Too many people, on both sides of the doctor-patient relationship, still think of healthcare as a service industry, according to Danny Sands, MD, founder of the Society for Participatory Medicine.
But that "carwash model" model doesn't work, said Sands, speaking Friday afternoon at Healthcare IT News' Pop Health Forum 2016.
Healthcare is "not a service industry, it's a collaboration," he said. "Healthcare cannot be successful unless both parties are involved in what's going on."
Among the conditions needed for successful doctor-patient collaboration he said: open communication, shared decision-making, mutual respect, information sharing and engagement.
Sands co-founded the Society for Participatory Medicine with an ambitious goal in mind: effecting a fundamental rethinking of how patients interact with the healthcare industry, helping them "shift from being mere passengers to responsible drivers of their health."
That's happening now. But only haltingly. The full transformation will take some doing, as the old visit-centric model – based on treating acute conditions as they arise, temporary fixes until the next time – is so ingrained.
Sands quoted Edward H. Wagner, MD, senior investigator at Group Health Research Institute:
"Our care systems were organized historically to respond rapidly and efficiently to any acute illness or injury that came through the door," said Wagner. "The focus was on the immediate problem, its rapid definition and exclusion of more serious alternative diagnoses, and the initiation of professional treatment.
"The patient’s role was largely passive," he added. "Since the full clinical course often played out over days or weeks, there was little urgency to develop patient self-management skills or tracking programs. Most practices continue in this vein despite the rapid aging of the population and growing prevalence of chronic disease."
There's been a lot of talk in recent years about patient engagement as a key enabler of better quality outcomes and more cost-efficient care – the "blockbuster drug of the 21st Century," in the oft-quoted coinage.
But Sands offered some historical perspective that showed sentiments such as those have been in currency for some time. He pointed to another quote, from renowned informaticist Warner Slack, MD, professor of medicine at Harvard Medical School. "The largest and least utilized healthcare resource is the patient him/herself."
"He wrote this in 1976," said Sands. "We're still having these conversations."
Sands said he was hugely optimistic about the future, however, with patient-generated data, biometrics and connected devices auguring big changes in how populations track their wellness.
Yes, on the clinical side, "we need systems to help separate the signal and the noise and single out important trends," said Sands. But these new tools offer unprecedented opportunities to move past a visit-centric framework whose failings – $200 billion in avoidable chronic condition costs, $125 billion spent on routine tests, to name just two he cited – have been obvious for so long.
"Health," said Sands, "happens between visits."