Category: changing health care

"What is patient-centered care?" with a photo of a provider and a patient speaking

What is Patient-Centered Care?

Posted on by Grayson

Patient-centered care has become a buzzword in healthcare in recent years, but what does it really mean? At its core, patient-centered care is an approach to healthcare delivery that prioritizes the needs, preferences, and experiences of patients. It emphasizes the importance of communication, respect, and shared decision-making in the patient-provider relationship.

While the benefits of patient-centered care for patients and providers are well-documented, implementing this approach in healthcare systems can be challenging. In this article, we will explore the definition and core principles of patient-centered care, its benefits for patients and providers, challenges and barriers to its implementation, and examples of successful patient-centered care programs.

Defining Patient-Centered Care

Patient-centered care is a healthcare approach that prioritizes the needs and preferences of patients, placing them at the center of their healthcare journey. It is a collaborative process where clinicians work with patients to address their unique needs, values, and goals. This approach emphasizes the importance of communication, respect, and individualization in healthcare delivery. It is a holistic approach that considers the patient’s physical, emotional, and social needs. This approach recognizes that patients are unique and have different preferences, values, and goals.

The concept of patient-centered care has been around for decades. It wasn’t until the 1980s that it gained mainstream attention, though. This was in response to patients’ dissatisfaction with the traditional, doctor-centered approach to healthcare that focused more on diagnosis and treatment than on their needs and preferences.

Core Principles

Patient-centered care is built on core principles that guide healthcare providers in their interactions with patients. Patient autonomy and shared decision-making are central to patient-centered care.

We know that patients have unique needs and preferences. This approach involves tailoring care to the individual patient, rather than a one-size-fits-all approach. It involves providing care that is responsive to the physical, emotional, and social aspects of a patient’s life.

Effective communication and active listening are key to patient-centered care. Healthcare providers must listen attentively to patients to understand, not to respond. Then, they work together to develop a care plan that addresses the patient’s needs and preferences.

Benefits for Patients

Patient-centered care has several benefits for patients. It leads to higher patient satisfaction rates. Patients feel heard, respected, and involved in their care, too, which leads to a more positive patient experience.

There are also a ton of links between this type of care, improved health outcomes, and reduced health disparities. When patients are involved in their care and feel empowered to make decisions, they are less likely to run into barriers around treatment. That results in better health outcomes overall and a lower likelihood of visiting the ER or being admitted to the hospital.

Most of all, this setup empowers patients to take an active role in their healthcare journey. Giving patients who have can’t control their conditions a sense of control and ownership in their care makes a huge difference. In fact, it leads to increased engagement and motivation to manage their health.

Benefits for Healthcare Providers & Systems

Patient-centered care benefits not only patients but healthcare providers as well. Provider-patient relationships improve due to better, more effective communication and collaboration. Having a more positive and trusting relationship between the healthcare provider and patient leads to better ratings.

Providers who practice patient-centered care often report higher levels of professional fulfillment and job satisfaction. This approach allows them to build meaningful connections with patients and truly see the positive impact of their work on patient outcomes. Accounting for barriers and working around them also helps providers worry less about their patients. Let’s be real – being a provider is hard. They take their work home, too.

Speaking of that, patient-centered care is linked to reduced burnout and turnover rates. A more positive work environment encourages collaboration and communication outside the exam room, too. Stress levels drop and work can feel less chaotic.

This manner of care can also lead to better ratings and fewer costs for the healthcare systems overall.

Implementation in Healthcare Systems

This isn’t just a concept. It’s a practice that healthcare organizations can incorporate into their culture. Here are a few ways healthcare systems can implement patient-centered care:

  • Create a culture that values the patient’s voice and experience. Empowering patients to be active participants in their own care can also help systems uncover barriers and issues internally. Involving patients and their families in quality improvement projects, such as Patient and Family Advisory Boards institutionalizes that work, protecting it moving forward and leading to even more improvements.
  • Offer training on cultural competency and health literacy to help providers better serve diverse populations.
  • Offer regular training to providers that is focused on patient-centered communication skills. This can improve their ability to listen, understand, and respond to patients’ needs.
  • Adapt to new technologies that allow for improved patient engagement and communication. For instance, telemedicine, remote monitoring devices, and electronic medical record portals increase engagement across the board. These technologies provide a more personalized approach to care delivery. Telemedicine in particular offers the clinicians the ability to see what a patient’s home life may be like, which can lead to addressing other barriers or socioeconomic issues.

There are many examples of successful patient-centered care programs. Some of these include the Mayo Clinic Model of Patient-Centered Care, patient-centered medical homes and primary care redesign, and the Patient-Centered Outcomes Research Institute (PCORI).

Challenges and Barriers

While patient-centered care has many benefits, there can be challenges and barriers that affect its implementation. Some insurance and reimbursement models may not incentivize patient-centered care. While this is ridiculous, it can make it difficult for healthcare providers to prioritize patient needs over financial considerations.

Language and cultural differences between patients and providers can cause misunderstandings and hinder effective communication. You can’t provide patient-centered care if you can’t relate to or center the patient in discussions.

Some healthcare providers may also be resistant to change, prioritizing traditional medical models over patient-centered approaches. This paternalism limits the adoption and success of patient-centered care. That’s especially true when healthcare systems don’t address paternalistic providers.

Future of Patient-Centered Care in Healthcare

As healthcare continues to evolve, patient-centered care will become increasingly important. As we think ahead to the future, here are some ways that this practice may show up:

  • Conducting clinical trials and further research of patient-centered care programs. This will be critical to improving outcomes and expanding successful programs.
  • Scaling of successful programs, adjusting them for different settings. What works in New York City likely won’t work in Appalachia, but we can imagine what changes we could make to improve and institute a successful program in Appalachia.
  • Increasing access to technology. This could create new opportunities for patient engagement. It may even help us to work through how changes in insurance and reimbursement models could create new challenges.
  • Developing better tools to measure patient engagement. These need to take into account issues such as socioeconomic status, oppression and discrimination, and equity issues.

Patient-centered care plays a critical role in improving the quality of healthcare delivery and patient outcomes. While it may not be easy to implement, the benefits of this approach for patients and providers are clear. By prioritizing patient needs, preferences, and experiences, healthcare providers can build stronger relationships with their patients and ultimately provide better care. As the healthcare landscape continues to evolve, it will be important to continue to prioritize patient-centered care and find new ways to meet the unique needs of patients.

#WTFix Virtual Patient Panel

Posted on by Grayson

Earlier this month, I took part in the #WTFix Patient Panel.

