By Annie Medina, MBA, ACNP-BC, Annie is Head of Healthcare Partnerships at Workpath and a practicing Nurse Practitioner
At the end of October 2013, I gave birth to twins. They decided to come almost 6 weeks early. Our time in the neonatal intensive care unit, coupled with being a new mom, brought on an intensity and depth of emotion for which I was wholly unprepared. One child had some physical abnormalities, which prompted visits from an array of specialists. We saw hematology, plastic surgery, orthopedics, and genetics before leaving the hospital. Some of that time is a blur, but I distinctly recall a physician recommending genetic testing, and linking some of the abnormalities with possible “catastrophic outcomes”. While our NICU time was mercifully short, I left the hospital with a list of follow-up appointments and an even longer list of “what-if”s.
Almost two months later, I found myself having to return to the downtown hospital to discuss the results of genetic testing. It was 3 days before Christmas, cold, wet, and gray. Parking downtown is awful, to say the least, and I had to navigate it and the maze of the hospital with two babies in carriers and my mother in tow. On return to my vehicle, I discovered that it had been side-swiped in my absence (narrow parking, even for valet). Mentally, I added repairs to the list of things I’d need to address in the coming weeks. The appointment itself lasted only 20 minutes. But the production of getting everything together, driving to the hospital, figuring out what to do with my vehicle, trekking inside, signing in, dealing with the accident, and doing it all again in reverse took all day. My husband returned home that night to find me exhausted, a mix of emotions (including relief), and in tears. If someone had asked me after the visit how I would have crafted this follow-up experience, I would have emphatically said I’d have chosen anything other than what transpired.
Choice in Healthcare
The concept of choice in healthcare is as tricky as the concept of individuals-as-consumers in healthcare. The theories around choice include how people make decisions, the fact that more is not always better, and coming to a “good enough” conclusion. Good decision making principles suggest that the person gather as much information as possible. Then, they should consider all the alternatives. Theories also suggest that incomplete information, urgent deadlines, and limited physical and emotional resources all limit the ability to make a good decision. Given these criteria, my previous story suggests I would never have been able to make a good decision. I recall reading an op-ed on whether informed consent is really ever possible. The author pointed out that, for many decisions that consumers have to make, it’s impossible for them to know all of the alternatives. It's also impossible for them to completely know what the consequences of a given decision are. There’s a reason why being a healthcare provider requires both education and practice experience, and why physicians specialize. There’s a lot to know, and you can’t learn the nuances from a Google search on Saturday morning. Couple this with the understanding that “having choices” is different than “making choices”, and it’s no surprise that this topic drives a wide array of conversation. (Another trend here is the push toward choices supported by shared decision making, consumer engagement, and expert knowledge. I'm not going to focus on that one.)
Trends in Choice
The consumerism trend in healthcare seems to acknowledge that medical decisions are difficult. Instead, organizations aimed to give choice in other areas. There is a shift to concierge and luxury options, advertising wait times, and more recently, offering different delivery settings. This makes sense. It is easier to know the alternatives when the choices aren't so complex and don't require having specialized knowledge. This approach satisfies the consumer's need for choice without making it overly cumbersome. The shift toward choice in setting is one that has me excited for the future of care. As someone who makes house calls, in-person care at home is a choice I tend to believe we should offer as often as possible. And, given some challenges faced by telehealth, should be an option when trying to meet the needs of people who delay care during this pandemic.
Bringing Choice to Consumers
One company in particular which focuses on choice for their consumers is Amazon Care. Consumers know Amazon for its ability to bring choice to retail consumers, and it manages to do so in its healthcare offering. Amazon’s brand promise is to be the “Earth’s most consumer-centric company”. After announcing its entry into healthcare, it’s clear they consider the people interacting with Amazon Care as "consumers". Amazon Care clients have the option of virtual or in-person care, the latter offered in-home or in-office. These are ideal choices. They are not so complex as to be overwhelming, and are important and impactful enough to encourage meaningful engagement. While the Amazon Care website doesn’t offer facility-based care as an option, Amazon did announce a partnership with Crossover Health. The partnership will launch an employee clinic, which would bring another meaningful option into the mix. The choice to interact with healthcare through a mix of virtual, in-person, and in-clinic/in-hospital care should be the standard. This is certainly the approach that Amazon care is taking.
My entire post-partum experience would have been very different if I had welcomed my twins this year. The in-hospital time would have been different, and the follow-up would have prioritized the three of us not returning to the hospital. Any hesitation around having a telehealth visit - whether with video or just a phone call - would likely have been cast aside as quickly as it arose. Looking back on those first few months of motherhood, I’m not sure which path I would have chosen. I do know, however, I would have liked to have the choice.