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Self-help vs Job share: How do we rate the work of patients ?

Health services worldwide are struggling under the strain of increased demand and exhausted (or frustrated) health care workers post-COVID-19.

Patients waiting for care might increasingly look to take things into their own hands, Google advice and purchase home monitoring equipment. Just this weekend a relative showed me a video of her mum who had fallen at home. They had installed an alarm system and were able to show the exact course of the accident (and the cause for any trauma).

Another patient showed me the change in heart rate that had been recorded on their smartwatch. It allowed us to see when the acute illness had started and decide together what treatment might work best.

All this is really helpful. But it is also work, the hidden work of patients and their carers. It might make healthcare better and safer. It might give patients a feeling of greater autonomy and control. But it will take patients' and carers' time, effort and money.

In some areas patient held monitoring is opening up new pathways of care. Services that did not exist previously. In other areas wearables allow those with more resources to get ahead. This means potentially more inequalities. But also possibly more capacity to care for those who are not able to buy-your-own.

The challenge of innovation favouring those who are more literate and wealthy is by no means new. It is often that innovation is first accessible to those who are better off first. Then innovation gets cheaper, the value proposition changes, the access gets broader till it is finally accessible to most. Books before Gutenberg's time were prohibitively expensive, then printed books were affordable to the more well off, then copy shops and home printing made the tools available to almost everyone. With monitoring in healthcare the advances might be progressing in a similar way - from the invasive monitoring in the cardiac cathlab and in Intensive Care to monitoring that is integrated into wrist watches and consumer grade devices that can be owned by most.

There is a question whether this type of technology advances differently in times of economic hard ship and financial pressures that force change or just a natural process.

I am sure that this is one of themes that will come up at #PatientPoweredSaferty #PPS2023 ! What is your view on innovation and its impact on delivery of equitable care?

On balance I think that patient owned monitoring will ...

  • Make care for most more accessible

  • Add little value and make care for the most vulnerable worse

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