Doctor’s Orders: Patient Communication and Medical Advice in the Age of Dr. Google
Just over 50 years ago, Dr. George Engel’s landmark publication in Science shook health systems across the world; he summarized his proposal with:
“The dominant model of disease today is biomedical, and it leaves no room within its framework for the social, psychological, and behavioral dimensions of illness. A biopsychosocial model is design[ed] for action in the real world of health care.”
The biopsychosocial model gained influence over the late 1900s and, by the early 2000s, had succeeded the biomedical as the dominant model of medicine. Diagnostic principles grounded in biology have barely changed in that timeframe. However, the real world that physicians operate in has changed radically in a way that Dr. Engel could have never anticipated: mobile phones and the internet quickly became universal, enabling instant access to humanity’s collective (medical) knowledge. By 2016 there was at least one cell phone per person worldwide.
As the paradigms of human knowledge and communication shift, so should medicine. With the new decade just beyond the horizon, how can doctors and care teams ensure patients receive vetted medical advice and make safe health decisions?
The majority of healthcare has never taken place within the clinic walls, but now the internet and cellphones have a stronger grip on patients than even the most attentive care teams. While technology continues to expand into everyday routines, doctors’ influence on patient decisions is undoubtedly shrinking. In the meantime, physician burden and burnout have been ominously rising due in part to increasing patient load, leaving less one-on-one time for each patient.
In an effort to bridge the gap between advice coming from care teams and internet sources, websites like mayoclinic.org, nih.gov, and my.clevelandclinic.org have developed comprehensive online repositories of verified and up-to-date medical information, revolutionizing patient education. Even with these advancements in access to medical information, a 2006 study in BMJ found Google searches led to correct self-diagnosis only 58% of the time (95% CI: 38–77%). Dr. Google isn’t problematic because the information it provides is wrong, but because people don’t know what to do with the information.
With patient decisions increasingly affected by outside sources, health systems and physicians must also adapt to and acknowledge the flaws that remain in publicly available knowledge:
1) Digital information’s inability to know when to be there for patients
2) The potential for contradictory and unvalidated information
3) Inherent bias towards generalized information without an understanding of patients’ context
Instead of turning to internet browsers for scattered and generalized information, patients with digital services like Memora Health can look to their text messages for their doctors’ guidance. Memora’s text-based follow-up brings physicians’ advice into the palms of patients’ hands by digitizing each physician’s current follow-up workflow. Memora’s customizable, virtual health coach texts patients information validated by their doctors, improves adherence to treatment plans via scheduled reminder messages, patient-reported outcome surveys, and automated answers to frequently asked questions in natural language, reducing the burden on physicians and care teams.
Doctors, nurses, and other care team members communicate the same essential information to the vast majority of their patients. According to the Pareto Principle, 80% of incoming questions usually correspond to only ~20% of responses. These interactions are ripe for automation, freeing up time for care team members to address remaining concerns and duties of their already busy schedules.
Online information may be ubiquitous, but that does not necessarily mean it’s brought to patients’ attention when they need it. They only get access to the information when they know to look it up, not necessarily when their care teams would like them to keep it in mind. Even when patients receive the correct information directly from their health care practitioners, ~50% of patients are still non-adherent to medication regimens and treatment protocols advised by their doctors. Furthermore, unfortunately only 20% of the information from doctor-patient interactions is retained by patients.
Perhaps more surprisingly, while half of this non-adherence is due to forgetfulness; the remaining half is intentional, often due to the breadth of unvalidated information patients receive online. Memora’s SMS-based communication addresses the issue of non-adherence on both fronts: automated reminders have been proven to reduce forgetfulness while direct communication with the care team addresses doubts in real time and answers questions from a source that understands their medical context hopefully before they Google what’s going on.
The available evidence indicates that secure SMS patient engagement is effective and engaging. For reference, a 2016 meta-analysis of studies pooling over 2700 patients showed that SMS reminders nearly doubled both short- and long-term medication adherence and patient motivation in various acute and chronic diseases. A randomized-controlled trial of 1,198 patients found SMS reminders significantly improved patient satisfaction, with 93% of patients finding messages ‘very helpful’ in regard to improving their adherence, 90% claiming they would like to continue receiving messages, and 92% mentioning that they would recommend SMS-based interventions to family and friends.
Health systems’ late arrival to these digital spaces of modern life is resulting in adverse outcomes, wasted resources, and lost doctor-patient trust. To counterbalance the new and immense sociocultural forces on patient decisions, health care systems must leverage these same technologies. With Memora, doctors gain direct access to patients’ most-used devices, the ability to securely communicate in real time, and have their routine advice automated and benchmarked.
The real world of healthcare is becoming increasingly complicated by a more connected, computerized, and (mis)informed public. This is epitomized by a comment from Dr. Emmanuel Fombu in The Future of Healthcare:
“It takes the average American four years of doctors’ visits to spend as much time with their physician as they spend with their phone in a single day.”
Any path to closing that enormous gap must involve representing doctors and their advice where patients are most likely to get it — their phones.
Memora Health is building the operating system for care delivery that implements intelligent, streamlined workflows and revolutionizes the patient experience outside the care setting. We offer a smart end-to-end platform that unifies fragmented health care data to enable providers, payors, and life science companies to automate care delivery operations — from patient communication to documentation to reimbursement. We uniquely use artificial intelligence to digitize existing care delivery workflows, giving clinicians infrastructure that learns from every encounter they have. Memora supports a full suite of virtual care systems from automated patient intake and scheduling to remote monitoring and care pathways to billing and documentation. Memora is backed by Andreessen Horowitz, SV Angel, Kevin Durant, Martin Ventures, and several healthcare strategic groups.
Reach out at info@memorahealth.com, we’d love to work together.
