The Patient of the Future

"The major change that's going to happen is about people getting their hands on their own medical data and their data traveling with them, rather than being bottled up inside a particular hospital," deBronkart says.

"These cognitive tools," Papier says, "will actually give the physician more time to do a more thorough exam." It could also curtail overreliance on testing. "These technologies are here today. It's not a meaningful use debate for five years from now."

Bob Stone, cofounder of Nashville-based Healthways Inc., warns not to believe that any one interface with patients will work.

"One thing we have learned in our business is there is no single silver bullet for establishing intimacy and sustaining engagement with the population," Stone says. "Everybody is different. Everybody has different comfort levels in terms of how they want to interact with caregivers. Some people love the phone. Some people hate the phone. Some people like snail mail. And as the population continues to age we will find more people who prefer e-mail or some form of social media."

Physicians and patients become collaborative partners
Patients come to appointments with Internet printouts tucked under their arms or stored on their PDAs. And instead of bristling at that, the clinician of the future will praise the patient of the future for doing his or her homework. Patients and physicians will build relationships and engage on a more personal level than is now the standard.

They drive many physicians crazy: know-it-all patients who come in to those five- to 10-minute appointments armed with a stack of Internet printouts trying to tell them how to do their jobs.

"We still hear about people whose doctor tells them, 'Look, who has the medical degree here?' And I understand that. Some patients are idiots," deBronkart says.

But the best way to improve medicine is to make it more collaborative, he adds. "It may be that this new form of relationship is not nearly as burdensome as people might reasonably anticipate," deBronkart says. "The reality is that there is an enormous flood of new information being published. It's just more than anyone can keep up with."

Paul Keckley, executive director of the Deloitte Center for Health Solutions in Washington, DC, agrees. "We continue to find that most consumers want information that they can't readily get from their hospitals and doctors." And they don't just want a photocopied handout with diagrams of exercises that ease general back pain. They want information that is personalized and customized, based on their own risk factors, preferences, and the exact nature of their back pain.

Ken Davis, MD, doesn't wait for his patients to come to him with their research—he helps them gather it. At the end of an appointment, the Conroe, TX-based physician brings his patient out into the hallway to a computer with Internet access. He shows her how to use MedScape and gives her a quick tutorial on how to find more information about the diagnosis. Taking a few minutes to do that saves him time, he says. A patient will come to the next appointment better informed and ready to work in partnership with the physician.

"You can engage patients with technology instead of it being a barrier," Davis says. "You can use technology to your advantage or you can get real upset because the patient went ahead and got a second opinion from the Internet. Doctors just have to get over themselves."

Patients actually start taking care of themselves
With wellness coaching from their team of caregivers, patients make lifestyle changes—they quit smoking, exercise more, and make healthy food choices. They check their blood pressure and show up for their colonoscopy appointments and monitor their glucose levels.

Of all the predictions about the patient of the future, this one is perhaps the most difficult to believe. Anybody who walks down the street today can see that people aren't interested in making lifestyle changes—they just want doctors to prescribe a pill to cure what ails them, even if what ails them is that they eat too much and don't exercise enough.

And when physicians talk about wellness, there's always that person in the room—usually a specialist—who says we can't make money if people are well, Davis says.

Physicians are paid to diagnose and treat sick patients, not to keep people healthy.

"Healthcare reform begins at home," Davis says. "Patients have to be empowered and they need to be expected to take some responsibility."

But it doesn't work when physicians just wag their fingers and lecture patients, or pretend not to notice that their patient weighs 300 pounds, or mention halfheartedly that he or she should quit smoking.

It's like a waltz, Davis likes to say. You have to know when to lead and when to follow.

Change can come, but slowly, Stone warns.

"Getting societal pressure on changing behavior is not hard to do, but the benefits don't inure overnight," Stone says. "It takes time, but we have seen it in the last 15 years in smoking patterns. I don't think the reduction in smoking has gone down because those people who wanted to smoke suddenly got religion."

In the future, however, employers, health insurers, and government agencies will give people cold, hard cash for healthy behaviors.

Quit smoking, lose weight, join a gym, run a marathon? Ka-ching! There will be incentives for doctors, too, making the whole "I don't get paid to keep people well" argument moot.

Consumerism goes from fad to trend—to reality
The patient of the future demands to know how much each appointment, test, outpatient procedure, or hospital stay will cost them—down to the very last prescription pill. And they use price and quality data to make decisions about where they go for care.

The conventional wisdom is that patients don't understand quality data and they don't care what their treatment costs. And why should they? After all, either insurance pays for their healthcare or they use the emergency room as their primary source for care.

But the idea that patients will become engaged, informed consumers is here to stay, says Keckley. But are medical professionals and the healthcare industry in general prepared?

"No," Keckley says. "For the most part physicians especially are suspicious of this concept of consumerism."