Here’s another technically easy and culturally hard product: Patient Friendly Orders. My version of this idea was born when I was admitted to the hospital for pneumonia about 5 years ago. Even though I had previously worked in that hospital, the quality of communication about my care between the patient and the medical team was poor. This got me thinking…
There should be a touchscreen by my bed that lists all the current doctors’ orders. They’re not hidden in the chart. They’re not explained only in ephemeral conversations that occurred without me present. Of course, if they’re in front of me, they’re going to have to get written in English.
Let’s organize the orders, too. Imagine a loved one is hospitalized for a severe skin infection which also caused his diabetes to get way out of control. He has difficulty sleeping in the hospital and also needs pain control. All the orders — whether for diabetes, infection, sleep, or pain — are organized according to the problem they address. (While doctors’ notes are generally organized by problem, their orders are not. I bet if we implemented Patient Friendly Orders, they’d be useful for doctors if only just for this reason.)
When the doctor or nurse or physical therapist comes in, the patient and family can have a conversation about the current plan, with that plan laid out in front of them. They make a shared decision, and the doctor can update the plan on the same touchscreen. “Sounds like a plan,” the patient says while actually looking at it. When you visit your loved one, he can show you the plan, too. If a question comes up about a given order, or why something is missing from the plan, you can make a note on the touchscreen so the medical team knows to address it when they next come by.
What about all the loved ones who can’t be in the room, the patient’s broader community? When I was in the hospital with pneumonia, for example, I wish I could have tweeted: “Switched from ceftriaxone plus doxycycline to zosyn. Does that make sense?” This of course raises important questions. Certainly, any such broadcast requires truly informed consent of the patient. I don’t think such a tweet would violate my doctor’s privacy assuming I don’t mention him or her by name. It would be fascinating to understand what a doctor might think: “Switching to zosyn — oh [bleep], what are they going to say on Twitter?” Is that a bad thing? I suspect the good would outweigh the bad.
But more important, it’s a conversation the patient and his or her loved ones must be allowed to have with their community. Indeed, we’ve probably all been a part of conversations about whether someone we care about is getting the right care. It’s just time the patient’s medical team and the patient’s community can be part of the same conversation.