Doctors are a Broken Record We Don't Comprehend >80% of the Time

Doctors are a Broken Record We Don't Comprehend >80% of the Time

As both the private and public sector aggressively shift healthcare incentives from a “do more, bill more” to a value and outcome based model, healthcare providers ignore patients role in driving outcomes at their own peril.  It is generally understood that patients forget 80-90% of what they are told at the doctor’s office. As incentives no longer reward outcome over activity, this is a disaster financially for health professionals. This will require healthcare leaders to think in a different way. One has to be in denial to think that healthcare reimbursement isn’t entering a deflationary period yet it’s not all doom and gloom for forward-looking healthcare organizations. In fact, it’s a massive opportunity to leapfrog competitors.

As the founder of the Institute for Healthcare Improvement, Dr. Don Berwick stated in an earlier piece.

The health care encounter as a face-to-face visit is a dinosaur. More exactly, it is a form of relationship of immense and irreplaceable value to a few of the people we seek to help, and these few have their access severely curtailed by the use of visits to meet the needs of many, whose needs could be better met through other kinds of encounters.

Note: One of the forward-looking physicians highlighted below, Dr. Natasha Burgert, is keynoting the 4th Annual Health Care Social Media Summitpresented by Ragan Communications and hosted by the Mayo Clinic. It takes place October 16-18 and can be viewed live or via webcast. Separately, I will be speaking at the Digital Health Conference in New York on October 16. I will touch on forward-looking providers I wrote about in the the Patient-Provider Communication chapter of the upcoming Patient Engagement book commissioned by HIMSS (book release will be prior to HIMSS annual conference). I look forward to speaking with Forbes readers who are able to attend. You can follow the hashtag #DHC12 for more.

Smart Doctors Recognize Their Inefficiency

If one were to observe a doctor for a month, you would find that doctors have their own FAQ for various conditions, diseases, prescriptions, etc. They are essentially hitting the Replay button hundreds of times a month. Smart doctors are recognizing that there is a better way. The patient and family benefits greatly when the doctor has a mini package of curated content (video, articles, etc.) that is developed for the patients. This is predominantly a manual process today (e.g., writing down web addresses in an appointment or emailing them afterwards).

Modern Patient Relationship Management systems automate the content creation/curation process and allow patients to digest the content on their terms. For example, many patients are embarrassed to ask the doctor to repeat something they didn’t understand so they walk away confused. This has been a boon to health information sites such as WebMD — patients fill gaps of information by going to “Dr. Google“. Most clinicians realize that communications is the most important “medical instrument” yet time pressures don’t allow them to spend a great deal of time with patients. Thus, they must come up with other ways to enable effective communications. Like Salman Khan’s experience, doctors realize that an asynchronous communication method can often be the most effective way to convey unfamiliar material.

Doctors’ Success Hinges on Transactor to Teacher Transition

The health professionals who will gain an edge will return to the roots of medicine. The etymology behind the word “doctor” was derived from the word ‘doctoris’ that means teacher in Latin and is an agent noun derived from the verb docere which means to teach. The doctors who are the best teachers are most likely to guide their patients to the best outcomes.

The old incentives have driven doctors to a transactional model as the systems reward moving patients through as many transactions (tests, procedures, appointments, etc.) as possible. 75% of healthcare spend is directed towards chronic disease and the decisions that most influence outcomes are made my patients (or their families). Health professionals who were rewarded for repeat patient visits in the past will be penalized in the future for that same thing.


Imagine if you sent your children to a school and you found out that 80-90% of the students were failing. You’d yank your kids out of that school in a heartbeat. Now imagine we’re talking about healthcare. It becomes clear why health professionals will need to become effective teachers once again. Doctors already naturally do this today, however the evidence would suggest that it is inefficient and largely ineffective if 80+% of what a patient is told is forgotten.

Medicine Can Learn from Bill Gates’ Favorite Teacher

From millions of students and parents to Bill Gates, the Khan Academy has impressed many and inspired some teachers to flip the classroom lecture/homework model on its head as described in the video below. Doctors are now recognizing similar value in videos for their patients.

Read more about flipping the classroom in The Economist and the man described as Bill Gates’ favorite teacher.

As you can see in the video below, technology has brought a human element back into the classroom making it more interactive and tuned to specific kids’ needs. Why limit this to students? Why not use this model to help improve health outcomes? In fact, we may not have a choice with the ever-increasing shortage of primary care physicians. One can look to what happened after Romneycare was implemented as a preview of what is to come with Obamacare since it’s a virtual carbon copy. The shortage of primary care providers greatly increased. Simply trying to put primary care physicians on a faster hamster wheel isn’t the solution. In fact, that is part of the problem.

One of the nice things about Khan Academy is learners with different skill levels can watch the videos in different ways. Some may get it just watching it once while others may want to replay the video over a few times before a concept sinks in.


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This post was originally published on the Forbes Health Care Blog. Distributed with permission of the author.

Dave Chase is the CEO of Patient Relationship Management company, Avado, that provides basic & advanced patient portals for healthcare providers in accountable models such as medical/health homes, accountable organizations, etc.. A Senior Consultant in Accenture's Healthcare Practice prior to founding Microsoft's Health platform business transforming it from Microsoft's worst vertical market to its strongest (in terms of 3rd party developer support & revenue). He left Microsoft in 2003 to follow his passion to work in startups as an executive to multiple high growth companies. Avado has been featured in the NY Times, Wall Street Journal, TechCrunch, Washington Post and numerous healthcare industry publications. Avado was also a finalist in the world's most competitive startup competition -- TechCrunch Disrupt. Chase has been named one of the 10 most influential people in healthIT (and the only vendor in the top 50). He's also part of the StartUp Health academy selected as one of the "healthcare transformers".