I joined Linked-In a few months back and haven't quite figured out what it's good for, but they do send me interesting articles about health care, mostly from the business perspective. I read two of these articles today and was somewhat amused to find that their views of medicine were near polar opposites... and both conflicted with my own.
The first was written by "a former hospital executive and consumer health behavior researcher" with a Masters in Public Health. His premise was that doctors need to change their view of compliant patients (who follow their advice and consult them about health choices) as being those with the best health. His reason for criticizing this view is that some of the healthiest people around are those with a marked distrust of doctors and medicine. Those of them who nevertheless placed a high value on maintaining their personal health and devoted significant time and energy to relevant pursuits were more satisfied with their health status than were traditionally defined compliant patients. The author suggested that all health care professionals (and he included himself as one) "incorporate the patient’s perspective into outcome and satisfaction measures."
The second article was an interview with Eric Topol—the chief academic officer at Scripps Health, who was touting the many digital diagnostic tools now available, although not yet approved by the FDA. He urged doctors to educate themselves about all these technological gizmos and to start incorporating them into their diagnostic and therapeutic regimens. Among the digital advances he mentioned were electrocardiograms with a phone, glucose levels via touch screen and genomic sequencing to determine certain types of drug sensitivity for each patient. He summarizes his conclusions as follows:
You can see that prioritizing the "digitization of medicine" over current practice, fails to take into account the patient's perspective touted in the first article. Practically speaking, if the doctor is concentrating on the details and logistics of technology for diagnosis and monitoring, how much attention is left to listen to the patient's needs and desires? Doesn't this focus further compound the skewing of outcome measurement toward the goals of the health industry rather than those of the individual patient?
My personal perspective on the digitization issue is that it has nothing to do with the excitement I felt as a premed. My goal was to have expertise that allowed me to help people to feel better after our interaction than they did beforehand. The more experience I gained, the more apparent it became that the most important diagnostic tool I had was the ability to listen. At times, that ability is the most effective treatment available as well. Digital media give me more data to interpret, change the way I record my actions and add to the information I can convey to patients, but they do not help me to empathize or communicate. Those skills are what will lead my patients to feel better... and that is the outcome I seek, regardless of how it is measured.
In my ADHD practice, evaluation and treatment is based almost exclusively on my patients' impressions and reports. The goals of therapy are the goals described by my patients for themselves. I try to stay current on the technologies available to help them, but I rely on their expertise in their own experience to inform the process we go through. The success of my practice is the outcome measurement I use, so perhaps I am utilizing my patients' perspectives for such measurements after all!