Monthly Archives: September 2013

Patient is the new kind of provider

It doesn’t take much effort to discern the fact that patient and provider dynamics are changing. People, especially physicians rue what they call was once a sacred relationship, that has now been overtaken by corporate interests, the government, overzealous hospital administration or even the annoyingly-attention-demanding radio-buttons and check-boxes in the EMR. These external forces are certainly influencing the way patients and providers interact with each other. But a more fundamental force may be turning the relationship on its head.

Traditionally providers have been called so because they bring two things to the table:  unique knowledge and know-how and the services they provide using that knowledge. When illnesses were short lasting, few-times-in-a-lifetime events this was largely true: providers saw a large volume of patients and overtime accumulated a wealth of information and experience that they used to the benefit of their patients. In fact this information asymmetry between the provider and the patient was and is exactly the reason physicians demanded such a premium in the health system.  However of late the nature of illnesses has changed.

Illnesses are now protracted and lifelong events that the patient has to deal with every single day. As a result not only does the patient have more longitudinal experience with the illness, he also has unique experience about how his body reacts with various therapies and treatment methods. This knowledge in very valuable especially given the individual differences in the natural history of chronic illnesses. True, specialist physicians are likely to bring in unique learning to the table but there is no denying the importance of  the patient’s learned knowledge, specially at a time when personalized medicine is the new rage in town. Oftentimes, young doctors to come across patients who have lived with an illness for longer than they have been in medical training and practice. Such patients are as valuable a source of learning to the doctors as any medical text.

Patients who live with chronic illnesses have to provide the majority of the services by themselves. They take their own medications, they work on a healthy way of life for themselves and they use their knowledge about the disease to manage through the course of the illness. It is not uncommon at all to come across a diabetic who correctly diagnoses their atypical hypoglycemia symptoms or a patient who points out he has only rectal pain with a Crohn’s flare. And since majority of the care in any chronic illness is delivered at the home itself than the hospital or the clinic, the patient, and may be his family, is suddenly the greater care provider!

Roles are changing. Chronic disease care providers now are more like a coach or a guide rather than the know-it-all Dr Welbys of yesteryear. As illnesses become more complicated, numerous professionals work with the patient, not very different from an athlete in an individual sport, a large team works in tandem but its finally up to the athlete to execute the game.

The current state of rueful confusion among care providers is representative of birth pangs of this new paradigm. Physicians and allied professionals however need not worry, there will always be more service needed than they can comfortably provide; they just need to recognize the fact that there has been some reassignment of the roles and designations.