My fellow Guide, Trisha Torrey, recently shared a conversation she had with a doc about the idea of very savvy patients being able to take care of their own treatment. In this doc's ultimate patient scenario, these folks would even be able to self prescribe their own medications.
Trisha describes the patients she envisions would be savvy enough for such a program:
These are patients who have chronic diseases that they keep under control quite well - some MS patients, some rheumatoid arthritis patients, some diabetes patients and so forth. Over years of dealing with their own conditions they have, in some cases, become more savvy than their own doctors. They stay up on the most current research and literature, they learn from the knowledge leaders for their conditions, they know how to manage the drugs they take or the testing they do. In short, the doctor becomes simply a gatekeeper - and one that may actually get in the way of what they need instead of improving their access to what they need.
I like her utopian enthusiasm, but I have to wonder if this is really such a good idea.
I might be a little biased. As a paramedic, I get a different group of patients. By definition, my folks should be calling me during moments of crisis. They are accessing healthcare during the outliers, the moments when whatever reality they live (healthy or with chronic conditions under control, whichever) is not in balance. They need help -- or at least perceive they do -- and we're asked to provide that help either through direct treatment or by transport to a facility that can provide the treatment.
I say they should be calling me during moments of crisis because the truth is that many folks aren't in crisis when they call 911. They are in want more than need. Many of my patients want relief, either physical or emotional.
A lot of my patients have chronic conditions and reach a breaking point, calling 911 for relief in the form of narcotics or simply validation of their suffering. Many of them -- as much as 25% of our patients -- reach that breaking point every day.
Ride with a paramedic. You might be surprised to see how many of the patients calling 911 for help actually know the ambulance crew by name.
It's these patients -- the proverbial boys who call wolf too much -- who must fight for everything they need. This population includes the most clinically savvy patients we see. These are the folks who know their conditions (or the conditions of their family) and can advocate for their needs when healthcare professionals don't provide it because we're leery of their motivations.
As weird as it seems, I think this adversarial relationship is healthy. I realize it's tough for the patients, but it is this need to advocate for themselves that creates the savvy patient in the first place. Trisha asks in her blog post: "Are you someone who would be in the category of being savvy enough to handle being your own doctor? Would you step up your knowledge to be able to be one of those patients? Or are you more inclined to want to lean on a professional (doctor, nurse, NP, PA) like you do today?"
I believe if the resistance wasn't there, there would be fewer savvy patients. It's the need to be a savvy patient that drives folks to do the research and stay on top of the latest trends. You have to convince the townsfolk that the wolf really exists before you get eaten.
Patients need doctors to tell them no. There's a reason that docs, paramedics and nurses make some of the worst patients. We think we have it all figured out. Without someone to challenge you, there's no motivation to think differently.
- Maybe Some of Us Just Don't Need Doctors - Trisha Torrey
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