In just the past few years, the changes in how we communicate with one another and process information are nothing short of amazing.
Between 2010 and 2013, the total amount of time Americans spent online increased 83 percent. In that same period, time spent on smartphones more than tripled, while time spent on tablets increased tenfold. American smartphone owners between the ages of 18 and 24 sent and received an average of 3,853 texts per month each in 2013. As great as that volume is, it has been overtaken by the number of messages sent via apps such as WhatsApp and SnapChat. Digital media has even surpassed the venerable favorite, television, in the share of time that adults spend with media each day.
In no aspect of life is communication more important than in health care. Effective communication between patients and caregivers can be the difference between satisfaction and dissatisfaction, wellness and sickness, comfort and suffering, even life and death.
A large body of evidence shows the importance of effective communication between patient and caregiver in diagnosis, treatment selection, patient adherence to treatment regimen, treatment monitoring, healthy behavior and patient satisfaction. Communication before and after treatment — choosing providers, making appointments, paying for services — is also a critical component of consumer satisfaction and business success. To manage communication, health care organizations have established and carefully maintained processes for when, where and in what form patients and providers exchange information.
New Demands for Communicating
Emerging changes in the health care business model are putting even more demands on communications. Under value-based payment, for example, identifying and communicating with high-risk patients is essential. In an increasingly retail health care environment, organizations compete for patients in part based on how convenient it is for patients to communicate with them and how well an organization uses a foundation of communication to build patient loyalty.
These new demands, along with the dramatic cultural and socioeconomic phenomenon of digital connectivity, are beginning to highlight the limitations of current communication methods in health care.
One limitation is accessibility. Patients fill out forms. They speak face-to-face with a caregiver during an appointment. They occasionally speak with a caregiver on the phone. Outside of these specified channels at these specified times, communication is on hold.
The communication itself tends to be formal and the topics circumscribed. In his book Being Mortal: Medicine and What Matters in the End, Atul Gawande writes about two common models for clinician-patient relationships: "Dr. Knows-Best," in which the paternalistic physician tells the patient the best path, and "Dr. Informative," in which the doctor acts as technical expert, leaving the decisions up to the patient. In neither model does the physician ask the patient's desires and goals.
In the new methods of communication, people can connect asynchronously, rather than only when both are available to speak. Communication can take place at any time of day. More than 40 percent of adults age 18–24 report that they send texts at 3 o'clock in the morning. Even when people are available for face-to-face communication, electronic messaging can be more convenient, more effective and preferred.
Formality-imposed barriers can fall when communication is easier and the pressure of real-time conversation is removed. Almost half of Americans age 18–24 report that a text conversation is as meaningful as a telephone conversation. Digital communication has proven to be fertile ground for emotional relationships, with the smartphone dating app Tinder reporting 13 billion interactions in its first year, to cite just one example.
Growing Momentum for Change
Innovative competitors are well-aware of the gap between modern modes of communication and the methods used by legacy health care organizations, and they are actively exploiting that gap. Companies like Teladoc, MD Live and Carena offer access to a doctor 24 hours a day, seven days a week via videoconferencing, phone and email. At upstart primary care company Iora Health, the technology platform allows patients to read and submit notes on their medical record. And Apple, Google and Samsung are all developing platforms to aggregate health-related apps.
By 2020, 80 percent of adults in the world will own a smartphone. Those of us who prefer a face-to-face meeting to a text message may bemoan the death of conversation, but it is unrealistic to think that we can limit the mode of communication in the face of this pervasive social change.
Granted, a text message should not and cannot replace a meaningful face-to-face conversation between doctor and patient about how to manage a serious condition. However, within just a few years digital communication will be so firmly entrenched as the societal norm that organizations communicating solely through traditional techniques run the risk of being overtaken by competitors that embrace more contemporary techniques.
A university professor was quoted as saying, "I sit in my office hours lonely now because if students have a question, they email, often late at night … . And they never call, ever." Health care providers will need to determine how to embrace this broad societal change if they, too, want to avoid sitting alone in their offices.