x Abu Dhabi, UAEMonday 22 January 2018

If patients don't take control of their health, who else will?

Perhaps in the future, true patient empowerment will mean that each patient controls his or her own health activity, and consults a doctor only when professional advice is really needed.

Throughout history, the doctor-patient relationship has been a one-way street, with the general practitioner acting as the font of all expertise. But that has changed because of the explosion of health information online and in self-help books and other media, including social media.

Recent decades have also seen a shift in priorities towards preventive rather than curative healthcare. This has sparked demand for technology to deliver medical information and care direct to the public through a range of devices and software.

Recently, more than 600 professionals attended the Fourth Annual Research Conference sponsored by the Abu Dhabi Health Services Co, known as SEHA, to discuss these developments and the implications for quality care. A two-day meeting, titled Medical Informatics Research to Improve Clinical Effectiveness, was full of information about this changing field.

Services that individuals can already access directly in at least some places range from the familiar - screening for glucose, cholesterol and blood pressure and testing for control of conditions such as diabetes - to patient-controlled and patient-held medical records, apps and devices to help individuals choose healthy foods, control portion size and the speed of eating, and electronic motivational "coaches" for exercise.

Some of these types of self-help technology have been around for several years, but increasingly social media such as Facebook and Twitter are being used to share the results. This recognises, and increases, the way in which we are heavily influenced and held accountable by our friends, family members and colleagues.

So what change will be next for the doctor-patient relationship? Patient-controlled medical records are increasingly being used in forward-looking healthcare organisations, but the power remains firmly with the doctor. Perhaps in the future, true patient empowerment will mean that each patient controls his or her own health activity, and consults a doctor only when professional advice is really needed.

Indeed, there is increasing potential for patients to own their own health data, and choose whether or not to allow access to organisations that may benefit from the information, such as pharmaceutical companies. Consider an analogy with the banking sector: we would not hand over all responsibility for our finances to our bank manager and expect him to contact us only if something was amiss.

The issue is patients' ability to be in charge of their health. The technology for very great patient empowerment exists right now. We could have patient-controlled records, owned by patients and shared with treating doctors, nurses and disease managers. We could also have more varied patient home-testing kits as well as retail clinics, pharmacies and walk-in laboratories where patients could have on-demand consultations, testing and procedures. We already have online medical-information hubs, such as WebMD.

Solutions are available to ensure that patient empowerment can lead to cost savings. Patient-held "health savings accounts" are being piloted in many countries; one example is the Oregon Health Insurance Plan in the US. Through such schemes, each individual is given a specific annual health allowance and is allowed to choose how to spend the money.

The thinking behind this is that patients will demand the most efficient treatment where there is a choice, selecting cheaper generic drugs, for example, rather than choosing costlier brand-name medicines.

Furthermore, incentives can be added, such as discounts on future premiums for low spenders, or the option of redirecting any unspent cash from the account to another use, such as education.

With today's wealth of information and access, it may be time for the medical profession, and policy makers, to begin looking for new ways to cooperate with the inevitable trend toward increased patient involvement and patient empowerment.


Dr Cother Hajat and Dr Jomana Fikree are physicians and academics based in Abu Dhabi