I've been a patient lately. Not just for preventive care, which I've been good about getting when I was working in public health, teaching, or doing telemedicine, but which has been near-impossible to get done when practicing medicine full time. Lately it's been appointments, surgery, follow-up, radiology, specialized tests, more appointments, texts, phone calls, and lots of different and incompatible electronic medical records. It's a mess. I'm as good as an American can be at navigating the health system and advocating for myself, and it's impossible. I cannot get the medical and preventive care I need. Not and keep a job. We must stop looking at the solution as incremental change to the existing structure. None of it works. For my care to be patient-centered, here's what I need:
1. All of my medical records in the cloud, secure and accessible TO ME and, when I give them permission, to doctors, nurses, and hospitals.
2. Medical care will always start with discussions via a secure interface similar to Facetime or Skype with my doctors on MY SCHEDULE so that I can keep working and meeting my job requirements. Telephone calls and texts when those are enough to get my questions answered and concerns addressed. Office visits should be rare and only when there must be a physical exam that cannot get done at my workplace or home.
3. That my device data (Apple watch, Fitbit, etc) will feed into my electronic health record with regular updates (daily or more often). For people with diabetes, their glucose monitor data; for those with hypertension, their BP readings. All of the device data. And peak flows for asthma, medication doses taken and when, etc. All of the information goes into the record.
4. Y'all figure out and agree on what I should eat for optimal health. Once it's determined what I should be eating, send menus, ordering instructions for restaurants, and grocery lists to my electronic health record and my phone.
5. Bring vaccines to me - to my workplace (also to schools, churches, public sites). The local public health department should do this. That's who should do all vaccines. Then upload the shot record to my medical record. Do this regularly - monthly or more- so that everyone can be up to date on all vaccines all the time. Nurses handle all preventive care - schedule tests, do the counseling, order the screening. Do this on my time and be at my workplace (school, church, etc) so it gets done without me having to take time off work.
6. When I do need to talk with or visit a doctor or hospital, or schedule a visit/procedure/radiology/lab test, I can get into their scheduling interface and make the appointment myself. Best if it allows interface with my work calendar so I can avoid conflicts automatically and not have to match two calendars.
7. House calls for illness and for preventive interventions that require in-person visit with a doctor or nurse. Nurses should start the process, do all they can, and only bring in the doctor in when needed.
8. Deliver my medications to my work or home and keep them at the right temperature/humidity at all times. (I don't think mail delivery can do this - will need a courier). Refill them on time and check with me about whether I need each refill (a text system will work)
9. Videochat psychotherapy, social work, patient education, speech therapy, advanced directive and complex care discussions - any care that is all talk.
10. Lab draw sites at workplaces and in convenient locations (schools, churches, public buildings), many of them so easy for all to access. Clear instructions that patient can see about which tubes are for which test, so we can avoid having to return for the wrong tube being drawn. All lab results to the patient, then shared with the doctor as the patient directs. Same for all other test results.
11. Tailored and realistic exercise prescriptions. The insurer negotiates with employers (if we keep private insurance) that opportunities for prescribed exercise (and healthy food) be at the worksite.
12. Scientifically-valid guidance easily available for minor illness, and quick access to a conversation with a nurse (with video) to determine appropriate site and type of care.
What do you need? Let's draw a health care system from scratch and stop assuming we must continue with any existing structure. It's not working for anyone except insurance company and health system executives. Let's make them work for us instead of us jumping through their hoops.
1. All of my medical records in the cloud, secure and accessible TO ME and, when I give them permission, to doctors, nurses, and hospitals.
2. Medical care will always start with discussions via a secure interface similar to Facetime or Skype with my doctors on MY SCHEDULE so that I can keep working and meeting my job requirements. Telephone calls and texts when those are enough to get my questions answered and concerns addressed. Office visits should be rare and only when there must be a physical exam that cannot get done at my workplace or home.
3. That my device data (Apple watch, Fitbit, etc) will feed into my electronic health record with regular updates (daily or more often). For people with diabetes, their glucose monitor data; for those with hypertension, their BP readings. All of the device data. And peak flows for asthma, medication doses taken and when, etc. All of the information goes into the record.
4. Y'all figure out and agree on what I should eat for optimal health. Once it's determined what I should be eating, send menus, ordering instructions for restaurants, and grocery lists to my electronic health record and my phone.
5. Bring vaccines to me - to my workplace (also to schools, churches, public sites). The local public health department should do this. That's who should do all vaccines. Then upload the shot record to my medical record. Do this regularly - monthly or more- so that everyone can be up to date on all vaccines all the time. Nurses handle all preventive care - schedule tests, do the counseling, order the screening. Do this on my time and be at my workplace (school, church, etc) so it gets done without me having to take time off work.
6. When I do need to talk with or visit a doctor or hospital, or schedule a visit/procedure/radiology/lab test, I can get into their scheduling interface and make the appointment myself. Best if it allows interface with my work calendar so I can avoid conflicts automatically and not have to match two calendars.
7. House calls for illness and for preventive interventions that require in-person visit with a doctor or nurse. Nurses should start the process, do all they can, and only bring in the doctor in when needed.
8. Deliver my medications to my work or home and keep them at the right temperature/humidity at all times. (I don't think mail delivery can do this - will need a courier). Refill them on time and check with me about whether I need each refill (a text system will work)
9. Videochat psychotherapy, social work, patient education, speech therapy, advanced directive and complex care discussions - any care that is all talk.
10. Lab draw sites at workplaces and in convenient locations (schools, churches, public buildings), many of them so easy for all to access. Clear instructions that patient can see about which tubes are for which test, so we can avoid having to return for the wrong tube being drawn. All lab results to the patient, then shared with the doctor as the patient directs. Same for all other test results.
11. Tailored and realistic exercise prescriptions. The insurer negotiates with employers (if we keep private insurance) that opportunities for prescribed exercise (and healthy food) be at the worksite.
12. Scientifically-valid guidance easily available for minor illness, and quick access to a conversation with a nurse (with video) to determine appropriate site and type of care.
What do you need? Let's draw a health care system from scratch and stop assuming we must continue with any existing structure. It's not working for anyone except insurance company and health system executives. Let's make them work for us instead of us jumping through their hoops.
Comments
Post a Comment