Not heard of WTFix? What’s the Fix? (#WTFix) is a movement focused on helping the health care industry learn from patients while inspiring people to make change through even the smallest fixes. We do this by collecting and amplifying patient stories, seeking creative ways to get people to think differently and challenging the status quo of today’s health care system.

https://youtu.be/3gZVk0CSt3Y

12 Things Your Providers Won’t Tell You

Posted on by Grayson

B&W pic of a HCP coat with blue-purple gradient text box and white text: 12 things your providers won't tell you

This November will mark my 26th year of living with chronic health conditions. I’ve had several appointments a month for the past 9 years. Working at a medical school and getting a masters degree in health care administration has given me more perspective on all of the difficulties health care providers face. I’ve learned a lot about what they have to deal with on a daily basis.

Without further ado, here are 12 things I’ve learned that providers often won’t tell you.

 

1. Insurance companies like it more if they give you a script for medications than if you go to PT.

Keep in mind that many people aren’t in favor of medications for pain right now. That said, this article about how we approach pain is WILD. Since medications are cheaper, they’re preferred – even if they’re not as effective as physical therapy, occupational therapy and more.

 

2. Insurance companies won’t generally cover alternative therapies – even if they help you.

Even medications that have been shown to be less addictive get the cut in favor of more common treatments and therapies. While that might be okay for some people, many others – like me – get a ton of relief from acupuncture. I’m lucky that I have access to a great local sliding scale clinic. In fact, that’s the only way I can afford it as often as I need it.

 

3. Insurance companies mess with their ability to provide the best care.

From refusing to cover medications and treatments to making patients jump through hoops and more, insurance companies are constantly interfering with the way providers give care.

If you want to learn more, the Global Healthy Living Foundation has done a study.

 

4. You don’t necessarily have to come to the office.

It may not always be right for mental health care, but telemedicine can be an incredibly important tool.

As a patient with both fragrance allergies and a compromised immune system, I hate going to the doctor’s office. I’ve become increasingly afraid of everything from colds and deodorant to the measles and shingles. Additionally, I’ve started working full-time not in my house! That means the travel time to and from the clinic is cramping my style.

If I had the ability to use telemedicine, I’d absolutely embrace it. It’s had some great results.

 

5. Getting enough sleep can help with a lot.

From a lack of energy to pain levels, getting the right amount of sleep can be key to improving so many things. This can be highly individualized, though. While some people need to disconnect from media to sleep well, others need the sounds and activity of podcasts or the television to catch those Zs.

Additionally, sleeping the right way can make all of the difference. Sleeping naked, for example, can be helpful to limit yeast infections by allowing genitals to breathe. Sleeping on your stomach can lead to neck and back issues. Using a pillow between your knees might help align your spine more optimally as a side sleeper.

 

6. Seeing new providers in the summer might be dangerous.

That’s the time of year residents most often begin to see patients at teaching hospitals. Being relatively new to the profession, they’re more likely to prescribe a medication that might not be the best for you.

Make sure that you question and look up medications, especially if you have concerns.

 

7. People are misdiagnosed and given the wrong medications relatively often.

According to a study in the BMJ, “diagnostic errors affect at least 1 in 20 US adults.” About half of these diagnostic errors could be fatal, especially when related to treatment.

It’s okay to push for second and third (and more!) opinions to go into situations with a sound mind.

 

8. If you’re looking to have surgery? Avoid Friday.

If you’re going to have a complication, it’ll often pop up the next day. This could leave you in the hands of people not as familiar with your case.

 

9. Medications have side effects – but so do lots of things.

Vitamins and anything ‘natural’ can interfere with your medications and even cause an uptick in some health conditions. St. John’s Wort – a staple for a lot of all-natural people – can cause heightened anxiety, fatigue, sunlight sensitivity, and more.

Just about anything you consume can have a side effect. One side effect of ice cream could be increased phlegm production. Other foods can cause heartburn, sleep disturbances, and more.

 

10. Providers generally don’t have to disclose a criminal history.

That could mean you don’t know your HCPs are violent sexual offenders like one Florida doctor. While some sites will show these things, not all do – especially if that provider has a private practice. Generally, teaching hospitals won’t hire those types of people… but they can always have their own drawbacks.

 

11. Their jobs aren’t like a 9-5.

Look, I know some patients aren’t interested in learning about provider burnout. It’s an important topic to dig into, though, because we have to remember that we’re all human here.

Not only is the weight of dealing with life and death often hard to handle, many providers don’t finish with their job during business hours. I used to work for pediatricians. They often wound up completing chart notes after dinner. This often led to staying up well into the early morning, only to be up by 6 AM to prepare for a new day.

Studies have shown having time to do things like read for fun is very helpful. While that’s great to know, when would providers find the time in that schedule? I just don’t know.

 

12. You may never be pain-free.

This can be a really tough thing to accept, so many providers just don’t broach the subject.

Pain is an alert system to draw your attention to something that needs your focus. This can start with something mundane like itching before moving on to various levels of pain.

Just because pain is inevitable doesn’t mean you should be forced to live with constant pain levels without relief. Talk with your providers about things you can try to decrease and manage your pain.

 

 

On The Passing of John McCain

Posted on by Grayson

black background with yellow textbox and black text: On The Passing of John McCain Not Standing Still's Disease

Senator and former POW John McCain died yesterday.

Scroling through social media, I’m dismayed. I keep seeing statements from people who have forgotten McCain was not a man of the people. And, me being me, I’m upset by that. McCain was not a good person, at least politically, and we need to remember that. He did a lot of harm to communities – that’s his legacy.

I don’t have to be sad that a person who spent his life harming communities I’m a part of or I support died. This man is not some amazing person to put up on a high pedestal… unless you want to praise the systematic oppression of anyone who isn’t white, cishet, rich, conservative, American-born, and the right kind of Christian.

It’s okay to speak that truth. In fact, I would say we have a duty to do so because the GOP sure as hell isn’t going to take a break from attacking marginalized communities. They’re still scheming while tweeting out their sympathies.

McCain was horribly racist. He used racial slurs and continued doing so, though less publicly. He played a major part in selling sacred indigenous land to mining companies and golf courses. He also voted against MLK day, later saying he wished he hadn’t. Of course, McCain also elevated Sarah Palin which essentially co-founded the birther and tea party movements. That led to the administration we see today, especially with prominent birther Trump in charge.

