Saturday, February 12, 2011

I Find Your Lack Of Will Disturbing

Consumer Reports has a good little survey in the March 2011 issue of “What Doctors Wish Their Patients Knew.” There’s a lot of information of various types, but I’d like to zoom in on a pair of datum points to make the extended point of, “What Doctors Wish Their Patients Knew (If The Health Care System Would Make It Easier).” Unfortunately, the article isn’t available in its entirety online, so this is transcribed directly from the original.

Here’s the first point:
Noncompliance with advice or treatment recommendations was the top complaint doctors had about their patients. Most of the doctors we surveyed said it affected their ability to provide optimal care: 37 percent said it did so “a lot.”

But compliance these days can be a lot more complicated than just remembering to take a pill, patient advocate Gruman said. Hospitals are sending patients home with long lists of self-care chores. Drug and lifestyle regimens allow those with chronic conditions to live longer, healthier lives but can be difficult to manage or, in some cases, for patients to afford.

A nice little apercu on the subject comes from the blog Modeled Behavior:
I argue that if the treatment only works if the patient does something that he or she isn’t going to do, then the treatment doesn’t work. Doesn’t matter what JAMA says. To the docs I say, you go to war with the patients you have, not the patients you wish you had.

Or something like that—maybe not all that extreme. Genuine wellness is a mutual effort, but I’m not sure how good the health care system is about it. Part of the problem is human fraility/weakness—have you seen how many diet books are out there? There’d be fewer by a factor of half at least if we were good at compliance, as a species. But still, the incentives aren’t really there—if anything (assuming doctor’s motivations were all cynical and profit-lusting), their incentives would be for you to have a recurrence of your symptoms/condition so they might perform more procedures on you, getting more cash from the insurance company. Obviously that’s not a great description of health care economics, but if you look at comparative readmission rates, there’s something there. The system isn’t optimized—if you want more proof, take a look at this TED talk I linked to earlier or Atul Gawande’s New Yorker article on medical hot-spotting—to care about compliance. It could be easier.

Like, here’s a specific point (on one of my favorite hobbyhorses! Two guesses…you’re right!) from later in the Consumer Reports survey to bolster this idea:
Slowly but surely, primary-care doctors are switching over to electronic medical records. Thirty-seven percent told us they keep their records electronically only, compared with just 24 percent who did so in 2007, during our last survey.

But they want you to know it still pays to keep track of your medical history yourself. Eighty-nine percent said that keeping an informal log of treatments, drugs, changes of condition, notes from previous doctor visits, and tests and procedures could be helpful. But only 33 percent of patients did so. Likewise, 80 percent of doctors thought taking a friend or relative to your office visit could be beneficial, but only 28 percent of patients did so.

The first paragraph deserves a well done to the medical system, I suppose. Something is better than nothing. The second, however, is more amusing than anything else. It’s unintentional irony, but nevertheless amusing, that the subject the column over in the article is “doctors are pressed for time.” No way! So are your patients!

It would be helpful, no doubt, to bring friends and relatives over for your doctor visits—but is this really realistic for many patients? Similarly, it’d be helpful to keep a pretty good record of all this stuff—but again, is this really realistic for many patients? For the former question, I’m not sure any change short of a revolution in organizing working life is going to achieve the desired effect; the latter question, however, is entirely and easily remediable: simply allow people access to their own medical records. Then they don’t have to keep an informal record of all that stuff, because they already have one. I have records of nearly all of my financial transactions of any consequence, my phone bills, my schooling, etc. etc. But it’d be difficult to guess where to begin to get my medical records, and it really shouldn’t be that way. It also shouldn’t be on the unreliable memories and weak wills of people to keep themselves organized when we have at our disposal a system of machines that, when combined, do not forget and do not have failures of will.

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