Letter to the Editor: The Promising New Development in American Healthcare: Involved Patients

Doctors have long said that the best patient is an informed patient. Today, we’re seeing something better still: involved ones. Not only are they changing the conversations in exam rooms across the country, they have the potential to improve outcomes and lower healthcare costs that have proven maddeningly resistant to other measures.

Photo credit: Charlotte Henning

Thanks to the Internet and the accelerating democratization of knowledge, there’s now a host of medical information available on any subject imaginable. It’s transforming how we practice medicine and dispense care. Forty years ago, a visit to doctor began with someone saying, “I haven’t been feeling well.” Today, it’s more apt to be, “I’ve felt dizzy and have read on WebMD that it might be something neurological.” This doesn’t mean Americans are on their way to becoming their own physicians. It means they’re going from passive recipients to proactive participants. They’re less likely to put off seeking help. More alert to symptoms. Better-educated about treatments. When a physician prescribes medication — a sulfonylurea to lower blood glucose, for example — they want to know how it works. When we discuss surgery, they’re likely to ask, “What are my alternatives?”

The dynamic isn’t limited to patients; we see it in caregivers as well, and it goes far beyond information. More and more, people want to know what they can do to improve their chances for a positive outcome. Diabetes runs in their family: should they be tested annually for A1C? What are the risks of annual mammography for a 30-year-old woman with no family history of breast cancer? Does a yearly screening for prostate cancer increase survival rates?

These are critical questions. By some estimates, nearly 25 percent of all annual tests performed in the U.S. are unnecessary. For surgeries, the number is 7.5 million. No responsible physician wants to miss something. The first rule of our profession is “Do no harm,” but tests and procedures have been how medicine has worked for years. You tell yourself, “I’m being careful” even when the literature says there’s no benefit. But when faced with a patient asking, “Do I really need it?” you reconsider.

Involvement is also changing our approach to medications. Prescription medicines have been the miracle of modern medicine but given the exploding costs and long lists of side effects, people increasingly want to know what else they can do. There’s a lot. Lifestyle, exercise, diet, stress management. Cruciferous vegetables like broccoli and kale are powerful antioxidants. Physical therapy alone can correct a slipped disc and relieve horrible back pain without invasive surgery or opioids. What it’s all doing is expanding our notions of care. It no longer just comes in a bottle of pills. Increasingly, care is how people live.

Consider my own field. 110 million Americans suffer from high blood pressure, or hypertension. 472,000 die from it each year. The annual cost to the healthcare system is $131 billion. Cardiologists have all kinds of tools to treat it: ACE-inhibitors, Beta-blockers, calcium channel blockers, diuretics. Collectively, it’s helped us turn what was once a death sentence into a condition people can live with. At the same time, I’ve seen patients normalize their blood pressure and cut their meds entirely just by reducing the salt — sodium — in their diets. This isn’t a binary choice. I’m not advocating for medicines or surgeries. But a year of Labetalol costs money. Cutting salt costs nothing. In many cases, it’s just as effective.

How important is this for the nation as a whole? The U.S. spends more per capita on healthcare than any other industrialized nation in the world. At the same time, we trail in critical markers such as life expectancy, infant mortality and diabetes. Employers are now predicting that the total cost of covering workers and their families will hit an average of $15,375 this year. Left to itself, this trend will mean higher deductibles and narrower networks. When CFOs are balancing healthcare costs for 50,000-employee workforces against the need to invest and bottom lines, something has to suffer.

But spreadsheets are a long way from people. No one’s more concerned with individual well-being than patients and their caregivers. It’s unarguably easier to take a pill than to take up jogging. But the evidence is unequivocal: patient involvement equals better outcomes.

Is this the innovation we’ve been waiting for? The history of science has been one of progress pushing up against skepticism. Germ theory was one of man’s great discoveries, yet initially came in for opprobrium from the professional classes. The answer is there isn’t just one answer. But the more people participate in their own care, the better that care will be. Doctors are taking note. Our notion of medicine is evolving from something done for people to something in which people take an active role. It sounds obvious. The most significant scientific advances usually are.

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