Technology Enables Collaborative Doctor-Patient Relationships

By Eve Harris

The doctor-patient relationship has become more collaborative as patients use technology to better understand their health. (Getty Images)

Not very long ago, a patient’s medical chart was considered proprietary information belonging to a doctor or a hospital. But just as technology is remaking the rest of the world, it’s also contributing to remaking the relationship between your doctor and you.

More patients have access to their data now that more doctors are moving to electronic medical records. Emerging technologies are also driving change. People with diabetes might use mobile apps to keep track of blood sugar levels, for example. So, with all this data at a patient’s fingertips, how is the doctor-patient relationship changing?

“Patients, when they come to the doctor seeking health care, aren’t necessarily looking for ‘raw data’ – they have already looked it up online. Instead, they are looking for meaning,” wrote Dr. Robert Rowley recently. Rowley is a family practice doctor in Hayward … but he’s also the medical director of Practice Fusion, an electronic medical record company.

Searching for meaning in the doctor’s office, I was intrigued. In an interview, Rowley told me that the role of the physician is shifting to “somewhat of a coach, a trusted advisor.” For example, a patient may want to discuss their medication if new or dangerous side effects were recently reported in the news. In a situation like that, Rowley told me, “My role is more of an interpreter.”

Rowley believes that the best care he can deliver today includes helping patients sort through and understand the “chaotic array of overwhelming data” as it relates to each person’s health. After doing a web search on their diagnosis, he said, “a patient will say, ‘help me understand this. Help me find meaning.’”

A study presented recently at the American College of Cardiology Scientific Session demonstrates the effect a personal doctor-patient exchange can have – not just on patients’ experience, but on their health outcomes. Cardiac patients in Los Angeles who had the opportunity to see their heart scans — clogged arteries and all — were more likely to follow risk reduction measures such as losing weight.

In short, the didactic, authoritative physician of the old days is giving way to that of highly trained medical coach or collaborator. In a recent New England Journal of Medicine editorial two doctors wrote, “The clinician needs to explain what is possible and negotiate potentially achievable goals with the patient. Then the clinician should provide a treatment plan, encouragement and advocacy to help the patient.”

Howard Luks is an orthopedic surgeon at and social media enthusiast currently serving on the board of the Mayo Clinic Center for Social Media. In blog posts and public addresses he, too, stresses that the doctor-patient relationship should be just that – a relationship. He tells doctors, “This is about stories. We treat patients. We don’t treat x-rays or MRI findings.”

But technology has a substantial influence on how the relationship changes, as with the cardiac patients who committed to losing weight not because the doctor prescribed it, but because the doctor showed them their clogged arteries.

Luks said recently in an interview:

Patients are…researching and diagnosing themselves through WebMD and then they’re searching for physicians who have expertise in that particular area.

Physicians are starting to realize that it helps us regain or recapture those relationships that older physicians had with their patients. They knew their patients…They knew their patients had a recent baby, or that they just bought a new house, that they moved, or they got a new job, or got a puppy, or whatever. Having a relationship with your patient in that respect for some is special and meaningful.

Much of that information is shared now via social media. Luks – considered when he speaks at medical conferences to be an evangelist about healthcare social media — tells physicians, “If you choose not to engage, then I feel that is to ignore your own relevance as a health care practitioner.”

Eve Harris is a Bay Area writer. Check out her health blog, A Healthy Piece of My Mind.

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  • Carla TN Berg

    You are so correct on all these points. Patients are getting more engaged and better equipped all the time (electronic records, good web sites, new apps and devices), and as a result, are feeling more empowered. Doctors are coming to see their role not as the “sage on stage” but as a “guide on the side,” a trusted consultant Together these changes this decade will impact our lives as much as the Internet did in the 90s. Thanks for the excellent summary, Eve.

  • http://marilynmann.wordpress.com/ Marilyn Mann

    Is this the study you are referring to?

