Portals | MD's - Part 4 - Patient Emotions

written by Dr Johann Schreve

Circulating Knowledge

Overview

Patient portals are now part of the digital patient management era and I thought that it would be a good idea to do a 5 part series around this controversial topic. 

Introduction to the Patient Portal


I go over some of the elements captured within the patient portal.

The Patient Centred Approach


 

I discuss the core reason behind the patient portal.

The Physician and the Portal


 

I discuss the physician’s role in making the portal successfull.

The Portal: Flow and emotions


I explore the core of the portal and how information flows through the specific levels of care. I also explain some of the emotions that drives certain patient behaviors and how you as physician, can direct these emotions.

Future Integrations


 

I go over some of the more futuristic ideas around the patient portal.

Portal Emotions and Behaviour

I thought it would be interesting to write about the emotions that are experienced when accessing the portal and how it might affect patient behavior. The infogram below provides a quick overview regarding the basic portal structure that currently exists, as well how it fits into clinic practice.

Current Model of Care

Physicians are trained to perform evidence based medicine. Our process is quit simple, yet highly complex in it’s execution.

The basic process can be summarized below:

  1. History
  2. Physical
  3. Bedside Investigations
  4. Special Investigations
  5. Assessment
  6. Plan

Within this six headings we can add multiple subsections, but this is for another day and time.

Once the physician establish that more tests are required to make an assessment, the patient is referred to a facility for special investigations. Technicians performs the test, while specialists read and interpret the result, to provide the requesting physician with the information needed to complete their assessment. This process may vary depending where the patient is assessed.

Benefits of the Portal

  1. Empowering patients to take an active role in their healthcare
  2. Helping patients to better understand their medical condition
  3. Bolstering patient adherence to healthcare advice and the taking of medications
  4. Engaging patients to confirm that their health record is correct and complete, which may assist in reducing errors
  5. Giving patients another way to communicate with their physicians, which is convenient and secure.

Access to care

Many of us feel frustrated when patients present to the “wrong” access point for a certain complaint or problem. In the section below, I explain some of the emotions that could drive a patient’s decision to access certain points of care and why.

Access to care varies depending on the facilities and health care providers available in your specific area. Telehealth is fast becoming an alternative form of healthcare that has many benefits. At this point and time, Babylon offers a consultation based platform that works from your smartphone and patients will often use this service when emotions take over. 

Telehealth will be discussed in detail in a later post.

Flow of Information

Once the physician or technician imports the information into the EHR / EMR, a document is sent via a secure interface to the primary care provider, requesting physician and patient. Portals are configured to release information depending on parameters set and this is usually agreed on by an advisory committee for that specific organization.

Once the information is received by the primary care provider:

  • The result is interpreted and applied to the clinical problem of the patient.
  • Reports are interpreted and the electronic chart is updated accordingly.
  • Further investigations, visits or consultations are then initiated to formulate a plan or do a reassessment.
  • Regardless the existence of the portal the CMPA still advise that physicians continue to be responsible for ensuring that patients receive test results and a timely manner, and are informed of a diagnosis and the consequences of the diagnosis.
  • Physicians still play a critical role in:
    • explaining medical information
    • exercising clinical judgment regarding diagnoses and treatments
    • Interpreting and communication test and lab results for their patients in a timely and appropriate fashion.

Once the information is received by the user a variety of emotions can occur that predicts further behavior:

  • Good Emotions:
    • Content – Patients with a clear understanding of the result or report will often feel content that they are in good health and will seek further care based on new symptoms.
    • Confident – Patients that use the portal to manage chronic conditions, will often feel confident in their treatment plan and will seek care based on the recommendation by their primary health care provider or specialist.
    • Relief – Patients that are particularly worried about a specific health condition will feel relief if the report or result is favorable.
    • Trust – Good reports, plans and assessments will often create trust within the physician-patient relationship which leads to a stronger therapeutic relationship with health care providers.
  • Bad Emotions:
    • Scared/ Anxious
      • Results or reports that contains negative information, can lead to anxiety and fear among users.
        • Certain reports are held until requesting physicians can communicate bad news to patients, before it is read by the user.
      • The common response to fear is either visit a walk-in, emergency department or see their primary care provider if able to schedule and appointment.
    • Sadness
      • Reading a negative report or receiving a negative result can lead to sadness. In the event of having a good support structure, sadness can be dealt within their local environment, however those with adverse childhood experiences, mental illness or poor social support might respond in an unpredictable way.
        • Ensure that bad results are communicated by telephone or in person in a timely manner.
        • Anticipate that patients might have experiences or conditions that could lead to drastic behaviors and offer support.
    • Confusion
      • Medical terminology is hard to interpret and this can lead to unnecessary frustration and visits to healthcare facilities.
        • In the event of dictating a report, ensure that you leave a section that clearly explains findings in layman’s terms.
        • Provide concise instructions in your report and add links to relevant patient ready information to enhance their experience.
    • Anger
      • Reports that contains 3rd party information, is judgemental or contains inaccurate information can lead to anger.
        • Be Sensitive
        • Be Concise
        • Be Accurate
        • Avoid Medical Jargon
    • Overwhelmed
      • Portals are developed by highly skilled IT personal and is optimized for the user’s experience.
      • Many results and reports as well as difficulty navigating the portal can lead to feelings of inadequacy or being overwhelmed.
        • Provide feedback to the IT team and they will be happy to fix it.

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