The ideas behind The Decision Tree, in a sense, focus on ways to create the next-generation patient. This new kind of patient will have to understand the context of their own medical self through a combination of genetics, personal metrics/data, and statistics. Needless to say, understanding one's own medical self will also require an increased medical literacy, where patients understand both their conditions, as well as where they fall within the spectrum of their disease.
Creating the next-generation patient will inevitably require new tools. Website services, such as PatientsLikeMe, have been a step in the right direction towards increasing patient knowledge by empowering people with general knowledge of their conditions, as well as and providing information of what others in their shoes are experiencing. However, focusing on the patient may only address half of the problem.
MedEncentive, a start-up company founded in 2003, approaches the issue of medical literacy by addressing both players in the problem, the physician and the patient. MedEncentive's product focuses on developing, or even better, redefining, the doctor-patient relationship. A statistic listed on their website states that on an average office visit, the physician will interrupt the patient within seconds of entering the room, while the patient only comprehends a fraction of the information given to them by their doctors. Drawing from my own mixed experiences dealing with physicians – including a recent diagnosis botched 3 times in a week – I could see how this could be true. If a patient had an increased understanding of their conditions, perhaps this interaction would not be so one-sided.
The company's core product is an incentive program for doctors and patients that centers around the exchange of medical information. Doctors who participate in the medical literacy program can earn about 20% more (~$15) per office visit by assigning their patients a "to-do" list. The company mentions some of what this list might include, such as questionnaires which determine how much a patient understands about both their current health status and the conditions they've been diagnosed with, as well as how they would rate their doctor's performance. The patients earn rewards, such as copay reimbursements or health savings account credits, for completing their reading assignments and the questionnaires.
According to the company, a medically literate patient will communicate more efficiently with their physician, while medically illiterate patients will consume more health care resources. But do people really care about this? Sure, it would be nice to reduce health care costs and make doctors and patients best friends, but is it really a big deal if a patient doesn't understand the ins-and-outs of their conditions? If you are not sold on the benefit of developing the doctor-patient relationship, consider the following figure. It was taken from a study conducted by physicians at Northwestern University and Emory University on the 5-year mortality rate of an elderly population. Medical illiteracy can become dangerous when it leads to an increased risk of death. So based on the outcome of this study, MedEncentive's thesis makes sense: when patients know more about their medical conditions, they have better health.
I acknowledge that there is a confounder to this study -- it was conducted in an elderly population. As we all know, the cognitive abilities of the elderly vary drastically across the population. For example, your 90-year old grandfather may be self-sufficient, living on his own, and sharp as a tack, while my 90-year old grandmother requires assisted living. So one question I asked myself when looking at this study was: are the people who are in the medically illiterate group also the ones who are in assisted living? In other words, is the increased risk of death due to the fact that the patient doesn't understand medical jargon, or is it due to an overall decline in their mental capabilities? Luckily, the clinical team already addressed this question. They found that both an increased medical literacy and a higher cognitive ability both independently indicated a longer, healthier life. So those that understand their medical conditions will live longer, but so will those who can still do the New York Times crossword puzzle themselves.
My take: The benefits of medical literacy, as outlined here, are: 1.) knowledge can improve the doctor-patient relationship, and 2.) knowledge can improve health. The Decision Tree is not about a single factor influencing a healthy life, rather it discusses a collective set of behavioral changes that lead to new way to think about and treat disease. I think the results discussed here show that medical literacy is an important piece of the next-generation patient puzzle. In the future, we will be asking a lot from patients, as more of the responsibility for staying healthy will be shifted to them. So I like the approach of MedEncentive to get the doctor involved as well. In the end, what we end up with is the next-generation patient, as well as a new breed of physician -- one who is willing to break the current mold.