Imagine a world where you could text a medical update to your doctor instead of coming in for a follow up. Or where your doctor could teleconference with several medical specialists at once to discuss your treatment, saving you a trip.
This patient-centered, technological approach was the focus of a symposium on expanding access to health care Thursday at Wesleyan University.
The program, which attracted about 220 physicians, community health providers and policy makers, was sponsored by the Weitzman Center for Innovation in Community Health and Primary Care.
Trevor Torres, an outgoing 17-year-old from Michigan with diabetes, led off the day by talking about what his generation of “Millennials” expect from health care and how they want to be treated.
Torres said millennials -– the generation born between 1981 and 2000 — do not like to be condescended to and reject the type of “dictatorial” relationship “basically putting the doctor over the patient.”
“The problem with dictatorial relationships is the patient really should be the primary driver” of his or her own health care, Torres explained. “If you have a dictatorial relationship, a lot of times the patient’s goals might not get accomplished.”
For example, he said his dietician wasn’t accommodating about finding out whether Torres could deal with his low blood sugar within the restrictions of his class schedule at school, prompting Torres to have to experiment to make his treatment work.
As part of a health-conscious generation that is the first to be always connected by technology, Torres said would like to see a future where patients can text questions or updates to doctors to cut down on visits for chronic illness.
“I didn’t have time to go to the doctor for a really, really long time during the school year this year. It was my schedule,” he said. “….. If I wanted to go to the doctor I would have set up this whole appointment, drive over two hours to get there, sit down for 15 minutes, ask one question and drive all the way back. If I had one burning question, if I could just text that to my doctor, wouldn’t that be so much easier?”
Torres suggested using what he described as a “patient graduation model” in which the patient would start out with frequent appointments and the doctor would provide a lot of education initially. The next year, the patient would have fewer appointments and could text more questions if need be. By the following year, most of the care could be managed through texting, he said.
Besides texting, the symposium also explored the concept of using video conferencing to help primary care physicians consult with specialists.
These “e-consults” allow primary care physicians to seek advice or reassurance from a specialist more quickly and often without duplicative testing and time consuming trips for the patient.
This type of arrangement can be particularly helpful in situations where specialists are no longer taking new or Medicaid or patients, the patient can’t get time off for an appointment, or there is a long wait for an appointment.
Studies of electronic consultation programs in San Francisco, Colorado and the Netherlands found that the need for face-to-face visits for patients decreased by at least half and the wait time declined by up to 90 percent, said Nwando Olayiwola, Chief Medical Officer at Community Health Center, Inc. in Connecticut.
In Connecticut, the Community Health Center Inc. has been building an electronic consult platform to launch an e-consult program for access to specialists for under-represented communities. The center is partnering with the University of Connecticut’s center for public health and health policy and the UConn department of cardiology for the two-year project.
The center also has been teleconferencing with a team of experts, including a pain specialist, a pharmacist, a psychiatrist and a behavioral therapist, at the Integrated Pain Center of Arizona. Using a wall-mounted, flat-screen television, doctors can discuss the case with the team and get valuable feedback for the patient.