The premise for this video was simple; a dos and don’ts list of visiting the doctor. To create tips around visiting the doctor implies that we need tips, which made me ask the question ‘why’? Contemporary society is moving at an incredibly rapid pace; we live in what might be the greatest technological boom in history and this is literally changing and shaping every facet of our lives; this includes healthcare. 20 years ago we visited the doctor fairly ignorant but now it’s not uncommon to see patients who have done huge amounts of research (credible and not-so-credible) and are expecting the doctor to take this seriously and collaborate with them on their diagnosis. To be able to justify why I wanted to create my 5 steps to visiting the doctor I needed more than a 3 minute video, so welcome to my think-piece on consumer-centred healthcare.
Like everything else in the world health is moving towards a consumer-centred approach. In the past the drivers of change in healthcare have been things like cost, population demographics, technology and shortages in certain areas. While this is still true, the idea of consumerism in health puts patients front and centre in terms of healthcare reform. This is exciting because it means that patients get to have a say in how healthcare is delivered. Some doctors are very resistant to this whereas some embrace it, some patients want to be partners in their care and some take this too far. As a nurse I am very much a middle man between patients and the doctor, which means I hear both sides of the consult. ‘The doctor was too rushed’, ‘The patient demanded a medical certificate for something they self-diagnosed from Google’, ‘The doctor didn’t look at this article I got from online’, ‘The patient won’t engage and expects too much from me.’ It’s a very tricky balance; when it’s good it’s great, but when the scales tip it can be a disaster.
Historically the relationship between a doctor and patient was very clear and hierarchical. The doctor was in charge, they were the gatekeepers of healthcare and patients handed over all responsibility about decision making. The positive aspect to this relationship was that it meant a doctor’s knowledge and years of training were well-respected. However it completely removed patients from taking an active role in their own healthcare; all the research proves that a patient who isn’t motivated or self-directed will achieve poorer health outcomes.
Enter capitalism and the huge boom in technology; things have shifted. Everything is becoming catered to us as consumers. We can buy and return clothes online, we can self check-out at the grocery store, there are apps to track our diets and we literally pay to have people deliver us food that is five minutes away. Health is following this consumer model. We can already see it in the introduction of systems like E-Health, where one day we’ll be able to manage our own medical records online, sexual health centres that will text people results, and the home-doctor service where at any time of day we can get a bulk-billing doctor to our house.
But what does this mean for the doctor-patient relationship? Well, put simply, a lot; more than I think we even understand right now. Consumerism works in retail and food & beverage because demand drives supply and need drives innovation, but healthcare is different. What a patient wants, or thinks they need, isn’t always correct; the customer is not, in fact, always right. A prime example of this in primary healthcare is medical certificates. Medical certificates are a representation of an assessment, carried out by a registered medical officer, which states you are unable to work, go to school or partake in a certain activity due to injury or illness. Nowadays though patients expect a medical certificate just for showing up and most doctors will provide them even if based on clinical assessment they absolutely could have made it to work that day. I work with one GP who won’t; she will only issue a certificate if she genuinely believes someone needs it, otherwise they just get a statement of attendance. This has caused more than a few awkward moments.
On the flip side of this is an increased stigma in Australia against primary healthcare doctors. People complain about wait times, short consults, out of pocket fees, lack of continuity or lack of empathy. Consider the current climate though and it’s understandable why these issues are arising. A continuing freeze on Medicare rebates mean doctors either have to charge a gap payment to keep up with inflation or if they continue to bulk-bill they are likely to see more patients per hour than other doctors and become over-booked. Also imagine spending around ten years studying complicated science, having huge legal and ethical responsibilities on your shoulders and being treated a bit like a grocery store. This is compounded by the fact that in medical school the doctor is still spoken about as a bit of a deity figure. That headspace is going to permeate, even in the most humble students, but it isn’t always the what people in the real world think.
At this moment I will pause to state that I know I am generalising. I witness and hear about beautiful doctor-patient relationships, I know patients who have the utmost respect for the medical profession and doctors who love involved patients. Despite this the way we consume healthcare is changing and it’s important to understand why.
So if we understand the issue then why does it persevere? Well firstly it’s hard to compartmentalise the consumer part of our brain when it’s validated in most other areas of life. With the huge access to information via the internet people will continue to look up health-related information; Google has recently designed a health toolbar with basic information (vetted by healthcare professionals) to address the fact that one in every twenty searches is health-related and that 80% of people aged 18-34 use Google to avoid seeing visiting the GP*. For doctors it is also difficult to communicate their side of this issue to patients because it is nuanced and a patient is there to have their needs addressed, not vice-versa.
While this sounds like a negative turn of events, I perceive it to be hopeful but only if we can evolve and adapt. Technology connects us in real time and allows people to have a voice. If ethical, responsible and intelligent people and organisations start speaking up to create change then we can create a healthier society as the consumption of health shifts.
The solution starts in schools. Firstly we need to introduce health literacy early into schools and cover topics like the appropriate use of technology, the doctor-patient relationship and how primary health care actually works. People can’t be expected to practice self-care and preventative health care if they don’t know how. We need realistic education on sexual health and on drugs and alcohol; so much of our schooling around these areas is archaic and doesn’t motivate youth to seek out more information. Finally we need to embrace the positive aspect of technology; a channel like Hot on Health can only exist and grow thanks to social media. If we dilute the pool of misinformation and endless stream of distraction online and start saturating news feeds with informative and entertaining health promotion channels we will see a positive change.
The health landscape is constantly shifting and it is a complex arena. This article is designed to give you a small insight in to how it is currently shaping. This video-article combination should give you more confidence moving forward to understanding primary health care and getting the most out of how you access your local health services. Thank you and as always remember, “There is no healthcare without self-care.”
*Aubusson, K. 2017, ‘How Googling your health questions just got easier and more reliable’, Sydney Morning Herald, NSW, accessed 25 Feb 2017, < http://www.smh.com.au/national/health/dr-google-makes-australian-house-calls-with-launch-of-new-health-condition-cards-20170131-gu232o.html>.
The George Institute 2016, ‘Putting the Consumer First: Creating a consumer-centred health system for a 21st century Australia’, The George Institute, NSW, accessed 10 Jan 2017, < http://www.georgeinstitute.org.au/projects/areas/putting-the-consumer-first-creating-a-consumer-centred-health-system-for-a-21st>.
Paslawsky, L. 2013, ‘International Trends in Healthcare - The Consumer View of Healthcare In 2040’, taken from a report presented at the International Design and Health Conference, AFG Venture Group, NSW, accessed 25 Feb 2017, < http://www.afgventuregroup.com/dispatches/afg-venture-group-newsletter/international-trends-in-healthcare-%E2%80%93-the-consumer-view-of-healthcare-in-2040/>.