Don’t forget that this man thought the ACA repeal effort – the one disabled people put lives on the line to stop last year – didn’t go far enough. He fought like hell to stop the ACA from being put in place. Instead of working to fix it, he campaigned on repealing it after it became law. It floors me that someone who helped with the ADA and tried to pass a patient bill of rights could also be so cruel.

On a more personal note, I didn’t have insurance coverage as a child because my mother sucks. Because SJIA is a pre-existing condition, I couldn’t get insurance on my own covering my SJIA until the ACA passed. It took a few years for me to get a job with an insurance option. I can’t imagine having had to wait until then to get care.

I could have easily died if McCain got his way, either by defeating the ACA initially or repealing it. MANY people would have. I don’t have to applaud him for making it through unspeakable things when he would’ve forced many of us into not dissimilar situations.

He could have saved disabled people. We could have stayed on home instead of being arrested. We could’ve taken care of ourselves instead of spending energy on basic human rights. All he had to do was say he would vote against it. Instead he wanted to pull a publicity stunt at the last second, telling reporters to ‘wait for the show.’

While I cried in bed, wondering what the fuck me and my disabled siblings were going to do without the ACA, McCain sat grinning on the inside like a son of a bitch. He did not care that his cavalier attitude was harming people. We were confronted with losing lifelines and he treated it like a game.

I stopped seeking diagnoses for things going on. I was afraid that whatever is going on neurologically or with my heart would get diagnosed. Without protections from the ACA, I could easily lose the ability to get any current diagnoses treated. McCain literally played a part in my poor health last year.

I won’t do about McCain’s legacy. I also won’t pretend that being a POW means he was a good person. What he chose to do when he got home and involved in politics is important. He chose to harm. He was a good republican.

I won’t speak well of someone who took pride in being a selfish asshole. If you choose to do that, you should re-examine why whitewashing history is a hobby of yours.

photo of a person with long hair and a white overlay with black text: "Market with Me, Not at Me: A Patient’s Plea for Inclusionary Strategic Marketing in Healthcare" and "Not Standing Still's Disease

Market with Me, Not at Me: A Patient’s Plea for Inclusive Strategic Marketing in Healthcare

Posted on by Grayson

For the month of April, I will be sharing things I’ve written in the process of obtaining my MS in Health Care Administration which I finished up this past fall.

In the last thirty years, the healthcare system in the United States has started to shift from a paternalistic (top-down from doctor to patient) view to a more participatory (doctor and patient as equals) model.  This has resulted in great changes to the healthcare system at large, including changes from the Affordable Care Act requiring more participatory medicine.  However, there is still a long way to go in order to reach an ideal state in healthcare marketing.

While participatory changes in medicine itself may have come a long way, the same cannot be said for the pharmaceutical industry.  As healthcare systems move towards patient engagement, healthcare marketing – especially in pharmaceuticals – needs to follow suit or be left behind.  This paper will examine the current state of healthcare marketing and examine what steps organizations need to take in order to reach the ideal states according to patients, pharma, and system viewpoints.

Healthcare Marketing

Strategic marketing is a “plan for getting from a point in the present to some point in the future in the face of uncertainty and resistance” for businesses and organizations (Zuckerman, 2005, p. 3).  Creating an effective strategy involves planning, sustainability, performance improvement, quality, direction, focus, scheduling, analysis, connection, and importance (Zuckerman, 2005).

In the 1980s, healthcare advertising began to grow (Thomas, 2015, p. 13).  In the next decade, marketing within healthcare grew to include the “direct-to-consumer movement” (Thomas, 2015, p. 14).  This led to the rise of consumerism in healthcare, something that had started a few decades earlier.  By the time the 2000s came around, business and marketing practices from other organizations in the pure profit world began to stick in healthcare (Thomas, 2015, p. 16). The use of social media and internet-based marketing also began to rise.

Portions of the Affordable Care Act have “ushered in a new era of strategic planning” (Zuckerman, 2005, p. 7).  This will require a major shift strategic marketing processes for many organizations, some of which is already in the process of happening.  In combination with the ACA, the Precision Medicine Initiative from the White House, released in 2015, has helped to push the envelope in medicine.  The goal of this initiative is: “To enable a new era of medicine through research, technology, and policies that empower patients, researchers, and providers to work together toward the development of individualized care” (The White House, 2015).  The world of medicine has not done a fantastic job of staying ahead of the curve without mandates, but the pharmaceutical world has done worse.

Current State of Pharmaceutical Marketing

Profits in the pharmaceutical industry are incredibly high, up to “three times the average of all industries” (Thomas, 2015, p. 86).  This often leads to a demonization of those in pharma, especially when some medications cost “upwards of $100,000 for a full course, and with the cost of manufacturing just a tiny fraction of this, it’s not hard to see why” (Anderson, 2014).  The costs of medications are often rationalized due to the low number of medications that pan out in the long run and become profitable (Anderson, 2014).  Additionally, pharma companies want to make as much money as possible before medications are able to be reproduced as generics or biosimilars (Anderson, 2014).

Pharma has failed to keep up with demands, let alone staying at the front of innovative ideas (Brozak, 2013).  Pharma seems to rely on their background of creating a handful of one-size-fits-all medication and marketing those as cure-alls.  Just as in marketing, these companies don’t focus on the development of new ways to deliver previously developed medications (Brozak, 2013). As Steve Brozak elaborates:

Companies using new technology and evolving marketing techniques to capture markets and displace predecessors, like Wal-Mart in retailing, Zappos in footwear, Volkswagen in cars, and others, were late entrants into existing markets but eventually surpassed their competitors.  Big pharma, beware, the same could happen to you. (Brozak, 2013)

The vast majority of money spent within the pharma industry is on marketing and not research and development (Swanson, 2015).  Even more troubling, the bulk of these marketing funds are “directed at the physicians who do the prescribing, rather than consumers” (Swanson, 2015).  More than 50% of pharmaceutical expenses, roughly $13 billion, were related to contact with healthcare providers with an additional ten billion through advertisements and other contact (Thomas, 2015, p. 86).  Companies, including big names like Glaxo Smith Kline, have committed bribery in the not-too-distant past in order to get their medications prescribed (Anderson, 2014).  With pharma barons like Martin Shkreli who will price gauge life-saving medications, the reputation of pharma employees and companies continue to take hits.

There is a lot of debate in the pharma industry on whether or not direct-to-consumer marketing is effective – and if this type of marketing is truthful versus convincing the consumer they need a medication.  Unfortunately, this can lead to a number of issues within the patient-health care professional relationship – just as much as it can empower patients by encouraging them to seek treatments and diagnoses (Thomas, 2015, p. 89).  The American Medical Association, in conjunction with a number of other medical associations, has even called for an end to DTC advertising (American Medical Association, 2015).  It’s important to note that the only other nation in the world that allows DTC advertising is New Zealand (American Medical Association, 2015).

