Abstract
Keywords: Physician-patient communication, patient-physician communication, patient engagement, participatory medicine, health data.
Citation: Graedon J. The power of facilitated followup. J Participat Med. 2012 Jun 6; 4:e12.
Published: June 6, 2012.
Competing Interests: The author has declared that no competing interests exist.
More than 20 years ago, I got into a heated argument with Tom Ferguson, MD, the guru of the medical self-care movement, the founder of e-Patients.net, and the creative inspiration behind the Society for Participatory Medicine. Tom imagined a day when doctors would interact with patients online, even prescribing medications, while people would buy their prescriptions from web-based pharmacies. Tom envisioned a time when many more prescription drugs would become available over the counter.
Such concepts seemed anathema to me. Where was the doctor-patient interaction? What about drug side effects? How could this concept ever be implemented in a way that would protect patients from drug disasters? I was convinced that the risks were just too great and the benefits way too small to permit either e-prescribing or significant over-the-counter switching.
Two decades later, Tom’s vision is poised to come true. The Commissioner of the FDA, Margaret Hamburg, MD, has floated the idea that patients might better manage chronic conditions like diabetes, hypertension, and heart disease if they had access to powerful prescription medicines. Dr. Hamburg has suggested switching some cholesterol-lowering medications, blood pressure pills, and diabetes drugs to over-the-counter status. E-visits are now common and millions of people buy their prescriptions from online pharmacies like DrugStore.com.
Rather than oppose the dawn of this new age, I am ready to embrace it. Tom persuaded me that his vision would be in the best interest of patients. Not only that, it could be efficient. It might even save a lot of money for a badly broken health care system. What’s more, Tom’s vision of the future of health care applies to much more than medications. It could have a positive impact on every aspect of health care as we know it today.
What was Tom’s vision? Great followup! Tom asked me a critical question all those years ago. “How well is the current system working?” I had to admit that it was abysmal. Even then doctors, nurses, and pharmacists had little time to discuss treatment plans or drug benefits and risks. Tom convinced me that the rubber meets the road after someone leaves the doctor’s office and starts taking the medicine or implementing a care plan. Tom forced me to think about the key questions people needed to ask shortly after they got home:
- How do I implement the program or take my medicine?
- Is it working? How would I know?
- Am I experiencing any side effects?
- What’s happening subjectively or objectively in my life?
Only when these questions are addressed and the health professional informed of the answers can outcomes be tracked and improved. Patients with diabetes who track their own blood sugar levels are in a much better position to learn how their meal plans, activities and stress levels affect blood glucose. They can also see the response to their medication. There are similar benefits for monitoring blood pressure for people with hypertension as well as weight for those with heart failure.
Regardless of whether someone gets a prescription in a doctor’s office or buys an over-the-counter medicine, this kind of followup is crucial to managing chronic conditions. Luckily for e-patients, there are lots of gadgets and apps that can help.
Tom loved tools, and he’d be thrilled with the myriad of ways we now have to measure what is going on with our health. Access to data is critical, but data alone is not enough. To use data as feedback to improve health, continuous communication between health care professionals and their patients is critical.
Copyright: © 2012 Joe Graedon. Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the author, with first publication rights granted to the Journal of Participatory Medicine. All journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.
Your idea of “facilitated follow up” and “continuous communication” is an interesting tool using prescription drugs as an example, but I can tell you from personal experience with doctors that they are not necessarily familiar with drug side effects, or they feel pressured not to think this way so they don’t reveal this to patients? Even when the side effects were screaming, “This is a side effect,” they missed knowing my drugs were the basis for my problems, transient global amnesia being one! I had many trips to hospitals, even by ambulance following a stress test while at my internist’s office with what was later decided to be TGA! At no time did he suggest it was the statin drug that could be or was responsible for the episode. How would your proposal have altered this process and prevented the various episodes that preceded and followed that event?
Elizabeth,
I completely understand your concern…and frustration. On our website [www.PeoplesPharmacy.com] we have received similar complaints that a prescriber either failed to warn about a side effect or chose to ignore it after it was reported.
The kind of followup we are advocating (see the shared editorial by Charles Smith, MD, and myself “Solving the Followup Dilemma” in this journal) can be implemented today with existing software. Even email contact could be a good first step. It will still require an open-minded health provider to listen attentively and do the homework necessary to respond appropriately.
Bad followup, whether in person, by phone or with new technology cannot solve the problem. It will require the principles upon which the Society for Participatory Medicine were founded, i.e. teamwork and respect.
(I completely agree with these comments from my colleague, Joe Graedon. There are no guarantees that we won’t continue to make occasional, if not frequent, mistakes of omission and commission; but, the combination of a different relationship between provider and patient, along with use of available technology to improve knowledge and research (the ‘web’) and improve access will, in our view, be a game changer. –CWS)