    MOTIVATIONAL EFFECT ON WEIGHT LOSS AFTER VISUALIZING CORONARY CALCIUM BY CARDIAC
    COMPUTED TOMOGRAPHY
    ACC Moderated Poster Contributions
    McCormick Place South, Hall A
    Saturday, March 24, 2012, 9:30 a.m.-10:30 a.m.
    Session Title: Imaging: CT – Coronary Artery Calcification
    Abstract Category: 24. Imaging: CT
    Presentation Number: 1109-445
    Authors: Nove Kalia, Dong Li, Matthew Budoff, Los Angeles BioMed Research Institute at Harbor UCLA, Torrance, CA, USA, University of
    Saskatchewan, Saskatoon, Canada
    Objectives: The aim of this study was to assess the effect on behavioral lifestyle changes (weight loss) in patients who underwent coronary artery
    calcium (CAC) scoring with cardiac computed tomography.
    Background: Despite convincing data demonstrating the benefits of weight loss for both primary and secondary prevention of coronary heart
    disease, it remains to difficult to motivate behavioral changes resulting in weight loss. In this study, we assess whether higher CAC scores are
    associated with beneficial lifestyle behaviors resulting in weight loss.
    Methods: We evaluated 518 patients that had undergone baseline CAC testing and returned for a follow-up scan with documented weights. The
    primary end point was measurable weight loss between visit one and visit two.
    Results: The study population consisted of 518 individuals (68% men, mean age 60 +/- 8 years) who were followed for a mean of 3 +/- 2 years
    after an initial CAC scan. Overall, behavioral modification resulting in weight loss was lowest (21.8%) among those with CAC = 0, and gradually
    increased with higher CAC scores (1 to 99, 35.7%; 100 to 399, 31.5%; > or =400, 38.2%; (p <0.001 for trend). In multivariable regression analysis,
    there is a dose-response relationship between increasing CAC score and weight loss. In the group that had weight loss compared to those without
    weight loss there was a 40% increase in mean CAC score (95% CI 0.2-0.6 p400 as compared to those with a score of 0 were 2.0 (95% CI 1.1.0-3.9 p<0.001),
    3.6 (95% CI 1.7-7.3 p<0.001) and 3.3(95% CI 1.6-6.9 p<0.001) fold respectively more likely to lose weight when adjusted for age gender and race.
    Conclusions: In conclusion, in addition to risk stratification of individuals, determination of CAC may also improve behavioral modification
    resulting in weight loss.

    • Eve Harris

      Yes, I believe that’s the one

  • http://www.mightycasey.com MightyCasey

    Why I use dating analogies in my presentations to both clinical and patient audiences, exactly. Technology enables patients to gather information, after which it helps immeasurably if their doctor welcomes that approach and offers the meaning and context for that information. Then a treatment plan has a better shot at a better outcome: everyone is on the same page (literally) and communicating. Nirvana.

  • anonymous

    I’m not a big fan of calcium scans. No one has ever shown that screening asymptomatic people with calcium scans results in fewer heart attacks than simply measuring cardiovascular risk factors such as cholesterol and blood pressure.

    In addition, calcium scans expose people to radiation, to the possibility of the scan picking up “incidentalomas” that have to be followed up with more tests, and to increased anxiety in the case of people with high scores. So even if there is a benefit for some people in the form of weight loss you have to weigh that against the harms.

    Also, I guess I’m missing something but how did you conclude this was collaborative care? Couldn’t it just as easily be doctors thinking that they can scare their patients into losing weight (or taking a statin, as in a companion study that was also presented at ACC) by showing them some scary pictures? From the doctor’s point of view, what this study shows is that calcium scans improve compliance.

    • Eve Harris

      I don’t suspect doctors of trying to scare patients, because fear has already been tried and it doesn’t work to motivate healthier behaviors. If it worked, we wouldn’t be in the public health messes we’re in.

      When I look at a provider who takes time to show scans to patients and answer their questions I see patients becoming empowered and being respected –fundamentals on the collaborative care continuum.

      • anonymous

        The doctors should not be ordering calcium scans on the patients to begin with. The radiation increases their risk of cancer, and calcium scans can lead to additional tests and run up costs for our health system. Calcium scans are one of the most obvious examples of medical waste and overuse. We have other ways of deciding whether to take a statin, such as calculating Framingham risk score.

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