There is, of course, a unique set of ethical and legal issues associated with marketing in both pharmaceuticals and medicine in general.  Limitations have been put into place by organizations like the Federal Trade Commission in order to halt improper advertisements (Thomas, 2015, p. 26).  There has also, from a pharmaceutical point of view, been a history of inability to communicate directly with patients or patient groups as a result of some of these limitations (Coe & Deverell, 2015).  This can certainly cause issues even when these barriers have, for the most part, been eliminated as the pharma representatives aren’t used to this line of communication being open (Coe & Deverell, 2015).

Ideal State of Healthcare Marketing: Patient Viewpoint

At the time of writing this paper, Kristin Coppens was the social media lead for Spectrum Health in Michigan.  She is also a renowned patient activist, working with organizations such as Stanford University.  She had this to say:

Often, the communications and marketing industry as a whole struggles with marketing AT people versus engaging WITH them.  The same can be said about healthcare.  I understand physicians and other healthcare providers have a level of education and expertise that the patients often do not have, but I think we [patient activists] are also not saying they don’t know what they’re talking about.  Unlike the flip side of the coin, patients are not pushing an ‘us versus them’ agenda.  We just want to be included and work WITH healthcare professionals.  Some of the ways the industry could do this would be to simply bring patients into the conversation, i.e. health systems using patients as patient advocates/patient experience.  Fill those positions with actual patients.  Or you could even have a patient-led board that regularly makes patient engagement enhancements and decisions.  Another way starts in medical school.  Teach these physicians to engage with patients instead of just talking AT them with jargon.  I think it all boils down to getting patients in “positions of power” so to speak. (Coppens, 2016).

As Ms. Coppens expands on, there is a lack of recognition of patients as experts in their own experience.  In medicine in general, this can lead to the perpetuation of the paternalistic attitudes that medicine as a whole has been trying to move away from.  In marketing, this leads to a lack of connection between the product/brand and patient/consumer.  This is especially true in pharma when commercials depict unrealistic activities for someone with, say, Rheumatoid Arthritis to participate in – no matter what medications they are on.

This lack of connection adds to the demonization of those working in the pharma industry.  Patients like Ms. Coppens often believe that these companies are not focused on their wellbeing as a result of this disconnect.  If pharma doesn’t understand what it’s like to be a patient and handle the symptoms of certain illnesses, how can they display a realistic version of improvement in their advertisements?

Realistically Moving to the Ideal State

As Ms. Coppens mentions, one of the biggest barriers between patients and others within the healthcare system and pharma is how we overcome the ‘us versus them’ mentality.  One of the common occurrences in the pharma world is hiring a third-party organization to conduct market research (Coe & Deverell, 2015).  While this may be best practice in some situations, the removal and seemingly refusal of pharma reps to interact with the patients they serve contributes to this mentality.  It is great to have pharma interested in obtaining reactions of patients, but this is often done through focus groups on already-produced materials instead of including patients in the development of advertisements or other materials (Coppens, 2016).

A bonus of ensuring better brand management and interaction with patients is that there is less need for the urgent use of relationship management personnel and resources.  Obviously, though, the biggest bonus is that these changes would help to contribute to a general sense of working together and removing the demonization of each party for the other.  From a marketing standpoint, these changes have the potential to increase profit while decreasing over-prescription of these medications and, therefore, any potential lawsuits and settlements related to such medication.

Having patients involved with the pharmaceutical marketing process also has the unique opportunity of addressing a variety of quality-of-life issues while promoting medications in very pointed groups or diagnoses.  It has been proven that patients’ individual health improves with an increase of their engagement in their own care (Greene, Hibbard, Sacks, & Overton, 2015).  This can also lead to fewer admissions and readmissions to the emergency room or hospital, fewer complications, and lower healthcare costs overall (Greene, Hibbard, Sacks, & Overton, 2015).  Having patients at large involved in improving healthcare for groups of patients can have an enormous effect on the lives of patients involved as well as patients, healthcare providers, and others who are reached with this information.

One pharmaceutical group already accomplishing this is Jansen, the pharma wing of Johnson & Johnson.  Through their group Joint Decisions, a partnership with arthritis-based site Creaky Joints, they aim to educate others about what it’s like to live with rheumatic diseases, ways patients can empower themselves to become better partners in their care, ways to handle life events such as travel with illness, and more (Joint Decisions, 2016).  Patients involved with Joint Decisions are among the leading rheumatic patient activists in the Western Hemisphere and are compensated for their involvement, something that is not the norm in patient activism (personal communication, June 2015).  Through this partnership between a non-profit organization, pharma, medical professionals and patients, better materials are being released for patients living with types of arthritis.

Conclusion    

As highlighted in this paper, there has been quite a lot of change within marketing in the last several decades.  However, there is still a lot of work to be done.  This is especially true in the pharmaceutical industry.  Patients are often left out of the marketing process or only brought in on the back end after materials have already been developed.  Organizations will need to include patients more in the front end of development, which will become especially important in the future as the United States focuses more on pointed care and inclusionary medicine.  If organizations within healthcare want to follow an example, investigating the partnership occurring with Joint Decisions – pharma, healthcare professionals, and patients – will lead to new best practices for inclusionary medicine and marketing.

Works Cited

American Medical Association. (2015, November 17). AMA Calls for Ban on Direct to Consumer Advertising of Prescription Drugs and Medical Devices. Retrieved from American Medical Association: http://www.ama-assn.org/ama/pub/news/news/2015/2015-11-17-ban-consumer-prescription-drug-advertising.page

Anderson, R. (2014, November 6). Pharmaceutical industry gets high on fat profits. Retrieved from BBC News: http://www.bbc.com/news/business-28212223

Brozak, S. (2013, May 25). Big Pharma Learned The Wrong Marketing Lesson. Retrieved from Forbes: Pharma & Healthcare: http://www.forbes.com/sites/stephenbrozak/2013/05/25/big-pharma-learned-the-wrong-marketing-lesson/#7060824346c4

Coe, J., & Deverell, C. (2015, March 23-24). Amgen. (P.-e. Wrap-up, Interviewer)

Coppens, K. M. (2016, June 17). Healthcare Marketing. (K. Schultz, Interviewer)

Coulter, A. (2011). Engaging Patients in Healthcare. Maidenhead, Berkshire, England: McGraw Hill/Open University Press.

