From Health 2.0: Re-Imagining the Doctor-Patient Relationship

Apr 27, 2009, 8:03 AM, Posted by Elizabeth Dickson

Several themes and memes emerged from the Health 2.0/Information Therapy conference over the last several days. One theme is the need to re-imagine the relationship between patient and doctor in order to prepare for a Health 2.0 world. In the past, doctors were the primary, if not the only, source of health information. Doctors defined what was relevant to patients' health (e.g. blood pressure, blood tests, height and weight), and they were responsible for collecting it whenever the patient came to their office. In the Health 2.0 world, patients seek information that is relevant to them ("given the pollen count today, do I need to take an extra dose of my allergy medication?"). This new dynamic views patients as sources of health-relevant information, much of which is collected outside of the clinical setting. Patients are no longer passive subjects, but "info-mediaries," as some attendees called them, in their own right.

 

Paul Wallace of Kaiser Permanente  and the Center for Information Therapy and Jamie Heywood of PatientsLikeMe debated the question during the session entitled "What is the Future Role of the Doctor?". Certain ideas and phrases -- in other words, "memes" -- filtered throughout the discussion, shaping the participants' efforts to rethink the relationship between patient, doctor and data. In order to get their minds around what this new relationship might look like, the panelists and members of the audience employed a few metaphors. These analogies quickly morphed into memes, and conference attendees referred back to them to summarize and simplify their perspective on the future relationship between doctor and patient. Here's a sampling:

  1. Football: The doctor is the quarterback. She is the leader of a team, calling the shots. Perhaps she gets direction from the care coordinator (the coach). Where is the patient in this model? The patient is the all-important ball -- the object of coordination among different health care providers as they move it up the field.

  2. Banking: The health care system is the banking system. Patients can access and control their health data via an online health management portfolio. The portfolio includes myriad tools, geared to different types of patients. In this model, the doctor is like a financial planner - she helps patients navigate the system.

  3. Organization: The patient is the CEO of her body, and her doctor is a hired consultant.

While similar in that they place increased importance on the patient, these metaphors also reveal very different visions for the future role of the doctor.

Meme/metaphor number one recognizes that the patient is the central focus (there "wouldn't be a game with out the ball" according to one Health2.0 attendee), and yet it portrays patients as passive participants in a system over which they have no control and little input. As Jamie Heywood pointed out during the panel, he "wouldn't want to be the patient who gets punted."

The wealth management metaphor implies that health providers and health consumers will interact within a highly organized and interoperable health care system. Few patients will wind up being the health equivalent of "day-traders," and they will still rely on their doctors as trusted advisors. But, doctors will not be patients' only resources. In order to stay relevant, doctors will need to acquire new skills - like how to locate, interpret and translate the most relevant information for their patients (another Health2.0 theme!).

 

The organization model defines the patient as the source of information and the locus of decision-making. It suggests that patients will navigate an open marketplace of health care providers, and that doctors will compete with one another on cost and value (i.e. better health outcomes).

 

Which of these metaphors resonates with you? Are there different analogies that pick up on other important features of this relationship? Can they exist in combination, or are they mutually exclusive? Are there implications in these analogies for the future roles of doctor and patients that the Health 2.0 attendees missed?

This commentary originally appeared on the RWJF Pioneering Ideas blog.