Wide ranging discussions are ongoing about how to systemically improve the collection and analysis of clinical information via electronic medical records and other forms of health IT. In addition there are more focused discussions about how to improve physician patient relationships. However, when a friend told me how a communication failure with her physician left her with less than optimal treatment instructions, I was reminded that at the very micro level there are additional communications issues that need to be examined.
Here’s the story: My friend had a temporary and rather minor – but certainly annoying – skin problem, and her doctor advised her that hot/moist compresses would be the best thing, and that she should wrap a potato in a paper towel and “zap it,” and then apply this to where she had the skin issue. The problem is that my friend doesn’t have a microwave – which is presumably what her physician meant by “zap it,” – and my friend, who is a university professor, didn’t want to get into a discussion about why she doesn’t have a microwave at home. (It’s because she’s an old school cook.) So rather than ask about other options, etc., she just let it go and left with advice that she couldn’t really use. (Yes, she understood hot/moist compress, but what the potato has more mass which stays hot and moist longer than just a washcloth or paper towels – and my friend is a social scientist not a physicist.)
Now, I realize that there are other ways to make a hot/moist compress and to heat a potato, (which I discussed with my friend), but this simple situation illustrates the need for individualized care and full communications between the physician and their patient. For example, if my friend had been homeless or living in a shelter, would the physician then recognized that she might not have access to a microwave or a potato? Probably so, but it still leads back to the conclusion that asking patients if they have any questions about what they are supposed to do to treat their ailments – or to even have them repeat back the instructions – and ask them if there are anything in the instructions that they might have trouble doing, are important for physicians to consider doing. Will this take more time? Yes. Will it help ensure that patients are actually getting the “treatments” that they should? Yes. It is really any different that asking patients if they can afford to buy a prescription medicine or checking to make sure that the specific medicine is on their health insurer’s formulary? No.
These are factors in delivering quality healthcare that can only partially be addressed with technology, i.e. the formulary issues certainly can be. But I’m fairly certain that most electronic medical records don’t have a question or check-box for “microwave available to patient,” but these types of capabilities and non-medical types of factors are important for patients health and quality of life, and thus need to be considered by physicians’ offices as they provide comprehensive care (and not just medical services) to patients. These are the types of issues that the “medical home” model tries to encompass by expanding the physician’s responsibility for their individual patients and emphasizing patient education through broader teams of healthcare professionals.