Greene, J., Hibbard, J., Sacks, R., & Overton, V. (2015). When Patient Activation Levels Change, Health Outcomes And Costs Change, Too. Health Affairs, 34(3), 431-437. doi:doi:10.1377/hlthaff.2014.0452

Joint Decisions. (2016, May). Joint Decisions. Retrieved from Joint Decisions: http://www.jointdecisions.com/

Ouschan, R., Sweeney, J., & Johnson, L. (2000). Dimensions of Patient Empowerment. Health Marketing Quarterly, 18(1-2), 99-114. doi:doi:10.1300/j026v18n01_08

Sanchez, P. M. (2003). Refocusing Website Marketing. Health Marketing Quarterly, 20(1), 37-50. doi:doi:10.1300/j026v20n01_04

Swanson, A. (2015, February 11). Big pharmaceutical companies are spending far more on marketing than research. Retrieved from The Washington Post: https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-pharmaceutical-companies-are-spending-far-more-on-marketing-than-research/

The White House. (2015). The Precision Medicine Initiative. Retrieved from The White House: https://www.whitehouse.gov/precision-medicine

Thomas, R. K. (2015). Marketing Health Services. Chicago, IL: Health Administration Press.

Weber, L. J. (2006). Profits Before People?: Ethical standards and the marketing of prescription drugs. Bloomington: Indiana University Press.

Zuckerman, A. M. (2005). Healthcare Strategic Planning. Chicago, IL: Health Administration Press.

white background surrounded by a blue outline with blue text: "The Economics of Patient Engagement"

The Economics of Patient Engagement

Posted on by Grayson

For the month of April, I will be sharing things I’ve written in the process of obtaining my MS in Health Care Administration which I finished up this past fall.

For this paper, several terms not generally utilized in economics will be needed necessitating definitions of these key terms.

Shared-decision making (SDM) is a term utilized in opposition to paternalism.  The latter is a form of practicing medicine in which the physician dictates what the patient is supposed to do without taking into account what the patient’s lifestyle is, the patient’s opinion, or other factors.  The former is a form of practicing medicine that is gaining traction and requires the physician to work alongside the patient in order to come to a mutually agreeable decision.  Informed Consent is needed in order to form this decision, meaning that the patient needs to receive education – from the healthcare team or elsewhere, but preferably the former – in order to give consent for treatment.

Quality of Life is a term that can mean many things to individuals.  Overall, this is how well a patient is able to live their life.  Many items can factor into the Quality of Life (or QOL) from whether a medication is an injectable or an infusion to how often blood tests are required to the efficacy of treatments to even more.

Adherence or compliance is how closely a patient may stick to their treatment regime.  There are, however, a variety of things that can affect a patient’s adherence or compliance to any given regime, including but not limited to transportation, access, cost, childcare, Quality of Life, health literacy, socioeconomic status, and social support.

Patient Engagement is how involved a patient is in their medical care.  This can be affected by health literacy, socioeconomic status, education, access, cost, Quality of Life, rapport with clinic/hospital staff, insurance, social support, and how involved their healthcare team is with shared decision making as opposed to paternalism. The Patient Activation Measure is a way to measure Patient Engagement via “a valid, highly reliable, unidimensional, probabilistic Guttman-like scale that reflects a developmental model of activation” (Hibbard, Stockard, Mahoney, & Tusler, 2004).

Patient Protection and Affordable Care Act

In March of 2010, the Patient Protection and Affordable Care Act (PPACA) was enacted (Healthcare.gov, n.d.).  Two of the biggest draws for the consumer side were the requirement for insurance plans to cover people with “pre-existing health conditions, including pregnancy, without charging more” and making it “illegal for health insurance companies to cancel your health insurance just because you get sick” (Healthcare.gov, n.d.).  Additional draws include giving younger adults more options including the ability to stay on their parents’ insurance plans up to age 26, education about the coverage a patient is receiving, and regulations placed on insurance companies surrounding increasing premium rates (Healthcare.gov, n.d.).

One of the innovations of the PPACA has been the “shifting from a reimbursement system based on the volume of services provided to one based on the value of care” (Abrams, et al., 2015).  The shift from fee-for-service to pay-for-performance is a great idea in order to bring more of a focus on quality to all parts of healthcare.  Sending a “clear signal to providers that they will need to adapt quickly to incentives that reward appropriate, high-quality care and good patient outcomes” has already begun to make improvements (Abrams, et al., 2015).

Among the many improvements already noted with the PPACA is “lowered annual increases in Medicare payment rates for hospitals and other facilities” (Abrams, et al., 2015).  As we are reminded of constantly, the reserved funds for Medicare and Social Security are running out of money (Reuters, 2016).  Paying out fewer dollars to providers can potentially help to extend the life of these programs by a few years.  Even overpayments to “private plans administering Medicare benefits through the Medicare Advantage program,” which will help with this as well (Abrams, et al., 2015).

Quality has directly been targeted as well (Abrams, et al., 2015).  Hospitals with high rates of “adverse medical events,” or such as Hospital Associated Infections (HAIs), have begun to be fined for subpar performance on key quality metrics (Abrams, et al., 2015).  Other innovations to improve quality include the Center for Medicare and Medicaid Innovation (CMMI), the Patient-Centered Outcomes Research Institute (PCORI), the Medicare-Medicaid Coordination Office, and the National Strategy for Quality Improvement in Health Care (Abrams, et al., 2015).

With education surrounding a patient’s coverage as well as the emphasis on quality, the theory has been that the PPACA will be able to increase a patient’s engagement with their own health.

Patient Engagement

Several studies have shown that increased Patient Engagement as measured by the Patient Activation Measure lead to overall improvements in health as well as economic benefits.  In addition, healthcare is moving towards Patient Engagement per request from patients and patient-led organizations.

Patients who are more activated or engaged in their own healthcare take part in more preventative measures such as check-ups than their less-engaged counterparts (Hibbard & Greene, What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs, 2013).  These same patients do not delay seeking medical care and have a higher likelihood of having better overall health (Hibbard & Greene, What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs, 2013).  These patients are also more likely to have better healthcare experiences when seeing the same physicians as their less-activated counterparts (Greene, Hibbard, Sacks, & Overton, When Seeing The Same Physician, Highly Activated Patients Have Better Care Experiences Than Less Activated Patients, 2013).  Patients who had more provider support in education and participated in more shared decision-making processes with their healthcare team were more engaged in their own care (Greene & Hibbard, Why Does Patient Activation Matter? An Examination of the Relationships Between Patient Activation and Health-Related Outcomes, 2011).

