Barriers: Providers and Patients

There are many reasons why the healthcare system might never reach the potentials being presented by ONC experts and proponents of advancing the doctor-patient relationship to a new level. There are barriers, both large and small, that exist throughout the field, amongst all relationships. Provider-patient is the oldest relationship in healthcare. As long as there have been doctors, they have had patients to treat. This history brings with it an entrenched relationship and some rigidly defined roles. This might include providers who are simply not interested in doing more than is required in the exam room to address their patients’ questions and concerns.

If this was the only limitation, we could work on breaking the barrier by providing hospitals proper levels of training and support to encourage a more open patient provider relationship. The difficulties, however, go deeper than this. Some of the greatest issues, even during an on-site appointment, are communication barriers. Studies have shown that Americans have a lower than average level of literacy when it comes to healthcare. This means they cannot fully interpret information given to them to make proper health care decisions. The only health literacy study done on a national level has shown that 12% of patients are proficient in completing the tasks we consider essential to understanding and acting on healthcare knowledge given to them.

In addition, on the other side, providers frequently do not realize their patient cannot understand. Often they ask the patient a “any questions?” instead of trying to truly ascertain comprehension. People of all classes are reluctant to do anything that they think might expose them as being less intelligent, and what does this more than admitting you do not understand what someone is saying to you? Now imagine the difference between the previous scenario happening in the doctor’s office, where a well-trained provider might be able to see or ask if the patient understands what has just been said, and a remote exchange, or an occurrence like the patient reading highly technical results. This is exactly the type of barrier that might make a patient prefer to avoid an online encounter.

In response to this problem, the Institute of Medicine has suggested that organizations become “health-literate organizations” that is organizations that attempt to present information at all times in a way to help patients with low health literacy understand and use information about their health. This means, for one thing, applying a “universal precautions” approach to health literacy: assuming that low health literacy may exist in all health systems or provider- patient interactions.

The issue as it currently exists is similar to what we see quite frequently throughout Health IT. It is difficult to break out of the everyday routine that has become very easy for healthcare workers. Embracing a new system is difficult, even with the knowledge that it will improve care and make for a better business.  It will require proper support and training for doctors, administrators and patients to break through the inertia.

Further Reading:

Health Affairs: “A Health Literate Care Model”

Institute of Medicine: “Ten Attributes  of Health Literate Health Care Organizations”

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