Communications By Any Other Name - Worthless

You may wish to skip this blog. This is because I am overly critical of another blogger. I normally respect this blogger and she has much good to say, but that was not my take on this blog.


Again, I wonder why is it that doctors misunderstand communications. Every doctor has his/her interpretation of patient engagement. Now I will add the term “meaningful use” to patient engagement and say that most doctors are trying to hide behind the two phrases and are not concerned about communications with the patient. To quote Dr. Rob Lamberts, “Communication isn’t important to health care, communication is health care. Care is not a static thing, it is the transaction of ideas. The patient tells me what is going on, I listen, I share my thoughts with the patient (and other providers), and the patient uses the result of this transaction for their own benefit.”


I respect the definition by Dr. Lamberts, but anything in other definitions is bull, and the quicker we as patients understand this, the better off we will be. I covered his blog that Dr. Leslie Kernisan refers to, but do not understand why she had to muddy the waters even more. I will quote Dr. Kernisan to show this: “Here’s my current take:  Supporting patient engagement means fostering a fruitful collaboration in which patients and clinicians work together to help the patient progress towards mutually agreed-upon health goals.” Mutually agreed-upon health goals may not always be in the best interest of the patient.


She says everything but communication as if communication is a term to be avoided at all costs. Then she uses the term to bring people back to patient engagement. I quote, “Communication with patients is, of course, essential to all of this. This is why any innovation that improves a patient’s ability to access and communicate with healthcare providers is proudly labeled as “patient engagement.””


Remember meaningful use, doctors may not meet this if they use communication instead of meaningful use. Then we find out that Dr. Kernisan prefers to quantify patient engagement when she states, “Back to the examples of patient engagement cited above. What are the “right metrics around what constitutes real patient engagement”? Obviously, it will be difficult to agree on metrics if we don’t first agree on the definition.”


Sounds to me she is trying to calculate how to fit this into meaningful use. Tell me this isn't so, doctor! I am even more concerned now and have to wonder what it is about the word communications that doctors are unwilling to accept this, with the exception of Dr. Lamberts.


I become very uncomfortable when doctors use the term patient engagement around me and even more when they use the term in surveys sent out to attempt to get praise for their actions. I refuse to return these and when one doctor called me to find out why I had not returned the survey, I am afraid I was not too polite in my response. I also said that the phrase patient engagement had no standard meaning and communication was definitely not part of my appointment other than keeping my mouth closed except to answer questions.


Of course, the doctor disagreed. I asked him who had set the goals I was to use for my health. When he said we both had, I reminded him that I had not indicated I approved or disapproved of the goals he had laid out. I then told him where I disagreed and why. He quickly asked me to complete the survey and return it. I said I would and I would send one to the administrator and keep another copy for my records. “Click” was the next sound and it was more of a “bang.”


I did return the survey, but he is no longer a doctor on my team and that is by mutual agreement.

The Practice of Medicine Must Change

This blog combines two other blogs of interest to me and helps explain why the practice of medicine must change. No, I am not talking about our broken medical system, but the participants in it and how they can make the change happen. Or at least this is my intent, but the end will determine if I am convincing.


Science has led to many important medical life-saving advances, but it has also led to harmful and dehumanizing medical care. Physicians and hospitals use wasteful and unnecessary tests and treatments. It is sad that about two out of every three families that declare bankruptcy, do this because of expensive medical bills. What is even more alarming is that over 70 percent had medical insurance.


The first blog is this blog by Dr. Leana Wen and I urge you to read it. Her points are very poignant and at the same time revealing about what needs to be accomplished. She does not say this, but I will, we – you and I, need to take charge of our medical care. Doctors are so harried today, that they do not let you tell your story about what is wrong with you.


I do understand that they interrupt many patients because we have too many drama-minded people that do not just state the facts and then let the doctor take over. Then we have the doctors that rely on the “cookbook method” and could care less about what is truly your problem. So both sides may be part of the problem. Patients, we need to just state the facts, forget the drama, and not let the doctor interrupt us until we have finished with the facts. This just may prevent a misdiagnosis.


The second blog is by Riva Greenberg that I am using. I laughed after reading this, but what she describes is happening more and more. Why? I honestly feel this is happening because doctors have lost their comfortable pedestal they want patients to see them atop of and are having burnout to some degree. Yes, some would call it laziness. I see it as being so harried by the lack of time, that they are not able to do their jobs and so drop the ball in many areas. They order tests and procedures just to move to the next patient. The problem is they may not even know why they ordered a test or procedure.


Clinical inertia is what Riva describes - clinical inertia can put a patient in danger, it is a major contributor to inadequate treatment, and it can lead to unnecessary tests and procedures. Riva is talking about diabetes and when this doctor is asleep at the wheel, you as the patient must take charge. Either be prepared to challenge your doctor when he goes on autopilot, or find another doctor. While this may not always be easy if you live in a doctor sparse (rural) area of the US, but it still needs consideration.


The transforming of healthcare does not require more politics, or even more technology. It requires that as patients, we refocus the appointment on us, the human connection – the old fashion form of communications. We need to revitalize the doctor/patient relationship, which is simple and straightforward. Some doctors will appreciate this and some patients will need to move on to a new doctor. This is the simple truth. We are still too far from knowing what the Affordable Care Act will bring, but our health is important now.


Again, I encourage you to read these two blogs and what they are saying.

ACA Without Meaningful Use = Failure

Healthcare be damned, full speed ahead for rationing. The author of this healthcare blog did not state it this way, but he should have. I have had the suspicion that patient engagement was not intended and Adrian Gropper, MD at least states this. Most physicians don't want patient engagement in the first place just like they do not want patients to have access to their electronic health records (EHRs) as I stated in my blog here.

Dr. Gropper had this to say about patient engagement, “Not surprisingly, patient engagement is an afterthought (talking about EHR).” Then he continues, “Patient engagement, from a health economics perspective, is incidental in care coordination but essential in avoiding the perception of rationing.” Ouch, the perception of rationing when rationing is planned. Many Medicare and Medicaid patients are already feeling the pinch of rationing as Accountable Care Organizations (ACO) and hospitals are attempting to make their funds stretch and grow their profits.

This statement is also worth quoting, “By paying ACO institutions instead of individual service providers, health insurance companies and Medicare provide direct economic incentives to reduce waste, lower costs and, if we’re not careful, withhold needed care. An ACO is by definition an organization or institutional construct.” Bold is my emphasis. “The book on patient engagement is yet to be written. EHRs still treat patient engagement as a liability and state health information exchanges (HIEs) are still being designed without any patient engagement at all. (Opt-in and opt-out is still as far as they go.) Both EHRs and HIEs still perceive strong privacy principles and fair information practices as obstructionist.”

At least Dr. Gropper recognizes the changing landscape and the need for stronger doctor/patient relationships. He acknowledges that patients and doctors need our Internet-age tools in a form for privacy and communications. Patient engagement is a euphemism for communication and I personally don't like the obtuse way they express this. Patient engagement is also used to describe meaningful use.

Dr. Gropper concludes by saying, “Let’s start by making sure our data can be liberated from the various EHRs via Blue Button Plus (see explanation below) and that every federally certified HIE includes provisions for a patient-accessible EHR Record Locator Service. These are the foundation of patient engagement (meaningful use) and essential to the success of the Affordable Care Act.

Blue Button Plus is a blueprint for the structured and secure transmission of personal health data on behalf of an individual consumer. It meets and builds on the view, download, and transmit requirements in Meaningful Use Stage 2 for certified EHR technology. Read more about this at this link.