One study in Minnesota showed that “for every additional ten points on a Patient Activation Measure score, the predicted probability of having an emergency department visit was one percentage point lower” (Hibbard & Greene, What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs, 2013).  Taking this further, patients who were not as engaged as seen on the Patient Activation Measure had “significantly higher costs than more activated patients” (Hibbard & Greene, What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs, 2013).  Activated patients also had fewer emergency department visits and hospital readmissions, leading to lower costs overall (Greene, Hibbard, Sacks, Overton, & Parrotta, When Patient Activation Levels Change, Health Outcomes And Costs Change, Too, 2015).

Intersectionality and Further Issues

There are some issues with Patient Engagement/Activation in that several barriers exist to many people achieving this state.  While similar expectations and wishes for physicians happen across racial and ethnic groups, differences in experiences are still reported (Welnick, et al., 2011).  This still occurs with other variables such as education status, socioeconomic status, gender identity, sexual orientation, age, and more (Millenson, 2016).  In the pediatric world, these barriers are often necessary to work around and work with in order to provide the most exceptional care to the patients as needed.  Several of these barriers can be worked around to increase engagement and education through understanding and education (Cox, et al., 2012).

Conclusion

The benefits of Patient Engagement far outnumber any negatives one might be able to find.  While there are difficulties in making changes in order to put programs in place, there are few negatives to even be found.  From an economic standpoint, the pay-for-performance principle instituted by the PPACA can be a vehicle for moving healthcare to focus more on Quality of Life and Patient Engagement.  Costs can be expected to increase in the short-term in order to provide education to both healthcare providers and patients as well as setting up a system to measure the efficacy of these efforts.  However, in the long-term, these costs can be expected to go down as Patient Engagement and Activation become the norm across the country.

References

Abrams, M. K., Nuzum, R., Zezza, M. A., Ryan, J., Kiszla, J., & Guterman, S. (2015, May 7). The Affordable Care Act’s Payment and Delivery System Reforms: A Progress Report at Five Years. (C. Hollander, Editor) Retrieved from The Commonwealth Fund: http://www.commonwealthfund.org/publications/issue-briefs/2015/may/aca-payment-and-delivery-system-reforms-at-5-years

Greene, J., & Hibbard, J. H. (2011, November 30). Why Does Patient Activation Matter? An Examination of the Relationships Between Patient Activation and Health-Related Outcomes. Journal of General Internal Medicine, 520-526.

Greene, J., Hibbard, J. H., Alvarez, C., & Overton, V. (2016, March/April). Supporting Patient Behavior Change: Approaches Used by Primary Care Clinicians Whose Patients Have an Increase in Activation Levels. Annals of Family Medicine, 148-154.

Greene, J., Hibbard, J. H., Sacks, R., & Overton, V. (2013, July). When Seeing The Same Physician, Highly Activated Patients Have Better Care Experiences Than Less Activated Patients. Health Affairs, 1299-1305.

Greene, J., Hibbard, J. H., Sacks, R., Overton, V., & Parrotta, C. D. (2015, March). When Patient Activation Levels Change, Health Outcomes And Costs Change, Too. Health Affairs, 431-437.

Healthcare.gov. (n.d.). Health Coverage Rights and Protections: Rights & Protections. Retrieved from Healthcare.gov: https://www.healthcare.gov/health-care-law-protections/

Healthcare.gov. (n.d.). Patient Protection and Affordable Care Act. Retrieved from Healthcare.gov: https://www.healthcare.gov/glossary/patient-protection-and-affordable-care-act/

Hibbard, J. H., & Greene, J. (2013). What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs. Health Affairs, 207-214.

Hibbard, J. H., Mahoney, E. R., Stock, R., & Tusler, M. (2007, August). Do Increases in Patient Activation Result in Improved Self-Management Behaviors? HSR: Health Services Research, 42(4), 1443-1463.

Reuters. (2016, June 22). Medicare Is Going to Run Out of Money a Lot Sooner Than Expected. Retrieved from Fortune: http://fortune.com/2016/06/22/medicare-reserves-exhausted-soon/

Skolasky, R. L., Mackenzie, E. J., Riley III, L. H., & Wegener, S. T. (2009, December). Psychometric Properties of the Patient Activation Measure among Individuals Presenting for Elective Lumbar Spine Surgery. Quality of Life Research, 1357-1366.

black background with dark purple border; white text under illustrations of pills: "The Need for Big Pharma Reform: How the Industry Can Improve in the Wake of the Opioid Crisis" and "Not Standing Still's Disease"

The Need for Big Pharma Reform: How the Industry Can Improve in the Wake of the Opioid Crisis

Posted on by Grayson

Healthcare reform continues to be a topic of discussion throughout the country. Multiple attacks on health benefits, Medicaid & Medicare, and other health-related entities continue to pop up seemingly every day. Bills to help ease the burden on patients as well as keep companies more accountable fail to go anywhere as party lines remain divided. With the opioid crisis going on, one thing that hasn’t gotten enough press is one health-focused initiative has united over 450 municipalities across the country.

Cities, states, and counties have filed lawsuits against 23 drug companies and distributors for the roles they’ve played in the ongoing opioid epidemic. The crisis claims over 100 lives per day due to opioid overdoses, and it shows no signs of slowing down. In 2015, there were enough opioid painkillers prescribed to treat every American continuously for three weeks.

These lawsuits will likely be the court cases to watch this year, and many suits specifically call out OxyContin maker Purdue Pharma. Ohio’s lawsuit, for example, blames the company for trivializing “the risks of opioids while overstating the benefits of them for chronic pain.” Johnson & Johnson, Teva Pharmaceuticals and distributors including CVS and Walgreens have also been assigned blame.

As we watch the pharmaceutical industry come under fire for its involvement, it’s hard not to wonder how other Big Pharma practices could potentially lead to more crises down the road. As states’ efforts to combat the epidemic get underway, let us consider the areas of the industry that prioritize profits over patients in the hopes of encouraging future reforms.

First and foremost, it’s time to bring clinical trial issues into the limelight. Drug companies can misrepresent their drug’s clinical trial evidence in order to see it brought to market. Although this may be seen as a win for innovation, it often puts patients at risk.

Take Purdue Pharma’s clinical trial for the powerful opioid OxyContin. Evidence from the trials contradicted the pharmaceutical giant’s marketing claims that the drug could provide 12 hours of relief. Patients in the studies were actually unable to manage their pain for that length of time under the recommended dosage, and doctors filed complaints after the drug’s debut in 1996.

