The Growing Complexity of Patients: Unveiling the Challenges Faced by Patient Advocates

Posted on January 16, 2024

Medical complexity considers various metrics such as patient age, comorbidities, medications, hospitalization frequency, and outcomes like ICU admissions, survival rates, and readmissions. The average hospitalized patient today is about 3 years older, twice as likely to have kidney disease, 70% more likely to have diabetes, and is on more medications, especially anticoagulants. Emergency room admissions have surged, and patients spend more time in the hospital each year.

In the not-so-distant past, a med student peered into the hospital room of a patient, filled with confidence about the things they could tell that individual. Fast forward two decades, and that student, now an attending physician, finds themselves in a healthcare landscape where patients seem markedly more complex. The sentiment is shared among many in the medical community and patient advocates. The realization prompts questions: Are patients truly becoming more complicated, or is it a perception skewed by the passage of time, diminished staffing levels and seemingly increasing responsibilities?

This concern finds validation in a recent Medscape commentary by F Perry Wilson, MC, MSCE, dated January 8, 2024. Wilson reflects on the evolving nature of patients over his medical career, pondering whether the perceived increase in complexity is real or a consequence of the aging process. The quest for answers leads to a study in British Columbia, providing valuable insights into the changing dynamics of hospitalized patients over the past 15 years.

The Tale of Complexity: Unveiling the Data

The study, "Population-Based Trends in Complexity of Hospital Inpatients,"[i] published in JAMA Internal Medicine, delves into over 3 million nonelective hospital admissions in British Columbia. Two factors make this study particularly insightful: the province-wide electronic health record system and the backdrop of universal healthcare, providing a comprehensive and uncluttered dataset.

The authors adopt a holistic approach to complexity, considering various metrics such as patient age, comorbidities, medications, hospitalization frequency, and outcomes like ICU admissions, survival rates, and readmissions. The findings reveal a clear narrative: the average hospitalized patient today is about 3 years older, twice as likely to have kidney disease, 70% more likely to have diabetes, and is on more medications, especially anticoagulants. Emergency room admissions have surged, and patients spend more time in the hospital annually.

Evolution without Deterioration: Unraveling the Outcomes

Contrary to expectations, the outcomes for these more complex patients haven't worsened. In fact, inpatient mortality is lower than it was 15 years ago, though 30-day post-discharge mortality has increased. The combination stabilizes death rates, with approximately 9% of people admitted for nonelective reasons dying within 30 days. Modern healthcare practices, including advancements in cancer and heart disease treatments, contribute to this paradoxical scenario where patients survive but face different challenges.

Behind the Complexity Curtain: Unmasking the Causes

Demographics play a role, with an aging population contributing to the complexity surge. The burden of comorbidities linked to the obesity epidemic further complicates the picture. However, a significant factor is the success of modern medicine in keeping individuals alive who might not have survived a decade and a half ago. Despite this, hospitals often operate with minimal staffing levels, raising questions about resource adequacy in the face of escalating complexity.

As patients become more complex, the burden on healthcare professionals intensifies. Yet, patient advocates, the unknown heroes in this evolving narrative, don't merely navigate; they champion adaptability in the face of changing medical landscapes. Their mission involves a perpetual search for solutions, often uncovering them in the most unexpected places. With a client base predominantly comprising individuals with complex medical conditions—representing a staggering 80% at Patient Advocates of Southwest FL, LLC—their experiences offer profound insights.

In a discipline where the ranks are not yet large enough to advocate for increased resources effectively, patient advocates forge ahead, challenging the status quo. Rather than settling for "No," they draw from a wealth of experiences that reveal solutions hidden in the complexities of our healthcare system. The journey of patient advocacy is dynamic and demands not just acknowledgment, but a deep understanding of the unique challenges faced by both advocates and their medically complex clients. It is a call for recognition, not just of the increasing complexity of patients but also of the invaluable role patient advocates play in navigating these uncharted territories.

About Me:

As the founder and senior managing director at Patient Advocates of Southwest FL, LLC, I am immersed in the intricate world of healthcare navigation for individuals with complex medical conditions. With a commitment to adapting to a seemingly ever-changing healthcare system, my advocacy journey is fueled by a passion for uncovering solutions in unexpected places. Over 80% of our clients at Patient Advocates of Southwest FL, LLC, currently represent the evolving face of medical complexity.

My hands-on experiences have revealed that the solutions we seek are often hidden in the nuances of the system. As an advocate, I continually challenge the status quo, refusing to settle for "No" and drawing insights from the unique challenges faced by those navigating the complexities of modern healthcare. Join me in this dynamic exploration, where patient advocacy goes beyond recognition to actively shape the future of compassionate and effective healthcare solutions.

[i] Medscape, January 8, 2o24. “Yes, Patients Are Getting More Complicated. F. Perry Wilson, MD, MSCE. https://bit.ly/3tN1Jkn