Doctor-patient relationships must change to reflect modern era of health care

By European Alliance for Personalised Medicine (EAPM) Executive Director Denis Horgan 

The times they are a-changing. And fast. In this modern era of ultra-new science in DNA profiling, biomarkers and more, healthcare is evolving and moving forward swiftly. The arrival of the internet, and now, ‘Big Data’, plus the Cloud and super-computing has made much more information much more accessible to much more of the population. Smartphones and other devices, meanwhile, mean that we can get the information we want, whenever we want and wherever we happen to be.

In the world of health care, these exciting developments promised a seismic shift in the way it is delivered. The rise of personalised medicine, as well as fundamental changes in patient-doctor relationships, mean that the promise is already being realized. Modern-day patients want empowerment, and to have their illnesses and the treatment options explained in a transparent, understandable yet non-patronizing manner to allow them to become involved in co-decision.

They want to own – and have unreserved access to – their own medical data as well as greater access to clinical trials and cross-border treatments that could improve their lives and, in some cases, save them. Obstacles to gaining all of the above are many, but among the solutions are; better training for healthcare professionals in up-to-the-minute technologies; a different mindset from those same clinicians that allows the patient to participate in discussion and decision-making at all levels; the setting up of data co-operatives allowing patients not only access to all of their personal data on request but giving them control over who uses it, how it is used and when, and; changes from on high – namely the European Parliament and Commission – to make clinical trials more accessible and affordable cross-border treatments a reality.

These days, we often hear the term “patient-centered (or patient-centric) care” but it is one that is often ignored by many in the healthcare industry, and it’s not always their fault. Generally, health systems have evolved bit-by-bit down the decades and there is often a mess of regulation, structure, care and payment strategies which all conspire to leave patients confused and unsatisfied, as well as the front-line clinicians themselves. Electronic medical records have helped, by increasing focus on assisting individuals to navigate complex systems, and most non-patient stakeholders in the broader health sector have begun to value, and respond to, patient feedback. Yet Europe still lacks the full democratization of medical data so that the patient takes a partner’s role when it come to his or her own health.

A significant development, on top of this, is that there are now so many ‘do-it-yourself’ opportunities for patients through Smartphone apps, Telemedicine and ‘Wearables’ that can run hundreds of routine lab tests at home and remove the need to physically see a doctor.

There are now so many possibilities for immediate medical care, full access for patients to their own medical records, lab results and genetic information should they wish it. Unfortunately, it’s a legislative, safety and ethical minefield – yet all this information should be ‘owned’ by the patient.  There are, of course, concerns over the potential down-grading of the doctor-patient relationship with all of this new technology. Yet, given that there will always be a need for doctors to inform and help the patient with necessary decisions over treatments, it is vital that Europe’s front-line care-givers are up to speed. Of course, humans being what they are, it is possible that many healthcare workers will battle against leaving comfort zones and resist any significant changes. This cannot be allowed to happen and the powers-that-be in Europe have a huge role to play here.

The Brussels-based European Alliance for Personalised Medicine (EAPM) is firmly of the belief that health-care professionals, or HCPs, cannot be expected to adapt to new ways of approaching patients and coping with new technology unless they are suitably trained. These HCPs are being asked to move beyond traditional reactive medicine towards proactive healthcare management, employing screening, early treatment, and prevention, and to classify and treat diseases in a new way, interpreting information from across sources that blur the traditional boundaries of individual specialties.  Professionals will need to be confident of the science behind targeted therapies, including greater understanding of the immune system and molecular medicine, and knowledge of the mechanisms of action and interaction of targeted therapies, as well as common adverse events.

Communication skills with patients will also need to be developed. It is equally important to develop training for the many other professionals whose disciplines are essential to the successful development of personalised medicine - in bio-informatics, statistics, mathematical modeling, and so on - to promote the shared understanding and collaborative development of necessary tools. EAPM has produced a health-care strategy entitled 'Better treatment through better education: A European education strategy for the personalised medicine era', which begins with this call:

By 2020, the EU should support the development of a Europe-wide education and training of health-care professionals’ curriculum for the personalised medicine era, by committing to this in 2015. The EU should subsequently facilitate the development of an Education and Training Strategy for HCPs in Personalised Medicine. Despite the fact that, during the next 20 to 30 years, patients will more-and-more often be screened and treated away from doctors’ surgeries, the clinician will always play a key role. But these HCPs must learn new technologies, better communication skills, knowledge of how to advise patients on the treatments they need to give them a better quality of life, as well as be able to pass on knowledge about the choices and potential side-effects resulting from what should be well-informed patient decisions in respect of their own health.

With an ageing population of 500 million potential patients across 28 member states, Europe must act decisively and swiftly to improve the many doctor-patient relationships that are lagging well behind the times.

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