The Patient Hierarchy of Involvement

Patients interact with disparate elements of the Sick Care system at differing levels of intensity and motivation. A big business has grown around getting patients more involved in an effort to improve their health and insurance IQs. That, theoretically, would lower costs, improve outcomes, and enable and empower patients to make better use of scarce resources. 

Patients seem to evolve along a hierarchy of involvement. The steps are: 


They use the Internet to get information about their symptoms or condition before they get involved with the Sick Care system. They do the cost benefit and decide whether to see a doctor or other Sick Care professional based on the results. The goal is to improve their Sick Care and insurance IQ. 


Once they see a doctor, they are reactive in following instructions or complying with diagnostic and treatment recommendations. Examples include showing up for surgery, getting prescriptions filled, and taking the medicine as prescribed and following postoperative instructions. The goal is to do what the doctor said to do.


As part of a given episode of care, the patient gets more actively involved at a fulfillment level. They are proactive in following up to get promised information that was not delivered or mail-order prescriptions that were not sent or received. They make the appointment with a consultant suggested by another doctor. Many of these activities fall under the category of "Sick Care tech support"  


Patients, at this level, take a proactive, not reactive, role in their care and involve themselves in disease prevention and wellness. They have high healthcare and insurance IQs and appropriately use resources. Moving from one level to the next is difficult and requires providing patients with the training, tools, and motivation to succeed. Smart organizations and doctors will give them the tools to move up the ladder. 

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs at