Want Your Patients to be More Independent? The Answer is Simple: More Simplicity

Derick Alison
Derick Alison
7 Min Read

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    Fred Pelzman is an associate professor of medicine at Weill Cornell, and has been a practicing internist for nearly 30 years. He is medical director of Weill Cornell Internal Medicine Associates.

Isn’t it time that we start to trust our patients and give them a little bit of autonomy?

Why is it that we created a world where to get the things that matter for their health, they have to go through so many steps, cross so many hurdles, for things that should be so simple?

We’ve made everything overly complicated. To get a flu shot, they need to call our practice and leave a message, or else send a message through the patient portal and wait patiently for a response. Then somebody’s got to check that message, and make a clinical decision — albeit a very small one — put in an order for the flu shot, associate that order with a diagnosis, sign that order, then reply back to the original message. Then the patient needs to be contacted to be scheduled for an appointment in vaccine clinic at an available time slot that works for them.

I don’t know about you, but I remember the days when we would drive through the parking lot of our local Safeway grocery store in my parents’ station wagon, they would stick their arms out the window, and someone would jab them with the flu shot, and off we went. No fuss, no muss, no mess. That’s what we should aspire to for healthcare.

All my patients who want their scheduled mammograms, and other things that seem routine, need to go through the same laborious processes. All of our patients who want an appointment or a referral need to go through multiple steps, first A, then B, then C, and so on, each time passing some sort of test and crossing a threshold, proving that they’re sick enough to deserve that appointment or that referral. Wouldn’t it be great if we could figure out a way to configure the systems we have so that people can get everything they were due for, everything they needed, at the right time, without a lot of this struggle?

I know healthcare isn’t all that simple. I know there’s supposed to be a lot of education and shared medical decision-making around so many of these things — understanding the risks, benefits, and alternatives of a flu shot, of a mammogram, of a colonoscopy, of a blood test. But how often, when a patient sent you a message asking if they could have a flu shot, have you said “no”?

Sure, there is the occasional patient who somehow forgot that they developed Guillain-Barr√© syndrome or optic neuritis after the time they had the flu shot 10 years ago, or forgets every year that they’re allergic to eggs and the system says they can’t take the flu shot (really, still?), but isn’t the answer almost always “yes”? And when my patient calls Radiology and sets up their appointment for a mammogram that’s due, and they then send me a message asking me to put in the order, isn’t the answer always “yes” here as well?

I’m not suggesting that patients should be able to set up an MRI every time they have a headache, or schedule themselves to get a cardiac catheterization every time they get some chest pain, but there are a lot of things that we could probably simplify, to help remove barriers to patients getting care, and streamline the lives of those of us inundated with all of this busywork that’s created by the systems we have.

Take, for instance, how simple our electronic medical record has made requesting refills through the patient portal. If I prescribe a medication to a patient, it’s on their active medication list, and they’ve met certain criteria for its use — such as a visit within a year, a blood pressure check in the past certain number of months, or a recent blood test needed for monitoring this medication — then the system can automatically queue up the order for the requested medicine to go to their requested pharmacy, and route it over for me to sign and finish it. One and done. If we configured almost everything to work as well as this feature does, it would be a better world.

Someday we’ll get to a place where everything patients need to do and everything they are due for can be queued up for them automatically. If they had questions, the appropriate medical education materials and an artificial intelligence system would help answer them and guide them to the right decisions.

Someday these things might even be smart enough to help guide ongoing care; titrate medications; set up and monitor home blood glucose, home blood pressure, and other parameters; advance goal-directed medical therapy; and even potentially initiate the workup of new clinical issues. Having smarter systems to help us move things along may be key to eliminating healthcare inequities and making sure all of our patients’ healthcare needs are as met as humanly as possible.

There may certainly be some resistance, an unwillingness to give this control up, to relinquish some aspects of our clinical care and medical decision-making, but I think in the modern world we live in, we should take advantage of everything we can to help get every patient all the care they need.

Make it as easy as it can be.

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