simply step on a scale to monitor weight changes that could shift doses of medication to avoid hospitalization. Diabetic amputations could be reduced just by looking every night at the diabetic’s feet – are there ulcers or cuts?
“It takes 90 seconds,” Edelstein said. “Why are so few patients engaged?”
Edelstein said there three types of non-engaged patients. The first he calls “shark surfers” who are unlikely to participate in a meaningful way in their care. He recalled a patient on a strict diet who came to his hospital twice after eating hamburgers – both times in a coma. “Unless you have infinite resources, move on,” from the shark surfers Edelstein told the audience.
A more logical place to focus resources are the “credit carders” whom he described as “enjoy now, pay later” patients. “They have no flu shot, they drive drunk and say ‘I haven’t been hospitalized for flu’ or ‘I haven’t killed anybody’. I can’t stop smoking. I can’t lose weight.”
Edelstein advises enlisting family and friends with the credit carders. “The most effective people to convince smokers to stop smoking are their children.”
The “different drummers” category of patients cover a wide territory beyond people who don’t speak English or come from different cultures.
“Older patients who were raised to believe they should never question the doctor are a huge problem,” he said. “Older patients trust us completely and that’s not good. Empower them to ask questions, make sure they understand what we said. You have to tell them it’s OK to not get it.”
Even Edelstein’s highly educated mother-in-law who was on morphine after a knee replacement couldn’t understand all the factors that led to her needing dialysis due to an infection.
For patients who are illiterate, a study on reading and learning skills showed those with inadequate skills ended up in hospitals much more often than those with adequate or even marginal skills.
Beyond illiteracy, they also may lack adequate housing, or they have an abusive spouse, they may be alcoholic or have no car to pick up meds. “Physicians are not specialized in this,” he said. “We need expanded teams of translators, social workers, financial types.”
Edelstein described engaging the different drummers as a “long play” with endless follow up. “These are lifetime conditions for most patients. This is not a one-time ride. This is not an urgent care center,” he said, comparing patient engagement to painting the Golden Gate Bridge. As soon as it’s painted, the painters start over again.
“Providers are important. Technology is huge but the patient is the key,” Edelstein said.
Matthew Holt, author of The Health Care Blog and Co-Chairman of Health 2.0, closed the symposium saying that venture capital funding of digital health reached nearly $4 billion this year and big brands like Walgreens are moving into digital healthcare.
Holt, a researcher, strategist and forecaster, said in the future “no part of you is not going to be tracked,”while showcasing a shirt that monitors breathing and heart rates -- and retails for under $100.
The implementation of electronic medical records is too slow, he concluded. “As consumers and clinicians, we need to insist” on access to medical records that are now available to Medicare beneficiaries and veterans via The Blue Button.
Jan can be reached at [email protected].
