"If doctors were in charge of airports, they would never have installed radar. They just would have put intensive care units all around them."
Doctors tend to be a pretty conservative lot. So are healthcare administrators. Physicians are prone to believe that the foremost priority is to maintain their authority to determine what is best for patients. For administrators, the crux issue is to provide services that generate the most profit (“margin” in the “not-for-profit” world), while doing what they can to match what their institutions offer to what people really need.
Doctors do what we think is optimum for patients. Patient preferences are not necessarily at the forefront of our decision-making.
These days it’s healthcare administrators, much more than doctors, who decide what is to be done in healthcare. Administrators may survey consumers in the course of deciding what to do. But patient desires generally take a back seat, at best.
Things are changing in the digital age. With few exceptions, every one of my patients has internet access, which means a large share of the medical information that is available to me is also available to them. As a physician, my value to patients resides less today in the information I can put my hands on and more, based on my education and experience, in throttling down the fire hose of medical knowledge to a manageable stream and choosing just the right fly to fish that stream for what a particular patient needs at a particular moment. Since information is power, patients are more my peers than they used to be in the healthcare transaction, in the same way as the Kelly Blue Book Online and Carfax have leveled the playing field between me and a car salesperson.
Electronic devices themselves are also helping people to take power over their own healthcare. Folks with diabetes have been checking their blood sugars for years, with ever more reliable, inexpensive and connected devices. Glucose levels obtained with these monitors are automatically graphed onto charts and interpreted by smart algorithms. Results may be sent automatically to healthcare providers and also may be shared with other people who have diabetes, in an exchange of experience and advice that can only come from someone with the same disease. A good deal of this activity is initiated and sustained outside of healthcare institutions. It is what marketers call “consumer-driven.”
Much of telehealth these days is consumer-driven. Let me repeat the definition of telemedicine from my book, Digital Healing: People, Information and Healthcare, quoted in the last installment of this blog:
Telemedicine is the use of electronic information and communication technology to overcome barriers of distance and time when delivering healthcare.
Notice that this description does not say who the deliverer is. It could even be the patient themself, which is, in fact, the case with the array of gadgets that people now wear on their wrists, made by the likes of Apple, Garmin, Samsung, and Fitbit, plus a zillion others. A simple device can monitor heart rate, steps taken and distance traversed. A fancy one can continuously measure heart rate, blood pressure, breathing rate, steps taken, distance traveled on foot or bicycle, calories burned, sleep time, stages of sleep, and swimming time; as well as incorporating a GPS to gauge position on the earth and elevation gain and loss. You can upload the data to your smartphone or computer, share it with friends or competitors, and even send it to your provider’s office. Graphs will display trends for any and all of these functions. Keep in mind, though, that a significant chunk of data, even from the best devices, is not very accurate or reliable.
Some medical practices will accept these data. Your provider’s medical record may have a file in which to tuck unsolicited physiologic data, but it won’t have a way to make sense of them. With or without an EMR, nobody really knows what to do with these data. No convincing case has been made yet in the medical literature for a measurable effect on wellness, fitness, leanness or anything else a person who straps on one of these devices would hope to achieve. If activity and physiologic monitors do wind up helping individuals or groups, they will probably discover it for themselves, not because a doctor, nurse, exercise physiologist or dietitian has come up with a bright idea about how to do it.
According to International Data Corporation, last year the self-monitoring market grew 27.5% worldwide; that’s 172.2 million units sold. If you’re interested in joining the burgeoning ranks of the self-monitored, learn as much as you can about it, including educating yourself online about what device to buy. Then go for it. If you think your provider might collaborate, ask them to. But don’t expect, at this point, that a health professional will know much more than you about what to do with a ton of not-so-reliable physiologic data.
Image credit: raconteur.net
Let me repeat, there are not good studies that demonstrate the benefit of self-monitoring. Go about it slowly and deliberately. Talk to friends about what they’re doing. You and your consumer-driven pals will probably figure it out. Perhaps you’ll even be able to educate a health professional or two.