Company Helps Patients Be Consumers of Health Information : CareWise system coaches people with medical data so they become more informed and spend less time and money for better treatment.

BELLEVUE, Wash. — The consumer movement is late coming to the practice of medicine. But it is coming.

One pioneering concept for health consumerism arises from the obvious and holds promise for the impossible.

The obvious: From birth, we have conditioned ourselves to be passive, trusting and impatient medical patients. For serious ailments we may be so bold as to seek a second opinion, but rarely more.

Take care of us, oh doctor, we say.

What if, however, patients could be coached with objective data to help them understand their ailments and possible avenues of treatment before they called the doctor? Or during treatment? Wouldn’t we be wiser consumers?

The impossible: Thus informed, we consumers receive better, cheaper medical care and need to visit doctors less frequently.

This is the precept of the CareWise system, a nine-year-old information and counseling service offered to employers to supplement ordinary health insurance. Other firms are now offering similar, competing services.

Unlike other health care, this service comes with a guarantee.

The subscriber fee is $45 per employee per year. Employers are promised they will save every penny of that cost through reduced medical care costs, says David A. Feffer, chairman and co-founder of Employee Managed Care Corp., which operates the CareWise system. Otherwise, employers or insurance companies get the difference refunded.

“When I started, the image in my mind was of a conveyor belt--patients passing through the medical system, passively having things done to them. The only decision they got to make was to walk through the door. It didn’t make sense that the patient was not part of the solution,” says Feffer.

Feffer believes patients need three things: A manual of basic home care, knowledgeable coaching for encounters with doctors, and access to the vast storehouse of dispersed and often unreachable medical information about what ails you.

Using registered nurses and toll-free phone lines, the process offers employees tutoring on what questions to ask doctors about their ailments. When treatments are prescribed, the service can provide the most current and prestigious published data on the probabilities of success and possible alternatives.

A patient with a bad back, for instance, may visit a specialist who recommends an expensive spinal steroid injection.

The doctor typically warns of possible side effects and explains that such injections are not always successful.

Often consultation between patient and doctor ends there.

But this new concept allows a patient quickly to obtain copies of independent research exploring the known probabilities of success, and the likelihood of danger. Studies, for instance, show that certain back patients have less than an even chance of emerging from a steroid treatment with long-term relief.

Such research also tends to highlight the difference in practice patterns among medical professionals. For instance, a Vermont study found that the probabilities of children undergoing a tonsillectomy by age 15 was 70% in one community but only 10% in a town just over the hill.

At a minimum, such information gives a patient something solid to discuss with a doctor. Often enough, patients have second thoughts about treatment. At least often enough so that CareWise claims that the smallest savings it has ever verified among its clients is $2 for every $1 spent for the annual enrollment.

Doctors are of a mixed mind about well-coached patients who come forth laden with the latest in medical research. Some, particularly specialists, may feel cornered and challenged. Naturally, some patients are prone to be a pain in the neck about that pain in their neck, particularly if they have the results of a 10-year study by the Harvard Medical School in their hands. Abuse, too, is inevitable.

Other physicians say they welcome patients who assume responsibility in their own care. For one thing, independent research tends to deflate the sometimes overblown expectations patients have for treatment. For another, self-informed patients may be less prone to win malpractice claims.

In any event, it is possible these days for a patient to become as up-to-date about an ailment as the doctor.

“Physicians are paid to treat people, not do research,” says Feffer. “. . . our experience indicates that a (utility company) lineman with a fourth-grade education, after six years of using our service, is more sophisticated about his medical care than someone with a Ph.D. who calls for the first time.”

Is Surgery Best? A Patient Helps Decide

Here is how the CareWise system works. The hypothetical patient is seeking help for carpal tunnel syndrome, an affliction that causes hand and wrist pain.

1. INITIAL CONTACT: The patient discusses case history and ailment with a CareWise nurse. The client has had chronic problems with carpal tunnel syndrome and in the past has tried rest, medications, a wrist splint and changing her work environment. The surgeon has now recommended surgery and the client has specific questions about her options.

2. RESEARCH REQUEST: CareWise studies the patient’s case and gathers information on the effectiveness and success rates of treatment with cortisone and by arthroscopic surgery.

3. RESEARCH RESULTS: The CareWise nurse discusses the information with the client. They review treatment options.

Among the options:

INJECTION--After rest and medication, cortisone injections may be the next step. Steroids may provide relief in up to 80% of patients, but the effect is transitory, with only 22% remaining free of symptoms 18 months after injection. Permanent relief after steroid injection is seen in only 11% of cases.

STANDARD SURGERY--The articles suggest that 30% to 40% of patients with carpal tunnel syndrome eventually require surgery. Surgical success rates: 50% total relief of symptoms; 40% fair to good outcomes; 10% no improvement or increased symptoms.

ARTHROSCOPIC SURGERY--Arthroscopic, or endoscopic, surgery offers the advantages of less post-operative pain, less scarring and more rapid recovery. One study of 149 cases gives statistics on how soon patients can return to normal activities. Potential disadvantages include poor visibility, inability to control bleeding and the fact that the endoscope blade comes closer than one-tenth on an inch to nerves. For a surgeon who only occasionally performs carpal tunnel release, it is probably safer to use the traditional open surgical procedure.

4. DECISION: The patient decides to seek a second opinion before receiving further treatment. The client requests copies of the research results so that she may use the information at her next visit.

Source: CareWise