“Come in and sit down…now, tell me, what’s the matter?” We’re all used to a typical consultation with a doctor - often about ten minutes long and with well-established routines to aid diagnosis. However, my prediction for 2014 is that clinical consultations are set to change and more people will begin to experience different kinds of consultation.
Here’s a sketch of a typical consultation now:
- Patient is asked to come in and sit down.
- Doctor asks the patient: ‘What’s the matter?’ or ‘How can I help’?
- Patient describes what’s wrong.
- Doctor asks questions, checks notes and test results, and examines them if need be.
- Doctor decides course of action, including wait and see, prescription for drugs or referral to another healthcare professional.
It’s so familiar, most of us probably don’t think twice about it. And while the sketch above is very rough, it’s useful to reflect some fundamental dynamics: the doctor leading the conversation, the focus on clinical treatment, and a deferral to the doctor to establish the best treatment plan.
“Take two apps, and call me in the morning”
There are ways in which this model is already being adapted to suit our lives now. Online and telephone consultations have great potential to deal with simpler issues quickly, freeing up doctors to engage face-to-face with more complex cases. But the basic dynamic – or ‘script’ – remains largely the same, it’s just that the channel of communication changes.
It’s also increasingly possible to use technology to change how information feeds into a consultation. This is partly about patients accessing existing data in structured electronic form – such as Patients Know Best – but it is also about patients generating and analysing new data themselves.
Health apps are one of the fastest growing segments of the app market and a small but growing number enable patients to track their own data and analyse it; including myfitnesspal for food and exercise, Diabetes UK for blood glucose, and Healthsome for blood pressure. These apps mean consultations can incorporate live data from the patient along with other biometric data, rather than just trying to remember how you felt last Tuesday.
These trends are extremely important to shift consultations to become even more data-driven. But I think the biggest gains are to be made when these important technological advances are combined with more collaborative consultations.
Collaborative, data-rich consultations
Collaborative consultations focus on keeping people well, not just treating their illness, which is particularly relevant to those with on-going health conditions that can’t be cured.
These consultations are less top down and more of a partnership between clinician and patient: patients are actively involved in their healthcare decisions; they are supported to become healthier by their clinician and others; and a ‘care plan’ is developed that addresses the social and emotional as well as physical aspects of their condition.
When a more collaborative script is combined with better data, you get a very big shift indeed. For a woman with chronic lung disease, the new tech-enabled collaborative consultation could look something like this:
- Patient arrives with new data on her smartphone, a list of her concerns and biggest health priorities. For example, she wants to be able to walk further without stopping for a rest. If she’s motivated and health literate, she could prepare for the consultation herself, or with others if she needs additional support.
- The consultation is run as a planning session between the doctor and patient, combining the doctor’s expert clinical knowledge and data with the priorities, insights and data from the patient. They decide together what the goals are, what support needs to be put in place, what needs to happen next, and how progress will be monitored. The resulting ‘care plan’ will include both the clinical treatment plan, and what the patient will do to manage her symptoms better and with what support.
- The outcome might include a renewal of a prescription for drugs but also a referral to a community-based support worker who can accompany her to the local community gym and work with her to improve her physical activity levels.
- The patient uses her smartphone to track her progress on key biometrics between consultations and gets additional motivation from a peer group of others with similar lung disease who compare their activity levels.
- The next series of consultations will be focused on checking progress against the ‘care plan’ and reviewing it if need be.
These more collaborative consultations have emerged out of a number of years of work, including Year of Care, Shared Decision Making and Co-Creating Health in the UK and the Chronic Care Model in the US. NHS England is now actively supporting the agenda including through Transforming Participation in Health and Care, National Voices has just launched a Care Planning resource and the Health Foundation has a Person Centred Care Resource Centre.
These consultations are scripted so that the patient has an active role to play. They also lead onto follow up activities that help the patient to make important changes to their lifestyle. In this way the consultation becomes the centre of whole network of activities and interventions, done by a range of different clinical, healthcare and volunteer roles inside and outside the formal health system.
Fully tech-enabled and collaborative consultations may seem a long way off but the building blocks are in place and have been developed for some years now. The evidence base needs to keep growing so we are clearer about which interventions work best, for which patients, under what circumstances. However, it’s a compelling future for consultations because it combines the best clinical knowledge with empowered patients and up-to-date data. So, in 2014 I predict more consultations will become more data-driven and more collaborative than we have seen before.