But, Purdue was dependent on this 12-hour relief because it allowed the company to have a competitive advantage over other options on the market. The manufacturer continued to stand by its marketing claims, blaming any wear-off of relief on too low of a dosage. The CDC warns that higher doses, which Purdue encouraged, could lead to increased risks when taking the drug, such as dependency and addiction. And so the epidemic began.

This misrepresentation of a drug’s clinical trial data isn’t just tied to the opioid crisis. It extends into common and often life-saving medications as well. In the case of newer anticoagulant Xarelto, manufacturers Johnson & Johnson and Bayer withheld data from its industry-funded clinical trial that would have implicated the blood thinner as less safe than more traditional options.

In the face of misleading evidence, the medication was approved in 2011 without an antidote to reverse its blood-thinning effects. The veil of supposed patient safety was lifted when thousands of individuals suffered internal bleeding complications and even death after being prescribed Xarelto. Similar to Purdue being blamed for its involvement in the opioid crisis, Johnson & Johnson and Bayer are embroiled in lawsuits because of Xarelto’s dangerous side effects.

Perhaps the most disconcerting is the amount of money Big Pharma pumps into its lobbying efforts. The pharmaceutical/health industry saw a 12.4% increase in its lobbying spend from 2016 to 2017, and the industry as a whole spends the most out of any other business sector. Although lobbying is a legal activity meant to serve as a means for citizens to have their concerns addressed to members of Congress, these high monetary donations can often sway lawmakers and influence policies to allow drug companies to stay focused on their profit margins.

Again, the opioid crisis serves as the backdrop for why Big Pharma should make reforms. Multiple states have attempted to pass laws that would limit opioid prescribing habits, but these efforts have been met with severe pushback from drug companies. The Pain Care Forum, funded by the industry, spent upwards of $740 million over the past decade to lobby against these laws aimed at halting the crisis. It’s evident that Big Pharma’s deep pockets and profit-focused mentality influence more than just the medications we’re being offered. It can have a direct impact on the very extent of our healthcare.

It will take many efforts on multiple fronts to bring about an end to the opioid epidemic, but thankfully these efforts are now underway. For one, the overdose antidote naloxone has become more widely available and discussions of pain management approaches, especially for those who suffer from chronic pain, are finally taking place. But, the greatest approach we can and should consider is reforming the very industry that is supposed to be an advocate for our health.

Only then will we stand a chance of making real progress in the name of healthcare.

Morgan Statt is a health & safety investigator who spends her time writing on trending news, consumer health, and public safety topics. When she isn’t researching, she can be found crafting Spotify playlists for every life situation. Follow her on Twitter @morganstatt. 

Repealing the ACA will kill disabled people

Posted on by Grayson
With the proposed changes coming to healthcare, I can’t afford to tiptoe around the situation.
Repealing the Patient Protection and Affordable Care Act will kill disabled people.
50 million Americans with disabilities depend on the protections that the ACA provides. The CDC recently came out with statistics that show that nearly half of all Americans live with at least one chronic illness – and they depend on the ACA, too.
Before the ACA went into effect – before I even started this site – I was uninsured for a while. While my father kept insurance on me until I was 18 as a part of child support, mother didn’t utilize it at all. Without continuity of care, I suffered immensely – not just pain but issues that wouldn’t have happened had she gotten me the right (or any) medical care.
Once I hit 18 and got into college, I was concerned about what to do. I knew I needed to get medical care but couldn’t afford anything.
2007 Kirsten
When I met T, I started trying to get quotes from insurance companies. I was very upfront about the fact that I had multiple chronic illnesses… which led to a lot of sad phone calls and emails. One memorable phone call with one representative got me to give up. I was told that it would be $2200 a month for coverage and that it would not cover anything related to my pre-existing conditions.
Since my diseases affect every single part of my body, there was no point to this. I obviously couldn’t afford it anyway.
I eventually was able to get coverage through our college’s partnership with an insurance company. It didn’t cover much, though, and I began to go into medical debt quickly. Luckily, some of that was forgiven as the hospital I saw my first adult rheumatologist at had a great forgiveness plan for us poor people.
 
Thank you Froedert Hospital.
Still, it was a constant fight. I had to get things rediagnosed or diagnosed at all. This meant far more visits than the average person has in a year with the accompanying blood draws and everything. I moved which meant transferring that care and then dealing with insurance not covering a lot…
which meant more medical debt (that we only recently paid off).
I’m lucky enough that I’m married to someone whose insurance covers me. It’s good insurance and allows me to have access to the specialists I need to see.
Not everyone is so lucky.
 
Others with disabilities or chronic illnesses rely on more services than I usually need. Others are better at seeking out the care they need than I am. Others simply have different needs that wind up costing more like wheelchairs and other equipment – along with the medical visits for physical therapy, etc.
Hell, if T and I ever got divorced? I’d be practically as good as dead. There are worries that these efforts will force those of us who need healthcare access to stay in abusive relationships because, like me, they need that coverage.
My family will still be affected by the ACA repeal. People in my family or group of friends will lose medical care making access to the life-saving medications and treatments they need nearly impossible. More people will go bankrupt or lose their homes as a result of medical issues. Others will no longer be able to afford to live in more accessible housing, accessible transportation, and more.
 
Some will die.
The ACA provides protections for many people – things that are often overlooked when we talk repeal.
It provides access to free contraception, yes, and better access to reproductive health care – but it also allows children up to age 26 to stay on their parents’ insurance plans.
It provides coverage for people through subsidies, but also (finally) makes good on a centuries’ old promise to Native Americans to cover their health needs.
Clinics in rural areas who depend on the ACA protections to keep them going will go out of business and jobs will be lost.
The things I care about the most? CHIP – the Children’s Health Insurance Program – and coverage for our pre-existing conditions? Those were basically just dumped.
 
If little Kirsten was young today and lived with a parent that wasn’t abusive? She would be incredibly screwed.
It’s not enough for those now running our nation to take progress back – they have to enact legislation that will remove protections for those of us with disabilities and pre-existing conditions. They have to kill us before they’ll be happy.
 
Write to your legislators. Call them. Tell them how this will affect you and nearly half the nation. Tell them that, like me, you’re not ready to die for their petty politics and racist ideologies.
 

