Consumerism is taking healthcare by storm: How is GI affected?

The trend toward consumer-centric healthcare is steadily moving forward. There gastroenterologists discuss how this trend affects their specialty.

Ask a Gastroenterologist is a weekly series of questions posed to GI physicians around the country on business and clinical issues affecting the field of gastroenterology. We invite all gastroenterologists to submit responses.

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Larry Good, MD, FACG, founder, CEO Good Pharmaceutical Development, CEO, Compassionate Care Center of New York: Consumer-driven health care has affected every area of healthcare, from elder care to on-demand endoscopy centers. Advances in IT, electronic data monitoring and virtual consultations will become more common.

The huge volume of information that is available on the internet drives consumer or patient-driven behavior, but may also misdirect them. Many patients present themselves as self-diagnosed and have done so incorrectly because they have misunderstood their symptoms or have misunderstood the information they have discovered.

Patient driven access to consultations also are driven by direct to consumer advertising. This was once only the province of Big Pharma, but now includes hospital systems, nursing homes, assisted living and palliative care centers, as well as individual and group medical practices.
These changes are here to stay and gastroenterologists and all physicians will have to adapt to these changes and protect and monitor their internet identities.
                
Hyder Jamal, MD, St. Jude Heritage Medical Group (Fullerton, Calif.): I like the shift toward consumer-driven healthcare. You can have a conversation with patients about the future, because the consumer knows more about personal healthcare issues. Looking at different diseases, we can see that people have started to come in for check-ups proactively. Many people who should be regularly checked for hepatitis C, for instance, didn't use to come in to get checked because they didn't have symptoms. Now, they're starting to come in of their own accord because they know they should – most likely because they're a baby boomer and have heard there's added risk. So that's a good thing.

The bad side is that so many people are buying herbs and supplements that may be marketed to help them but aren't necessarily direct and proven solutions to health issues. It's difficult to talk people out of using popular products that might be harmful.
Overall, consumer-driven healthcare encourages people to learn more and have more awareness about their health, which is really great and allows conversations about gastroenterology to move forward. But we GIs haven't done as good a job at consumer education as we need to. Consumer-driven healthcare offers patients education, and that educational role is being filled by pharmaceutical companies, blogs, nutrition fads, television and the like. We should have a unified medical source and leading expert voices to take on the responsibility of educating people. There are GI societies, but they're not generally for the public. Advocacy groups like the American Liver Foundation do some great work, but we need more legitimate public-facing information to help patients make better decisions.

The bottom line is that people have more information, but they are not necessarily better informed. That's why they come in to see GIs; to seek credible advice and direction.

Kavitha Kumbum, MD, Seton Healthcare Family (Austin, Texas): Consumer-driven healthcare plans are designed to encourage consumers to choose cost effective and personalized care and bring overall healthcare costs down. When patients understand the costs involved in their healthcare, they may be more willing to choose a cost effective option and avoid unnecessary repetitive tests. For example, with understanding the costs of a generic medication versus a branded medication a patient may be more willing to choose the less expensive one.

Another example, patients coming for colonoscopy will be more adherent to bowel preparation instructions and avoid repeat studies for inadequate preparation. Consumers may also be cost conscious and willing to shop around for less expensive services. A well informed and usually wealthy consumer may seek preventive services like screening colonoscopy more often. Patients may also be more compliant with their medications once they understand the cost involved.
However, the less wealthy and less educated, particularly those with chronic illnesses may avoid seeking preventive services. High deductibles may discourage patients from getting needed services in a timely manner as well. I anticipate that there may be some increase in number of screening colonoscopies, but definite reduction in unnecessary repetition of endoscopy with consumer driven healthcare plans. There is no clear evidence yet about the cost savings or effectiveness of these plans.

More articles on gastroenterology:
7 gastroenterologists on the biggest opportunities for GI innovation
Frank Chapman: Finding the ideal vendor in an imperfect world
New edibles in development for colonoscopy prep: 5 things to know

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