Rediscovering the patient-consumer through telemedicine
Telehealth is projected to be a $19.5 billion market by 2025. The American Telemedicine Association’s 2018 message marks the movement of Telemedicine from possibility to necessity. At the HIMSS Europe/Health 2.0 conference a few weeks later, the sentiment is echoed - we are entering the era of patient empowerment.
The more I explore the capabilities of practicing medicine from afar in preparing to launch a virtual pediatric clinic, the more firmly I believe we will see a virtual vs. in-person care model replace the current inpatient vs. outpatient systems around the world.
In our collective excitement for this space, the concentration has been overwhelmingly on the provider’s perspective:
How do we make the platform convenient?
How do we make transitions smooth between care environments?
How do we make the remote exam reliable and high-quality?
How do we integrate the latest technology and gadgets?
What does this mean for credentialing, licensing, reimbursement?
Well and good. All important questions. But there is another half to this equation that is equally interesting:
What does this mean for patients, and how will it change their role in healthcare?
I predict the rise of virtual care will cause patients to think and behave more like consumers, which will further the democratization of medicine.
I have previously discussed the lack of agency for patients and providers - the only two groups that should have agency - in our current system. Specifically for patients, navigating the maze to get care is full of the illusion of choice - choosing a hospital, choosing a doctor, choosing an insurance plan, designing a plan of care. In reality, patients play an exceedingly passive role.
With the rise of virtual care, providers will have the opportunity to optimize an independent platform and bring back the days of physicians as the original small business owners. The market of telehealth is currently dominated by a handful of urgent care style platforms that quickly connect a patient to a doctor. From here, the extension into fully virtual primary care clinics is inevitable. Revolutionizing access to primary care, as an entry point into healthcare, will give patients a degree of choice that can serve as the first step to creating a space that resembles a true market.
Providers may question whether this marketplace is desirable. Nearly every healthcare professional has had the frustrating experience of the demanding patient, so should further transformation of patients into consumers be encouraged? For these concerns, I would like to offer two considerations:
We already treat patients as consumers - but of the system and not of our own practice, which is the real source of frustration.
Hospital hallways have seen an increase in posters like this:
Why does HR feel the need to teach providers basic manners, including smiling and saying hello, as if in kindergarten? What do these posters say about the current status of provider-patient interactions?
Medicine has made positive progress towards shared decision making with patients. However, the pressure for patient satisfaction from administration (with arbitrary markers for evaluation) worsens the disconnect between doctors and their patients, augmenting the sense of shuffling people through the system. Providers are often distracted by demands of the system to minimize legal problems, which makes it harder to listen and respond to patients. To use my original analogy, this twist on customer service is similar to taking a group of people who studied for years to become chefs and having them work as line cook + waiter in a kitchen that mass produces pre-packaged meals. The restaurant holds the workers responsible for costumer satisfaction but gives them little freedom to customize the experience.The lack of ownership and genuine connection, in addition to restrictions of an assembly line, can turn the wishes of the customers into frustrating demands. What if, instead, we were liberated from this structure and given more ownership of the patrons? This leads to the second consideration:
Is there really such a thing as a demanding patient? A so-called demanding or “noncompliant” patient is one whose wishes and actions do not fit with the providers’ recommended course of action. The point of medicine, however, is about the patient’s experience, not about the ease of a provider’s work. A patient's resistance or insistence is just as much a part of the narrative as the physical disease. Somewhere between the science and the art of medicine is the physician’s job to teach, listen, negotiate, and improvise, which are all important parts of healing. Dismissing a patient’s wish as noncompliant or demanding would be ignoring a large part of our job. In this sense, we have much to learn from the service industry’s motto of “the customer is always right.”
The scale of modern medicine was made possible by organizing into centralized healthcare systems that industrialized clinical care. In the process, however, we have lost some focus on the patient and convoluted the extremely personal nature of the patient-provider relationship. As the momentum of the world gathers speed towards de-centralization, virtual healthcare has the potential to reclaim these lost elements in the art of healing by empowering both providers and patients to have more choice and autonomy. The transformation of patients into consumers, then, might be the critical first step in rediscovering the patient.