Is It Possible for Patients to Become Too Engaged in Their Healthcare?

As various health reform programs encourage and rely on increased patient engagement, I’m left wondering: is increased patient engagement always the healthiest option for patients?

My concerns focus on three increasing occurrences highlighted in the media:

• Patients accessing physicians’ notes
• Patients receiving lab or test results directly from the lab
• Patients undergoing various lab or tests at retail lab centers

The first occurrence - accessing physicians’ notes - is a right guaranteed to patients by federal law. But according to recent articles appearing in the Washington Post and Kaiser Health News, physicians have not always made accessing notes easy for patients.

Many are reluctant to hand over the goods because they fear their patients won’t understand the notes, that they’ll misconstrue them, or that reading them will cause undue stress, according to a recent study published in the Annals of Internal Medicine.

Still, physicians may need to halt that reluctance. According to the Post, the movement to give patients direct access to their health information is picking up steam. The proponents argue that accessing physician notes will increase patient engagement and communication with healthcare providers.

The second notable occurrence - allowing patients to access lab or test results directly from the lab - is also a point of contention.

Just seven states, (Nevada, West Virginia, Maryland, Delaware, New Jersey, New Hampshire, and Oregon) and the District of Columbia, explicitly allow patients to get test results directly from the lab without physician approval, according to American Medical News.

While patients might receive test results more quickly if able to access results directly, this could also lead to serious problems for patients. Especially if a patient’s test results are not favorable. In that case, a physician’s presence to explain the results, outline treatment options, and perhaps even comfort the patient, is essential.

Yet, it could become increasingly common that your patients access their results without you. In fact, the Department of Health and Human Services recently proposed a rule giving patients in every state direct access to their lab test results.

The third and final occurrence - retail lab centers - is most disturbing. The number of these centers, in which patients can walk in and order tests for themselves, is increasing, according to NPR. One such center, Any Lab Test Now, has over 100 stores and it even offers HIV screening.

Kevin Hein, a lawyer who represents lab franchisees, told the news organization that the labs are “another way for people to take control of their own health and monitor stuff that they feel is important to monitor without always having to have a doctor involved.”

But do patients always know what tests they need and what test results mean without a trusted physician’s guidance?

Michael Wilkes, professor of medicine at the University of California, Davis, told NPR, "If you order enough tests, something will eventually come back positive.” And without a doctor's input, he said, that can send someone into a panic.

Where would you draw the line when it comes to increasing patient engagement? Are all of the above occurrences beneficial to patients? Are any of them? Share your thoughts with us.