Bettine Pluut is consultant on care innovation at Zenc in The Netherlands, with an emphasis on the effects of EHRs.
Amir Hannan is a General Practitioner working at Haughton Thornley Medical Centres in the UK. He works with an Electronic Health Record (EHR) to which both doctor and patient have access. Through the web-based EHR named Emis Access patients and their families can gain access to personal health information that is available at the clinic. In addition, patients can book appointments with their GP online and order repeat prescriptions. After interviewing Amir Hannan it is clear to me that he is a vivid example of a “health 2.0 doctor”. So what are Amir Hannan’s ideas about the changing doctor-patient relationship? And how can ‘health 2.0′ be put to work?
According to Amir Hannan the ideal doctor-patient relationship is one in which both participants are equal. Doctor and patient need to enter a partnership of trust. Whereas most doctors find it difficult to deal with emancipated patients, Amir Hannan finds patients that choose a passive role more problematic. He doesn’t believe in a traditional role division with the doctor as the expert. Research has clearly shown that if patients are not actively involved in their health this leads to problems with therapy loyalty. Emancipation is thus crucial for high quality care and therefore Hannan believes he has the responsibility to stimulate patients to become (more) actively involved in their healthcare.
Critical appraisal
According to Amir Hannan, the clinician of the future is a coach, someone who helps patients to take better care of themselves. Among other things, this asks for patient access to medical records. Moreover, patients need to be able to be sign-posted to high quality (scientific) health-related information on the Internet or in the library. In this way patients are better informed, more involved and better capable of making their own decisions about health-related issues.
Dutch GPs recently warned patients for the dangers of using ‘Dr Google’ because many patients are not able to judge the quality and relevance of information that is available online. I ask Hannan whether he also finds it dangerous that patients search the web for information about illnesses and possible treatments. Hannan answers with a firm ‘no’. It’s not that he denies the risk, but he believes this is where GPs have an important task to fulfil. So what if one of Hannan’s patients reads a story about a panacea in the newspaper and asks him for this drug or treatment? If such a situation occurs, Hannan finds it important to first show the patient his appreciation for the research s/he has done, because this shows him that this person is really interested in his own health. Then Hannan helps the patient to critically appraise the information s/he found. Doctors need to teach patients how to handle information with care and how to be able to determine which information is relevant and reliable. If necessary, doctor and patient can together search for other resources. Such a coaching role asks for specific skills. Hannan therefore believes that teaching patients to apply the principles of critical appraisal should be part of the medical education.
Can Hannan understand the fact that many GPs find active patients annoying or too time consuming? Yes, Hannan admits that some patients can be really challenging, but at the same time it is important not to discourage them. It can be really upsetting for a patient if s/he gets a negative reaction from your GP after having spent many hours on the web looking for information on possible treatments. Furthermore, emancipated patients keep a GP sharp as well, because they have more than once corrected Hannan by informing him about new discoveries on drugs and treatments. Of course this coaching role costs time and energy, but this is a valuable investment. Eventually the gains will outweigh the costs. Hannan is getting more efficient every day, because he’s getting accustomed to this coaching role. Moreover, emancipated patients often make less appointments, since they can often find answers to their questions themselves and because of better therapy loyalty.
The 80-year old Margaret, a real innovator!
Margaret Rickson shows how much is possible in emancipating patients. She was 76-years old when Hannan first introduced her to her electronic health record. Hannan asked her to study her medical situation by giving her a computer disk with her medical record on it. At first she was shocked by this request; “I don’t know the front end or the back of a computer disk, let alone how to use a computer”. Margaret never finished school, because her parents didn’t find this necessary for a woman. However, Hannan knew how to make Margaret enthusiastic for becoming more involved in her medical situation and Margaret decided to take a computer course. Margaret is now a frequent user of the EHR; she even teaches other persons how to use it. Hannan calls her a real innovator.
In the second part of this interview series we will see how Hannan translates his ideas about the doctor-patient relationship to online services in the healthcare environment.
In 2007 Amir Hannan produced a series of introductory videos on Patient Record Access.
