TED Conversations

e-Patient Dave deBronkart

Change Advocate for Participatory Medicine / Let Patients Help, Society for Participatory Medicine


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"WHY is the patient the most under-used resource in healthcare?? How did that happen?" (Follow-up to LIVE TED Conversation July 27)

"e-Patient Dave" deBronkart is an advocate for patients being "E": empowered, engaged in their care, equipped, enabled, educated, etc. As described in his talk from TEDx Maastricht, he beat a near-fatal cancer, supplementing his great medical care by using the internet in every way possible.

Today, as blog manager and volunteer co-chair of the Society for Participatory Medicine, he has studied the social, technical and sometimes political factors that make healthcare ignore the potential of patients contributing to their care.

In his TEDTalk, he quotes senior physicians who have said for decades that patients are the most under-utilized resource in healthcare.

Why is that? How did it get to be that way? Is change valid? Why now, and not 20 years ago? And what can we do about it?

Watch the talk, and come back to discuss. *Your family* will be affected someday.

ADMIN EDIT: e-Patient Dave has requested that we keep this conversation open for 1 week. After 2pm ET July 27, he will periodically check in to answer questions and respond to comments.

Topics: Healthcare

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    Jul 27 2011: I think one contributing factor to patient dis-empowerment are the constraints that our insurance system puts on the time that doctors can spend with patients. There's very little time for doctors and patients to really talk!
    • Jul 27 2011: Dianna, that is a great point. If patients and doctors are pressed for time and patients are underutilized, how can they become effective collaborators in health care?
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        Jul 27 2011: Lindsey & Dianna, this "insurance constraint" issue is exactly why concierge medicine (direct pay, unlimited services for a flat rate) is coming back into fashion. The more expensive insurance gets, the more people are saying "screw the system." And as a child of the Sixties, I have no objection to that. :)
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        Jul 27 2011: AND, btw, concierge medicine is no longer just for the rich, e.g. $10k/month. I know a group of docs whose members mostly charge < $150/month for unlimited office visits AND most prescriptions are free, bundled into it.
        • Jul 27 2011: To me, $150/month is mighty rich.
        • Jul 27 2011: patient is underutalized because this kind of a solution is hard to know it exists. And it doesn't exist in all markets. Small markets, force me to large solutions.
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          Jul 27 2011: I'd like to learn more about this, Dave.
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          Jul 27 2011: But I don't want this to be "concierge" I want it to BE PATIENT CARE.
        • Aug 10 2011: What community is this membership medical located? I would like to study it. I pay more than that per month for insurance. I'm blessed to be able to afford what I have chosen. Do you think it provides high quality care? Would LOVE to learn more.
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      Jul 27 2011: Agreed, Dianna - insurance is a very limiting factor. But the point of our question here - why are patients under-utilized - was true 40 years ago, before insurance started running healthcare. Puzzling, eh?
    • Jul 27 2011: What does that mean Diane, TIME to talk? Is that why they move so fast and act so distracted and you remember the things you should have asked after you left the office? Is that on purpose?
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        Jul 28 2011: Tracie, re "remember the things you should have asked after you left" - e-patients commonly tell each other to write those things down BEFORE you get there. In my case, I send them in by email before I even go there.

        The cancer described in my video was discovered during a routine annual check-up. I had prepared for that physical by sending my doctor a note describing the 12 things I wanted him to know about. Reading is faster than speaking; and we took care of some so quickly that they consumed NO time during our meeting.

        He says he LIKES it when people send their "agenda" ahead of time, because he has his own agenda, too, so it lets him prepare for the meeting better.

        We do this with other professionals, or in day-job meetings; why is healthcare so backwards? C'mon, let's modernize. :-)
    • Jul 27 2011: this is very true - ie no real relationship and empathy can develope ...
    • Jul 27 2011: Indeed - This speedup is really one of the key problems. I posted this quote from a wise teacher in another conversation - Mindfulness being - paying attention to what is truly happening - on many levels... "Speed is the enemy of mindfulness. The antidote is being appreciative and observant of life's every detail." Doctors could also learn to be trained in the techniques of listening and responding in the most appropriate ways - during medical school. - and the ethics involved in giving this kind of attention. There are many fine doctors out there!

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