There’s a revolution beginning in the practice of medicine. It’s about a shift in power which will change the way doctors work. It’s quite fascinating to see the early shoots appearing and it’s way too early to be able to say exactly how this is going to develop.
One of the change factors is what is being termed “Health 2.0”. This term is being used in different ways but it mainly refers to the use of social networking tools. This is one of them – a blog. Blogs allow anybody to publish anything of interest. Some blogs are just websites trying to sell something, and some are so highly personal that they are only of interest to readers who already know the blog author. But the most exciting blogs are those which allow sharing of experiences, views, information through tools like links, tags, comments, blogrolls and so on. Social networking sites like Facebook, Myspace, Bebo and so on are other ways of sharing experiences views and information. I could go on, but I won’t! There are more and more tools emerging all the time. What do they have in common? They are about sharing. They allow people to access the stories of others’ experiences.
What’s this got to do with health?
Well, the traditional doctor-patient relationship is based on a doctor as the expert who knows best and a patient who will passively accept the doctor’s recommendations, whether that be a prescription or an operation or whatever. The power sits with the doctor and the patient often feels intimidated or unheard. The new way is patient-centred, another term which means different things to different people, but which usually includes giving a higher prioirty to the patient’s issues and wishes.
There are two elements to this “Health 2.0” change – doctor-patient communication and patient-patient communication. The US Institute of Medicine’s report “Crossing the Quality Chasm” suggested that care be seen in future as less “event based” and more “relationship based”. It recommended that doctors and other members of health care teams be more accessible to patients and that care becomes an ongoing process rather than conceived of as something that only happens in “consultations” or “office visits” or “admissions”. An article about these changes was published in the BMJ last week. It highlighted the need to shift towards what it called “conversations”, giving one example of moving the patient record from being a doctor-held property to being a document co-created and shared between doctor and patient –
An example of this conversation is that created when general practitioners share records with their patients by posting them on the web. It is being pioneered by a group of English GPs in the patient access electronic records collaborative, using the EMIS information system for primary care. GPs will post up the patient records on a password protected site and patients and their GP will be able to access them.
This sharing of information is a major driver in the shift of power. Not only will personal information no longer be the sole preserve of the authorities (think also of Donald Berwick’s speech to the NHS where his first recommendation for improvement was this – “Put the patient at the absolute centre of your system of care—In its most authentic form, this rule feels very risky to both professionals and managers, especially at first. It means the active presence of patients, families, and communities in the design, management, assessment, and improvement of care. It means total transparency. It means that patients have their own medical records and that restricted visiting hours are eliminated. It means, “Nothing about me without me.”) but more and more information is being shared. The BMJ article, for example, highlights the development of the NHS Choices supersite http://www.nhs.uk and facilities like Healthspace and Medpedia as examples of the much wider publication of health related information.
The second element is collaboration and sharing between individuals. These new tools allow people with similar problems to not only share their experiences but also to discuss what they’ve personally found helpful or harmful.
Demos, a UK-based thinktank has recently published an excellent document entitled “The Talking Cure” which encourages people to think about these changes. In that document they state –
“If we are serious about engaging patients in their own care, we need to recognise that current structures of choice inhibit responsibility.” Choice “requires a genuine negotiation, a conversation between patient and doctor, and a shift in logic.”
and
Truly personalised healthcare allows patients to articulate their experiences, express their values, set their priorities, be aware of their options, exercise their preferences and be educated in managing their health. This means an end to paternalism
The Demos document very interestingly compares the mechanics and hairdressers as models of ways in which doctors work – yes, really!
Today, the typical motorist may have a rough idea of what is wrong with his or her car but leaves it to the mechanic to make an exact diagnosis, define a successful outcome, and prescribe the procedures needed. A visit to the hairdresser on the other hand begins with a conversation to elucidate what the client wants done (and whether it is practical) and may continue throughout the visit. At the end, the client assesses the outcome.
I find all this very exciting. It’s going to shift health care into collaborative relationships which focus on the needs, experiences and wishes of individual patients. This represents a huge challenge to the command and control, expert knows best, model of passive patients who are told what to do by others who claim to know better than the patient what will make their life better.