 

5 Questions to Ask a New Doctor

Posted on by Grayson
We’ve all been there – you’re sitting at home the night before seeing a new physician and trying to prep. You’re not sure what questions you should ask them and, frankly, you’re more concerned with trying to express your entire medical history in half an hour.
Fear no more! Here are my 5 most important questions.
Do you believe in XYZ diagnosis?
Fibromyalgia has a history of not being believed as a diagnosis. There are, unfortunately, many doctors who still believe this is a fake diagnosis essentially for female hysteria and hypochondria.
If you encounter an older male doctor especially and have fibro, ask this question.
Do you feel comfortable taking on my case?
This is more applicable than the above for most people. Humans are complicated beings. We have multiple medical/health issues, sources of stress, medications, and more. For those of us with rarer conditions, this is a pivotal question to ask.
When I was investigating new rheumatologists this time two years ago, I called an office and asked if they could see if this doctor would be comfortable seeing someone with my conglomeration of fun things. I expected to get a call back from a medical assistant during a lull or maybe the nurse, but doc called me back. She wanted to ask more and we have a pretty long conversation.
She outlined for me right away what she would do, what she would avoid, and more. She was upset that I wasn’t on one of the SJIA-approved medications and wanted to try Kineret/Anakinra right away.
Needless to say, the amount of care she took in speaking with me before I was even her patient led to my decision to see her.
What is your communication style like?
I think it’s important for people to at least be aware of communication preferences or styles that we each may have. This is important in any relationship but can be vital in healthcare.
I mean, this stuff gets into life and death sometimes y’all.
My rheumy and I utilize the electronic medical record system known as MyChart. It’s a widespread EMR system that is fully customizable and happens to be local-ish for us, too. It winds up being like sending an email and is pretty secure. In her office, I usually get same-day responses or (rarely) may have to wait until the next day.
In other offices, it can take up to a week for a response.
This is definitely a part of why it’s important to see what your doc wants to know in what way(s).
When XYZ happens, do you prefer I contact you or another physician?
This is one that I frankly need to ask all my current healthcare peeps.
I see my rheumy and related healthcare providers most often. This means that I sometimes am not sure who I should alert about certain things. Sure, things like sinus infections, etc, usually wind up warranting a trip to urgent care since I’m on immunosuppressants. Injuries do, too, due to their severity, like when I split open my foot.
But what about a new symptom that could be a rheumy thing? Do I go GP first, even though she’s really inaccessible as far as schedule?
Some people really rely on their specialists due to the crummy quality of their primary care selection. I once had an old PCP tell me 1) this abscess I clearly had was a pimple, and, 2) to take my biologic as scheduled.
He also laughed literally in my face during that, so he was definitely fired.
The point is, we have to start asking this. It’s just as important as who to contact first in an emergency.
Are my medications ones that you feel comfortable prescribing?
This is one that I wish I had asked before seeing my new rheumy. The non-steroidal anti-inflammatory (NSAID) and Lyrica that I take several times daily aren’t things doc feels awesome about. That said, she knows I might not be alive without them, so she prescribes them but always with a goal of lowering them eventually.
The supply muscle relaxers I had ‘just in case’ is currently dwindling and she’s not down with prescribing those like my last doc was.
This is something that I will have to ask my primary care doctor about instead. I believe that she would be down with that, especially if I were to tell her how long this last bottle has really lasted.
What questions do you ask new healthcare peeps? Are there any you’ve learned to ask the hard way?

 

Book Review: When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests by Leana Wen & Joshua Kosowsky

Posted on by Grayson

I first learned about Dr. Leana Wen from Stanford’s Medicine X conference. She’s presented to their courses as well on the power of the patient narrative. So when I found this book written by Leana and Dr. Kosowsky, I knew I needed to pick it up.

The goal of this book is to help educate patients on the questions to ask and things to do to avoid being misdiagnosed, unnecessary tests, and unneeded hospital stays.

One of the biggest issues in the last decade, according to Wen & Kosowsky, is the turn to the cookbook approach to health care. You have symptoms A, B, and C, so you must have disease AB. The era we’re in now with this approach is what they refer to as the Era of Depersonalized Diagnosis (the previous eras were Spiritual Healing & Magical Thinking, Early Empiricism & Disease Classification, and the Golden Age of Medical Diagnosis).

This cookbook approach to health care does not work for most. An example was given of a middle aged guy who came to the ER with chest pain… who had also been moving furniture recently. They kept him in the hospital overnight to run tests despite the fact that his practitioners didn’t think he had a heart attack and earlier tests basically showed that he had not.

The best way to fix these types of mistakes? By getting back to the importance of the doctor-patient relationship, of course!

When you go to the ER (or a doctor, but especially in the ER), they essentially want to find your chief complaint and narrow that down to 1-2 words (i.e., chest pain, hip pain, etc). These can often be paired up with pathways, or basically recipes that the doctors have been told to/feel they have to follow to eliminate big picture issues (i.e., heart attack, etc). Oftentimes, the correct chief complaint isn’t entered because someone hears something like chest pain and assumes that is the chief complaint and then follows the pathway. As a patient, you really have to make sure that you assert yourself, which also means asking why docs may be reacting to your story in such a way.

One of the things I loved most about this book was the different sections. There was one about patient stories, and those stories were used throughout the book as examples. There was another about a crash course on diagnosis, a prescription for patients, and another on the pillars to a better diagnosis. Every single section recapped information at the end, which is always great for those of us who have some memory or brain fog issues.

A big takeaway from this book is the advice Drs. Wen & Kosowsky give to patients. There is everything in here, from making sure doctors hear you (and what to do if they don’t) to making sure you have a working diagnosis before you leave to bringing up what you are most worried about to putting your symptoms in the context of YOUR life. Saying your hands hurt and lock up is one thing, but talking about how hard it is to live your day to day live because you can’t bathroom/cook/take care of your pets or kids is another.

The eight pillars to a better diagnosis are: tell your whole story, assert yourself in the doctors’ thought process, participate in your physical exam, make the differential diagnosis together, partner for the decision making process, apply tests rationally, use common sense to confirm the working diagnosis, and integrate the diagnosis into the healing process.

All in all, this book helps to get patients engaged and involved in their own health care – something that has been missing for some time and is also sorely needed. Drs. Wen & Kosowsky even point out that patients often feel as though it isn’t our place to tell the educated white coats they’ve got something wrong – or perhaps worse, to question them.

It’s time that we start becoming active and involved with our bodies, from what we eat to how we exercise to what we perceive as normal (regarding looks, etc) to the health care we receive. If you’re looking for a book to help you get started on that, look no further. This book is one of the better ones I’ve been able to read in a long while – go pick it up!