Time to phase out physician office visits?

'We have this visit-based system that developed 100 years ago. That doesn’t make sense in a world of chronic conditions.'
By Eric Wicklund
08:47 AM
Patient in doctor's office

It's time to stop thinking about healthcare in terms of the doctor's visit.

Healthcare takes place in between the visits, and away from the doctor's office. And once the healthcare community realizes this, it can move beyond that time-honored tradition of delivering "epistrophic care" and do something useful for the patient.

Those words of advice helped kick off the HIMSS and Healthcare IT News Patient Engagement Summit on Monday in San Diego. And they helped launch a discussion of just how far apart most doctors are in knowing what their patients really want.

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Daniel Sands, MD, an instructor at the Harvard School of Medicine and co-founder and co-chair of the Society for Participatory Medicine, kicked things off with an opening keynote that put to rest the idea that healthcare is a service industry. It's not like a car wash, he said, where one goes in, gets a good cleaning and vacuuming, and walks out as good as new. 

[Learn more: Meet the speakers at the Patient Engagement Summit.] 

"Healthcare is a collaboration," he pointed out. And while patients are demanding that collaboration – through the sharing of data, mutual respect, shared decision-making, communication and engagement – providers are still struggling to see beyond the delivery of epic catastrophic ("epistrophic") care.

"We're moving from healthcare to health, and we're moving from the office to the home and, actually, anywhere," he said.

In other words, forget about the office visit and look at all the spaces in between – what he called the "frequent life touches." And that requires figuring out a new way to go from delivering volume to delivering value.

"We have a shifting paradigm in healthcare, the old has to be displaced is information asymmetry – it's a burden," Sands said. "We have this visit-based system that developed 100 years ago. People didn't develop chronic conditions, everything was acute. That doesn't make sense in a world of chronic conditions."  

It's not an easy process, as was pointed out in a panel discussion following Sands' keynote. For example, Clark Kegley, assistant vice president for information services for Scripps Health, pointed out that he'd actually changed his career path to healthcare after he and his wife were completely ignored by a doctor during a consult before his youngest son's birth.

Meanwhile, Alicia Staley, chief patient officer at Akari Health, brought up a study done some time ago in which patient-generated data differed significantly from data entered into the patient record by a nurse, who was prone to filtering the data provided by the patient.

The issue, Staley said, wasn't whether the patient-generated data was more accurate – it was the patient's data, the patient's perceptions. "That pain is real to you," she said, no matter whether the nurse thought it was less intense than you did.

"From the patient perspective, this is our lives," she said. And providers need to manage that perspective with their own.

That's going to require a different business case for healthcare, the panel suggested.

"Patient engagement is not how much money I can make in the next 30 minutes," Kegley said. "It's how much of an impact I can have over the next 30 years."

"The business model doesn't exist for patient engagement," added Staley.



Here's what happened

Patient engagement tips from the pros
Making patient engagement a hard science
Patient engagement: 'Behavior dominates technology'

Patient engagement advice? Expect irrationality
Docs need to make consumer engagement a priority
Time to phase out physician office visits?

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