Rethinking health care with patient advocacy
New strategies to facilitate patient care and communication with doctors can allow for better treatment options and cut wasteful spending. The Commonwealth Club of California convened a panel of health care experts to share their knowledge and ideas for advancing patient-oriented care and advocacy.
Among those on the panel was Jennifer Brokaw, M.D., the founder of patient advocacy organization Good Medicine. Brokaw serves her clients by being bedside as an “outsider” in hospitals. Advocates, Brokaw says, try to shepherd clients from the hospital to home while evaluating care from an unbiased perspective.
According to Good Medicine, “[Brokaw] advises clients about medical decision making, coordinates care with both primary doctors and specialists and provides support and advisement to families of patients in the hospital.”
Good Medicine, which is based in San Francisco, has already had much success. According to The New York Times, “Dr. Brokaw and her colleagues have thus far helped about two dozen people explain their goals and preferences, at a cost of $1,500 for each person.”
Patients pay out of pocket for services such as hers, but Brokaw finds such a charge actually benefits consumers. “We don’t answer to anyone other than the person that’s paying us,” says Brokaw. This relationship helps patients trust advocates more than doctors and insurance companies.
“Hospitals for example, are not interested at all in making sure patients don’t come back to the hospital, because they get paid every time they come back in.”
The panel also addressed the need for advance care planning. Brokaw says she would like all Americans to ask, “What is the minimum quality of life you would accept for yourself?” A death in the hospital instead of one in the comfort of home may stem from a lack of planning. Many of the calls Brokaw fields are from children of seniors who want to ensure their parents are making the right decisions.
Wayne Pan, M.D., of Health Access Solutions says he believes hospitals actually encourage repeat visits and treatments without much consideration to patients’ wishes. His firm helps coordinate and streamline care. Pan says, “Hospitals for example, are not interested at all in making sure patients don’t come back to the hospital, because they get paid every time they come back in.”
Talk of misinformation and misunderstanding about the costs of care threaded throughout the panel discussion. These costs are a problem both doctors and patients face. According to Brokaw, “It’s really incredible how little we understand about our health care.” She continues, “Even worse, doctors have no idea how much they spend of our total health care dollars when they order tests.”
Brokaw says that record keeping, made easier with technology, can help remedy this problem. Building flags into the health care system will eventually help control spending through the use of electronic health records, says Brokaw. Doctors will be advised to order less expensive medicines when possible and be more timely with tests, similar to the managed care of the 1980s.
Jay Tenenbaum is the founder of Cancer Commons, a scientific non-profit dedicated to continually refining information about cancer subtypes and treatments. Tenenbaum explained how patients can benefit from the undiscovered research of oncologists. “What Cancer Commons is trying to do is build the knowledge base that everyone needs. To be able to take the 100 thousand papers that are published every year in cancer and the results of the 10 thousand clinical trials and reduce that through web-based collective intelligence.” Cancer Commons aims for every patient’s treatment to be recorded and archived for future patients with similar diagnoses.
The panel remained optimistic. Brokaw believes that in 20 years, the system will be much easier for patients to navigate.
Audio of the event is available at the Commonwealth Club of California.
Learn more about patient advocacy at Good Medicine.
Learn more about planning at The New York Times.
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