‘’Empowered Patients’’: A changing dynamic

Tapan J Ray

In the good old days, when someone used to fall sick in the family, a friendly local medical practitioner, known as a ‘family doctor’, used to be called for treatment. Unfortunately, they are a vanishing breed of caring doctors in today’s world.

Thorough knowledge of patient’s medical history gained over a period of time used to come handy to these ‘family doctors’ while treating patients. Their smiling or at times even an admonishing look for falling sick due to avoidable reasons, a caring approach and willingness to patiently answer all questions even beyond sickness, used to instill a strong confidence and hope to the patients for a quick recovery.

Today’s perspective is very different. The concept of a ‘family doctor’, by and large, does no longer exist, even in the urban families of India. Though the elite groups belonging to the upper echelon of the society still talk in terms of ‘my dentist’ – ‘my cardiologist’ – ‘my physician’, common patients, on the contrary, have already started experiencing that their healthcare needs are being greatly compromised.

The good news is that in future, one can still expect to call a doctor home for treatment, which may not cost a bomb, as it happens today. However, they may not exactly be of the same ilk as the ‘family doctors’ of the yesteryears. For instance, a media report in early January this year talked about how an IIM-A student decided to drop out of the course and set up a business where he promises to deliver both doctors and medicines at the consumer’s/ patient’s doorstep over a phone call.

That said, the doctor–patient relationship has also undergone a vast change over a period of time. The healthcare environment of this era in India, more often than not, smacks of commercial ‘gain and loss’ of the private service providers, just as the public health system has been failing to deliver.

In a situation like this, the civil society also has a critical role to play. Like, many other countries of the world, in India too, the society should encourage individual ‘Patient Empowerment’ by making him/her understand how the healthcare system is currently working on the ground. Make people aware, who and what are the key obstacles in getting a reasonably decent healthcare support. At the same time, there is a need to carefully explore how effectively those issues can be addressed in the democratic framework of the country.

To achieve this goal, the movement of ‘Patient Empowerment’ started in the US in 1970’s, which asserts that for truly healthy living, one should get engaged in transforming the social situation and environment affecting one’s life, demanding a greater say in their respective treatment process by observing the following tenets:

• Patients’ choice and lifestyle cannot be dictated by others
• ‘Patient empowerment’ is necessary even for preventive medicines to be effective
• Patients, just like any other consumers, have the right to make their own choices

Thus, the ‘Empowered Patients’ should always play the role of participating partners in the healthcare process.

‘Natural Health Perspective’ highlighted ‘Patient Empowerment’ as follows:

• Health, as an attitude, can be defined as being successful in coping with pain, sickness, and death
• Successful coping always requires being in control of one’s own life
• Health belongs to the individual and the individuals have the prime responsibility for their own health
• An individual’s capacity for growth and self-determination is paramount.
• Healthcare professionals cannot empower people – only people can empower themselves

In today’s world, as said earlier, the distrust of patients on the overall healthcare system is growing all over the world. This situation makes an ‘Empowered Patient’ resolve to actively participate in his/ her medical treatment process.

In a scenario like this, other stakeholders in healthcare will also require to align themselves with a ‘Patient-Centric’ approach, which has already started happening in many parts of the world. In India, as ‘out-of-pocket’ healthcare expenses are skyrocketing in the absence of a comprehensive and affordable Universal Health Coverage (UHC), ‘Empowered Patients’ will increasingly demand to know more of available treatment choices and medicine prescription options.

As a proactive measure to this emerging trend, many global companies have already started taking new initiatives to open up channels of direct communication with their primary and secondary customers to know more about them in order to satisfy them better.

In future, with growing ‘Patient Empowerment’ the basic sales and marketing models of the pharma companies are also expected to undergo a metamorphosis. There could probably be a switch from ‘hard-selling’ to a new process of achieving business excellence through constant endeavour to satisfy both the expressed and the un-expressed needs of the patients, not just with innovative products, but more importantly with innovative and caring services.

In the years ahead, more and more ‘Empowered Patients’ are expected to play an important role in their healthcare decision making process, initially in the urban India, ensuring further improvement not just in the public and private healthcare system, but also in engaging the pharma industry to be a part of that changing process.

In the book titled, The Empowered Patient: How to Get the Right Diagnosis, Buy the Cheapest Drugs, Beat Your Insurance Company, and Get the Best Medical Care Every Time, Elizabeth Cohen articulated as follows:

“The facts are alarming. Medical errors kill more people each year than AIDS, breast cancer or car accidents. A doctor’s relationship with pharma companies may influence his choice of drugs for you. The wrong key word on an insurance claim can deny you coverage.”

‘USA Today’ dated August 31, 2010 in an article titled, “More empowered patients question doctors’ orders,” reported: ‘In the past, most patients placed their entire trust in the hands of their physician. Your doctor said you needed a certain medical test, you got it. Not so much anymore.’

Unfortunately in India, the situation has not changed much just as yet.

Reinhard Angelmar, the Salmon and Rameau Fellow in Healthcare Management and Professor of Marketing at INSEAD, was quoted saying that ‘Empowered Patients’ can make an impact even before the drug is available to them. He cited instances of how the empowered breast cancer patients in the US played a crucial role not only in diverting funds from the Department of Defense to breast cancer research, but also in expediting the market authorisation and improving market access of various other drugs.

Angelmar also highlighted that ‘Empowered Patients’ of the UK were instrumental in getting NICE, their watchdog for cost-effectiveness of medicines, to change its position on the Age-related Macular Degeneration (AMD) drug and approve it for wider use than originally contemplated by them.

To respond to the challenge posed by the ‘Empowered Patients’, pharma companies especially in the US are in the process of developing innovative approaches for a more direct relationship with the patients and patient groups. Creation of ‘Patient Empowered’ social networks may help addressing this issue effectively.

For example, to respond to this challenge of change companies like, Novo Nordisk has reportedly developed a vibrant patient community named ‘Juvenation’, which is a peer-to-peer social group of individuals suffering from Type 1 diabetes. The report also says that this programme was launched by the company in November 2008 and now the community has over 16,000 members, as available in its ‘Facebook’ page.

To cite another example, Becton, Dickinson and Co. reportedly created a web-based patient-engagement initiative called ‘Diabetes Learning Center’ for the patients, not just to describe the causes of diabetes, but also to explain its symptoms and complications. From the website a patient can also learn how to inject insulin, along with detailed information about blood-glucose monitoring. They can even participate in interactive quizzes, download educational literature and learn through animated demonstrations about diabetes-care skills.

Some other global pharma companies, who are reportedly in the process of engaging with the customers through social media like Twitter, are Pfizer, Johnson & Johnson, Novartis, Boehringer Ingelheim, AstraZeneca, Bayer, GlaxoSmithKline, Sanofi, Roche and Merck.

Thus, many pharma companies, over so many years, have been increasingly trying to be more and more ‘Patient-Centric’ in their endeavour to satisfy the demands of the new generation healthcare consumers – ‘The Empowered Patients’.

In today’s era, increasing general awareness, rapid access to information on diseases, products and cost-effective treatment through the cyberspace, together with instant communication between the patients and also the patient groups through social media like, ‘Twitter’ and ‘Facebook’, I reckon, would hasten the process of ‘Patient Empowerment’ in India too. This trend, in turn, will have its own inherent potential to change the overall dynamics of healthcare in the country significantly.