Friday, July 27, 2007

Doctor Patient Relationships - Raising Your Patient’s Health IQ

When I go to see the doctor, my IQ drops 50 points.

David Hingsburger, Chewing The Fat Blog

Seek simplicity and distrust it.

Alfred North Whitehead

“Engaging” and communicating with patients, and overcoming health illiteracy are very much in the news these days. These are all part and parcel of the wellness and health movement, which first gained traction about 25 years ago.

Just over 20 years ago, as a partner in a clinical laboratory, I came up with the idea of the HQ. The idea was simplicity itself. You can measure a person’s over all health, by measuring three pieces of data routinely and easily collected in a physician’s office.

•Demographic data, age, gender, family history of premature heart attack or stroke

•Physical data, BP, pulse, height and weight with calculated body mass index, chest, hip, t and waist circumference

•Laboratory data, glucose, blood lipids. Cholesterol/HDL ratio

From this data, you can calculate a person’s HQ with 50-75 being subnormal, 76-125, being normal, and over 126 being in superior health.

To make a long story short, we applied this calculation to over 4000 State employees in Oklahoma, most of who were sedentary. The average HQ in this population was 77. About 30% were hypertensive (>120/80), 50% were overweight with a BMI index over 30, 5% were diabetic (glucose > 120), and 8% were in imminent danger of a heart attack (total cholesterol/HDL ration 13.5). With each report, we sought to “engage” the patient by sending a personal letter stating their HQ, advising them to visit their doctor if the HQ was love, and telling them to go immediately with threatening lipid evidence of a possible impending coronary event.

I regard our little experiment as an early method to “engage” patients by informing them of their true health compared to peers. Patients and doctors alike responded positively, but employers were not yet read to spend the $39 we charged for testing and sending a personal letter.

Lately I’m seeing a renewed push by multiple quarters to engage patients as “partners” in their own care. This patient engagement is taking multiple forms.

•The Institute of Medicine, in its 1999 report, To Err is Human, brought patient engagement to the forefront by reporting that 98,000 hospital patients died unnecessarily and something had to be done to implement “patient-centric care” to educate patients and minimize hospital dangers.

•The Institute for Healthcare Improvement, spearheaded by Donald Berwick, MD, picked up the gauntlet and launched its “Saving 10,000 Lives” campaign in 2004, which advised hospitals to follow 6 measures to increase hospital safety, one of which was to educate patients and their families and to listen closely to their complaints.

•In 1997. Regina Herzlinger wrote Market-Driven Health Care, and in 2002, she followed with Consumer-Driven Health Care. The central theme of both books was that health care consumers are very bright people, and given the right information and the right financial incentives, they will become fully engaged in their care.

•In 1998, Susan Keane Baker wrote Managing Patient Expectations: Te Art of Finding and Keeping Loyal Patients. She emphasized educating, engaging, and meeting patient expectations at 15 critical “moments of truth” which occur during every patient visit to a doctor’ office.

•In 2001, a company in Chicago, Emmi Solutions, Inc, developed a series of over 80 online interactive programs to educate patients precisely what to expect from surgery and certain disease episodes. The reasoning was that patients expecting surgery would become “engaged” in learning about their impending surgery, especially if that information was presented in plain language, fortified by visual information, and allowed patient questions.

•Between 2001 and 2007, “Health Illiteracy” became a burning issue in American Health Care, in part due the complexity of health care, the jargon employed by the medical establishment, and rising tide of non-English speaking immigrants from different cultures. In response, The Joint Commission published Patents as Partners; How to Involve Patients and Their Families in Their Own Care. Oakbrook Terrace, Illinois: Joint Commission on Accreditation in Healthcare Organizations. 2006. Also i 2006, Michael Roizen, MD and Mehmet Oz, MD followed with a highly readable book The Smart Patient – An Insiders Guide for Getting the Best Health Care, The Free Press, 2006).

To some degree, I’m surprised by all of this talk and movement towards “engaging patients.” I thought patient engagement was what the practice, and the Art of medicine, was all about. Online interactive videos, educational videos in the front office, links to disease information on physician websites, training in interviewing techniques may help but there is no royal road to simplifying the process of patient engagement or raising patient health IQs.


Unknown said...

I love the HQ concept. Healthcare needs something like this.

I disagree on the engagement principle. Although I would love to believe that every physician has the time and visibility to help engage patients on the best way to manage their care, it seems unlikely. The average patient sees multiple physicians, goes to multiple pharmacies, uses vitamins and OTCs, and does other activities.

Plus, until physicians are incented around costs or other outcomes, I am not sure they will modify their workflow to address some of the opportunities that exist. I would love to believe otherwise, but I haven't seen it.

In one program I ran, 30%+ of the MDs didn't even trust chemically equivalent generic drugs (and I excluded NTI drugs in the question).

Anyways, good blog. I am focusing my blog on the engagement issue -

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