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Riding Shotgun: Why Involved Patients Get Better Care

by Saroj Misra, DO, FACOFP

I love when my patients ask questions. It tells me they are invested in their care and are advocates for their own health and well-being. I like to refer to these patients as ‘riding shotgun’—they’re getting involved rather than taking a back seat when it comes to care. So I share, explain, and make each patient a part of the process.

Not every clinician embraces patient empowerment or the idea of shared responsibility. But as health care management becomes increasingly burdensome and patient cases progressively complex, medicine needs to be a team experience and the patient is a natural participant. In the past, the opportunities for patient involvement have been slim and limiting, but times are changing.

Over the past decade, we’ve seen an explosion in personal health technology or tools of the “Quantified Self” as some call it: health tracking devices like activity monitors, connected scales, and blood glucose monitors, as well as mobile health (mHealth) applications. This idea of measuring one’s own health metrics dates back centuries, some say, to the days of Leonardo da Vinci. But it wasn’t until the late 1700s, when the first pedometers were created, measuring steps and distance while walking. Today, we’re seeing that the capabilities and innovations within personal health technology only get better every year – the pedometer now goes far beyond walking to track specific activities and even sleep quality.

For patients and consumers, these devices are beneficial because they provide interesting data about their health. For physicians, they provide something even more powerful: the ability to engage patients in their own health management.

One of the traditional challenges in medicine is what I refer to as the ‘patient paradox of healthcare.’ As clinicians, we want our patients to be knowledgeable about their diseases, yet we often make decisions based on lab values and indices that confuse the layperson. Traditional methods of patient data collection have been less than successful due to the need to maintain extensive paper records or spreadsheets, which the patient may not understand or remember to bring in. Not unsurprisingly, patients often become disinterested in managing their diseases, instead relying on the physicians to ‘tell them what to do.’ However, with more sophisticated personal health technology available, physicians can obtain patient-driven data in real time to remotely monitor key health metrics, particularly for chronic disease.

One of the most difficult aspects of the patient experience is adherence. When patients are on their own, they often struggle with lifestyle changes that require maintaining diet or exercise regimens, or sticking to medication schedules. mHealth apps and other monitoring devices can serve as reminders and support—they’re the intermediary in the moments outside the doctor’s office—and they help keep patients engaged.

Imagine patients who can track their blood sugars with a mHealth app, check their trends for the week, and then make adjustments to their insulin regimens without having to call the doctor. Or consider asthmatics with increased episodes receiving an automatic alert to increase their medications while a message is simultaneously sent to the physician’s office requesting an appointment. Now, that’s progress, and those advances are in the not-too-distant future. Yet another example of how far medical technology has journeyed from the humble pedometer.

I believe involved, engaged patients translate to better patient outcomes. So I encourage my patients to ‘ride shotgun’ with me. With the personal health technology available today, there’s no need—or excuse— for them to ever take a backseat.

Saroj Misra is a board-certified osteopathic family physician who currently serves as program director of the family medicine residency at St. John Health System in Warren, Michigan. He is also an Epocrates client.

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