Paul Tang, M.D. gave his audience something fairly major to think about last week, when he delivered his keynote address, entitled “Patients 3.0: What’s the Job of a Patient?” to attendees at the Health IT Summit in San Diego, sponsored by the Institute for Health Technology Transformation (iHT2, a sister organization to Healthcare Informatics). Dr. Tang, who is renowned as a healthcare industry leader, pulled no punches in his speech Jan. 20 at the Omni Hotel San Diego. Essentially, he told his audience of healthcare industry executives that they and their organizations needed to stop thinking of the individuals they care for as “patients” and start thinking of them as people.
That sounds both simple and obvious, doesn’t it? What’s more, at first blush, such an appeal might sound like an exercise in semantics. But as Dr. Tang convincingly proceeded to argue, there are many implications in all this, and a lot of actual strategic, operational, and point-of-care consequences flow from the conceptual shift.
Paul S. Tang, M.D., at iHT2-San Diego
Positing a framework of three levels of thinking about patients—“Patient 1.0,” “Patient 2.0,” and “Patient 3.0”—Tang told his audience that if the “Patient 1.0” concept—the historical way in which clinicians and patient care organizations viewed people under medical care—was all about patients “complying” with and “adhering” to physician orders; and the “Patient 2.0” landscape has been about patients becoming better-informed, as through web searches and other means; then what we’re inevitably headed toward, a reboot to “Patient 3.0”—will be about patients—soon to be known as people—moving forward to co-create plans for improving their health, in true partnership with their physicians and other providers, rather than following anyone’s orders.
“The danger of being ‘patient-centered,’” Tang said, “is that we’re still focusing on being in control” as providers, on giving patients the opportunity for more convenient appointments with their caregivers, for example, but still maintaining the physician and clinical team as the center of the universe.
In other words, being “patient-centered” isn’t enough. Of course, first, one has to get to “patient-centered” from the provider-centric and operations-centric thought process that currently dominates most of U.S. healthcare. Too often, as all of us know, care delivery and operational processes have been created around, and remain centered around, how hospitals and medical groups work, rather than what is optimal for individuals under our care. The idea of “patient-centered care” that first emerged in earnest in the early 1990s was an effort to rethink that mindset, and it has in fact already yielded many rewards.
But as Dr. Tang noted pointedly, even in organizations whose leaders have embraced the “patient-centered” concept, the thinking among physicians, other clinicians, and administrators, remains focused on clinicians and their organizations being in charge, when in fact, faced with a tsunami of chronic illness and an increasingly web-connected and well-educated populace, the only way that health outcomes will ultimately improve long-term is if patients—I mean, people—themselves become the driving forces in their own care.
As Dr. Tang explained, using the example of a real-life patient named Brian, trying to compel “patient compliance” with dietary, lifestyle, and medication recommendations from clinicians is ultimately of limited value, because that’s not how patients—people—think. Instead, get the individual to think about what his or her goals are in her or his life—and you will get that person to move forward towards such goals—whether it’s living longer or living better, along a number of different dimensions—and everything else will fall into place.
So Brian, who is a diabetic, wants to live to be 90, for example; and he wants to be able to enjoy a healthier, happier life; and he wants to be able to play with his grandchildren in the park. Starting with goals like those, human ones, Brian’s physician can then help him think through the choices he will have to make in order to try to move approach those goals, rather than simply sharing blood sugar guideline charts and weight loss pamphlets with him.
Given two incredibly important trends—the explosion in the presence of chronic illness in the lives of Americans, and the growth in the education and sophistication of our population, particularly as supported by online access to consumer health information—this shift in thinking among providers only makes sense. Yet as Dr. Tang himself acknowledged, it will take years before clinicians and administrators in patient care organizations really manifest new vocabulary and approaches to support the concept of person-centered healthcare.
Still, even thinking about this is a start. It will be fascinating to see how quickly this kind of thinking is adopted by clinician and administrative leaders across U.S. healthcare—and when we will begin to see the results in terms both of the physician-patient (or really, clinician-person!) relationship, and in terms of improved health outcomes among our people. At least industry leaders like Paul Tang have set us on the path. It’s the first step in a thousand-mile journey, but it is a step, and a step forward into the future.