After 23 years in family practice in Topeka, Kan., Douglas Iliff, MD, said that despite what he reads about consumerism being the wave of the future -- or the present -- patients usually want him to tell them what to do. Even the patients who ask the most questions -- typically those who have high-deductible plans paired with health savings accounts -- honestly want his recommendation, not just coaching or a list of options, he said. "Since the Internet revolution came along, yes, patients ask more questions, and ask more intelligent questions. But they'll come to me with those questions asking what I think." Research by consulting firm Deloitte supports Dr. Iliff's observation that most patients do like what it terms an "authoritarian" or "traditional" physician. But it also suggests that a growing number of patients is seeking more details from doctors, in terms of both costs and treatment. Paul H. Keckley, PhD, is executive director of the Deloitte Center for Health Solutions, which conducted the nationwide survey of 4,001 adults in the fall of 2008. He said the survey, released this spring, supports his contention that physicians need to adjust to patients who are more likely to want choices and detailed information from doctors, not just a prescription or a referral. "The good news is, most consumers are generally happy with the physicians they see, and they are still trusting in the recommendations of those physicians," Keckley said. "The challenging news would be they're becoming a bit uncomfortable with the lack of information they'd like to get from physicians." Patient personality types As in Deloitte's first consumer health care survey, released a year ago, respondents were split into six personality segments based on their answers. The largest group, 28.5% of respondents, was "content and compliant," characterized by satisfaction with the current health care system and preference for traditional approaches in medicine. Nearly as common, 27.6% of the respondents were defined as "casual and cautious," defined by disengagement in health and treatment, disinterest in options and a weak sense of quality differences. Another 25.3% of respondents, however, were "sick and savvy" -- very aware of quality differences and likely to participate in health care decisions. "Out and about" patients, who made up 8.2% of respondents, were interested in nontraditional medicine and were least likely to trust doctors' advice. The 8% of patients described as "online and onboard" were characterized as most likely to shop around for doctors, ask for drugs by name and to participate in wellness activities. The smallest category, "shop and save," encompassed 2.4% of respondents. These patients were likely to change physicians or health plans to save money, but also likely to not fill a prescription because of cost. Although nearly a third of respondents remain in the "content and compliant" category, Keckley said those patients are older. He said that population is, to put it bluntly, dying out. The respondents in the most recent survey were incrementally more likely than those in the 2008 survey to be in the "sick and savvy," "online and onboard" or "shop and save" categories. Those patients are active and engaged in choosing physicians and hospitals, asking for reliable medical advice, and seeking quality and cost information. Keckley said physicians need to change their practices now to be ready for the future. "For a patient to leave the doctor's office newly diagnosed with a condition without a referral to a trusted Web site to find more information is simply a mistake," Keckley said. Physicians who want to get ahead in their markets need to use the Web to interact with patients between visits via a personal health record connected to patients' homes, he added. Physicians who "are not tech-savvy are physicians who are going to be paid less, and they're going to regret it." Adopting the patient-centered medical home model is one way physicians can create a practice that caters to different types of patients, like those in the "complex mosaic" outlined by Deloitte, said Lori Heim, MD, president-elect of the American Academy of Family Physicians. The medical home is generally defined as a base from which health care is coordinated. A physician has an ongoing relationship with a patient and helps coordinate the patient's health and treatments across the entire health care system. Dr. Heim said running a practice as a patient-centered medical home would help a physician care for every patient, whether they are "content and compliant" or "shop and save" patients. "I think the successful physician, just like the successful person, is someone who can adapt their style to be the most effective with the patient," she said. Cultural shift on costs The Deloitte report also suggested that the cost of seeing doctors and getting treated for illnesses or injuries could be behind a continuing shift from a more passive patient population to a more active one. Sometimes patients decide to ignore a doctor's advice altogether if it's deemed too expensive. So what can physicians do to keep savvy patients engaged but also discourage them from skipping needed care? David C. Scroggins, a Cincinnati-based practice management consultant and principal with Clayton L. Scroggins Associates, said physicians should talk to patients about what can and cannot be postponed when money is tight, and they should remind patients that even cut-rate insurance plans often cover preventive visits. "Then, when they have to make choices when they've got money to spend, they think, 'Maybe I will spend it on my health,' " he said. Dr. Iliff said he is skeptical of surveys like Deloitte's that ask consumers what they want in an ideal world, or what they would do under certain circumstances. What matters to his practice, and where he said "the system is falling apart," is what people actually do, not their intentions or wishes. The original and full article can be found here: