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Over the weekend I bought new window blinds to replace the ones my cat damaged (note: claws and miniblinds don't mix well). I checked myself out at the cash register, guided by an eerie computer voice that always sounds like a lost cousin to the Starship Enterprise. Self checkout is something we've all gotten used to. Most stores have this option; it's especially great for customers with only one or two items.

As the economy has soured, other industries have caught on to the idea of putting customers to work. People who fly certainly know about ticket and check-in kiosks, although only today did Continental announce it would allow passengers to board by themselves as well. So, with health care costs rising, it's only natural for some in the medical world to start wondering if patients should, in part, heal themselves.

There's a lot that can be said about patients administering care. After all, only the patient knows how bad the pain is, or exactly where it hurts. Many of us self-diagnose all the time; certainly, my mother became an expert at common childhood ailments when I and my siblings were growing up.

There's a whole personal health movement that desires to put the patient firmly in control of his or her medical destiny. That includes full access to medical records and the use of Personal Health Records (PHRs). In fact, one of the people who spoke at the meaningful use press conference was patient advocate Regina Holliday, who shared her story about attempting to care for her late husband during his final months, and the struggle she had to get access to information about his treatment.

Mrs. Holliday and many others believe we're on the cusp of a patient-led revolution in health care. FierceHealthIT reported back in April about what changes Electronic Health Records are predicted to make:

"'For as long as we've known, healthcare has been "I go to the physician, and they tell me what to do, and I do it,"' says Dr. Nitu Kashyap, research fellow at the Yale Center for Medical Informatics, tells Scientific American. 'Soon more patients will be arriving at a hospital or doctor's office having reviewed their own record, latest test results and recommended articles about their health concerns. And even more individuals will be able to skip that visit altogether, instead sending a text message or email to their care provider or consulting a personal health record or smartphone application to answer their questions,' the magazine reports."

There's no doubt that health care has to be personalized (just check out these charts from the PricewaterhouseCoopers' Health Research Institute), and that medicine should encourage patients to be proactive about their health. After all, we want doctors to actually listen when we tell them what's wrong with ourselves or a loved one.

The most frustrating doctor's appointment I remember experiencing involved a provider prescribing more rest after (what felt like to me) a cursory examination. It was the end of my first year in college, just before exams. Certainly sleep would have helped, considering how little I had gotten by that point in the semester. However, I had also been exposed to a virus from one of my siblings at home, and my symptoms were a perfect match. Besides, I was frustration at being told to rest more at such a stressful point in the year: did the doctor think anyone on the whole campus would sleep well until exams were over?

So, both from personal experience and general beliefs, I'd certainly like the patient to be represented better in the doctor's office. Not only would such a transition affect greater care, but it could save lives. Just read about this New York Times author's close call to a serious medical side effect.

However, there's a philosophical model that describes change called the pendulum effect. Anyone who's ever pushed a kid on a swing knows that the farther you pull back, the higher the swing will soar upon release. Similarly, when we transition to new ideas, we have a tendency to go a little too far away from our past. My question in the midst of this patient revolution is this: just how broadly do patients want to be put in charge of their health?

Certainly, I think there are some who'd like to "take the reigns" and become masters of their own destiny, only going to a professional when in absolute need. But what about the average person, someone with a career, a family, a religious/community duty, and hobbies? How autonomous does this person want to be made?

Many proponents of electronic records have wondered why PHRs haven't done so well. Microsoft's HealthVault is still available, but Google Health isn't being given much support. Of course, there aren't many EHRs for these programs to link to right now, which is part of the problem. But I wrote this response to a blog post on the subject over at Chilmark Research:

"I think the market just isn’t quite ready for this concept yet. In reading about PHRs and the meaningful use requirement to offer patient access, I’ve often wondered how many people really want that responsibility. I know, I know, it’s about empowering patients, but as SpiderMan knew, 'With great power comes great responsibility.' Most of the older people I’ve asked (admitedly a small sample to survey) have said they don’t want it. One person told me, 'That’s what I pay a doctor for.'
My college health class used car upkeep as a metaphor for how we take care of our health. With my car, I know I should pay more attention to everything: it’d probably run better if I looked at it more, kept up with the latest from my manufacturer (hey, actually read my owner’s manual). But honestly? I’m just as happy to pay a mechanic to keep track of what I need, when I need it. The money I pay is as much to escape the tedium of keeping up with all that knowledge as it is for the service itself. I’m willing to bet a lot of people feel that way about health: they probably believe they should be involved, but when push comes to shove they’d rather just pay someone else to worry about it."

I still stand by that assertion. I think many people would like access to their records, especially if they have a serious disease or medical disorder. Most would like to have a doctor who takes the time to listen to them and really find out what's wrong. But I don't know as many who'd like to take over things. If not confronted with an emergency, few of us want to pour over our medical charts from the last decade, or compare our last few blood tests. We're simply not interested in the routine status of our health: as long as we feel good, and the doctor gives us the OK, we turn our attention to other problems.

Whether that should be the case is a different matter. Many chronic problems like high blood pressure, heart disease, and obesity require involvement from patients to overcome. Diabetics certainly know all about managing personal health, as do those with deadly allergies. The question is, what will get the moderately healthy Joes and Janes out there to care as much, before they are forced to go to the emergency room?

Then, of course, there's the legality question. How much can a doctor safely turn over to a patient, without worrying about whether it will be used later in court? Will great patient involvement in health care lead to more or less litigatiton? How responsible do we really want to be?

For now, it looks like the major technology disrupter in health care to involve patients will be in the form of telemedicine and remote monitoring. Just today the Wall Street Journal reported on remote monitoring of vital signs, and here's an earlier USA Today article on "telecare." In both instances, patients are in charge of checking and reporting certain metrics, like blood pressure. One person claimed this form of care would eventually "become as common as a cellphone...."

What do you think? Would you like to have complete access to your charts at all times, via a PHR or portal into the doctor's EHR? Do you want more responsibility for health care, including checking your own vital signs? Or do you want to rely more on a professional health care provider? How patient led should health care be?

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