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Health Fellow Spotlight: Kistein Monkhouse, Patient Orator

Meet Kistein Monkhouse, a 2022 Aspen Ideas: Health Fellow who's bridging gaps in patient/provider communication with a storytelling app that empowers people to own the narrative of their health journey.

  • May 21st 2022

Kistein Monkhouse is a public health expert and patient advocate championing efforts to combat healthcare disparities. During her time working as a certified nursing assistant, she noticed high readmission rates with patients of color, women, and seniors, as the result of communication breakdowns between patients and providers. After speaking with several hundred patients about their experiences, her training as a care coordinator kicked in to find a better way. Now she leads Patient Orator, a digital health solution powering meaningful communication between individuals and their health teams to improve health outcomes. We caught up with Kistein ahead of Aspen Ideas: Health 2022 to learn about her big idea and how she's putting it into action.

Tell us about your big idea!

During a typical healthcare encounter, patients of minority identities, including women, LGBTQ, and the poor, face an increased risk of having pain symptoms and other problems dismissed by medical providers because of a “stereotype threat”. This breakdown between patients and providers can lead to improper treatment, lack of diagnosis, and insufficient care. But what if patients could document their health concerns from the comfort of their homes, without the fear or anxiety of being in a doctor’s office or the possibility of being interrupted by their health care team? My big idea is that we can use digital narrative storytelling to empower patients to more effectively share their health journeys and bridge communication gaps that exist with their health care providers. 

What is stereotype threat and how does it impact patient/provider communication within health care settings?

Stereotype threat is experienced by individuals with stigmatized identities. In short, it relates to the unpleasant psychological experience directly linked to an individual's race, ethnicity, gender, sexual orientation, class, or socioeconomic status. According to one publication by the Journal of General Internal Medicine, stereotype threats can impair intellectual functioning, i.e., working memory, and interfere with cognitive abilities. The impact of stereotype threat on patient-provider communication is heightened by the longstanding presence of implicit and explicit bias among healthcare systems in the United States, leading to healthcare disparities among underserved groups. For instance, in a situation where the patient sees the healthcare professional as someone in the majority population, the patient may feel threatened that they will be negatively stereotyped- and that fear and lack of trust can result in ineffective communication. Healthcare professionals cannot get essential information when this breakdown occurs, which can, in turn, impact the care patients receive.

Why is digital narrative storytelling a powerful tool for patients who often don’t feel heard by their medical providers?

Each of us must learn how to tell our own stories to overcome disparities as systemic change to combat health inequities has been slow. For example, studies have revealed that Black patients are routinely prescribed significantly lower doses of pain relief prescriptions compared to their White counterparts. And stereotypes of women ("emotional") and men ("brave") have led to a "pain gap" that can have a significant impact on patients living with chronic pain.

In the context of healthcare, patients are storytellers that must teach their medical providers about their medical symptoms through their symptom stories as a prerequisite for treatment. When we digitally record our story, we create evidence of said problem's existence, helping to remember, clarify, and detail it extensively to inform and educate our care teams. But most importantly, digital storytelling is a powerful tool for communicating our medical issues without the interference of implicit or explicit bias, stigma, or dismissal from medical providers.

How does a patient use the Patient Orator app to document and share their health concerns with their health care team?

We've standardized the symptom story, digitally formatting it to enhance narrative storytelling about the patient's medical issue, social needs, and care preferences. This culturally explicit solution empowers people to document their problems in real time to help them remember the issue, track their concerns, and communicate their problems with their medical providers effectively.

When patients encounter healthcare teams, they are routinely required to share their reason for the visit/symptom story at various parts of the encounter with numerous care team members. Using the Patient Orator app, they can easily show the details stored within the app or share their health concerns verbally by orating their patient story to their providers. They can also electronically share the story of their symptoms through email. Currently, we are working on connecting the symptom story to the electronic health record, so providers can better understand the patient's needs ahead of their visit. By doing so, we aim to provide a turnkey solution that improves communication for both patients and providers to bridge existing care gaps.

In addition to empowering patients, how do the stories recorded through the app help health care teams provide better care?

Healthcare teams are often limited within their interaction with patients by time constraints, patient communication skills, or physician burnout. In fact, a study found that physicians will interrupt patients within 11 seconds when they share their reason for a visit. But another study found that a patient will speak for up to 92 seconds if left interrupted. These interruptions can negatively impact the patient’s outcome since the physician may be missing vital information on the patient’s health and well-being. Interruptions often feel disruptive and can lead to longer patient interviewing time.

With Patient Orator, patients will come into the care setting capable of telling their patient story within 50 seconds, helping providers elicit the patient agenda, concerns, and treatment preferences in a more efficient, culturally competent, patient-friendly way. We're streamlining both the quality and quantity of information shared during the visit by the patient communicating previously gathered and documented thoughts to clinicians who would be less likely to interrupt knowing that the patient has something to communicate.

What is the next step for Patient Orator? How do you envision this tool providing hope to even more patients and disrupting health care delivery for the better?

At Patient Orator, we understand the need for clinical teams to function out of a unified digital system. As such, we have tailored our platform to work with various electronic health records (EHRs) so that information flows in a seamless and timely manner between the patient and clinical team. We see this solution as impactful across the care continuum in the future. Imagine a world where you enter an emergency or urgent care setting and are not asked to publicly disclose sensitive health information by telling the care team about your condition in a crowded waiting room. Imagine your digital health narrative acting as evidence that you are ill, where you no longer need to validate your health issue to gain access to quality care, and your healthcare providers point you in the right direction for appropriate social support and medical care designed around your preferences and needs regardless of your race, gender, sexual orientation, age, zip code or socioeconomic status. We envision Patient Orator continuously being an asset to improve patient experience before, during, and after health appointments, bridging the communication gap between patients and their care teams, and accelerating shared decision-making between both parties to improve outcomes. 


The views and opinions of the author are their own and do not necessarily reflect those of the Aspen Institute.  

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