Wednesday, November 19, 2014

Patient engagement in hospital medicine

A recent post on patient engagement for hospitalists offers these suggestions:

1. Encouraging patients to ask questions when they see their doctor every day
As simple as it sounds, this is not done nearly enough, and is a big missed opportunity to make a difference to patients’ understanding of their illness...

2. Giving patients all the knowledge they need about their medical condition
Writing details such as blood count numbers on the whiteboard at the end of their bed is one way to do this. In the future, patients will likely be able to pull up some of their own data on computers. The more that patients know, the more empowered they will be to make important health care decisions.

3. Involvement of families
Just as important as the patient, is the family. This is true for any patient who is too unwell to speak for themselves, and particularly applies to the elderly...

4. Involving the patient fully in the discharge process
The discharge process by its’ very nature is a risky endeavor. Typically there are medications that have been changed, tests pending, or even an uncertain diagnosis. All this at a time when the patient is still very frail. It is a crucial transition point, more important than almost any other to get right.

5. Follow-up care
All hospitalized patients must follow-up in a timely manner after being discharged. Nipping a potential problem in the bud can help reduce readmissions and potentially serious complications.

Those are great ideas although I have a problem with item 2. Few patients, even among the most intelligent lay persons, have the ability to interpret raw clinical data in a way that is useful for medical decision making.

Patient engagement is not a new idea. In fact, it's old school (I mean that in a good way). It was one of the key tenets of evidence based medicine, a movement launched in 1992. Because of its focus on the individual patient it does not work well with top-down, pathway driven or population based medicine.

The biggest barrier to this type of medicine is a lack of time as I pointed out before. [1] [2] Unintentionally, and to its potential embarrassment, the medical profession has increasingly attempted to circumvent the time problem by involving the discipline of palliative care as I once explained:

Palliative care is nothing more than good primary care. Or what an excellent internist or hospitalist should be doing. So yes, there is a definition for palliative care but it goes unspoken because the profession is, or should be, embarrassed by the fact that we need a “specialty” whose focus is to offload the rest of us from doing all those things that make for excellence in comprehensive care because we don't have the time.

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