Posted on | May 15, 2013 | No Comments
This week, the Washington Post published a lengthy piece focused on Medicare Part D, its history, and how it might be improved.(1) The suggestions – ranging from mining data to requiring diagnostic codes on prescriptions – zeroed in on “better prescribing”. What they missed completely was a simpler strategy with arguably greater benefit to health consumers – “less prescribing”.
Let’s step back for a moment and review the last 30 years of the health consumer movement. Gaining steam in and around 1983 as part of the civil rights movement, we have seen health consumers move from emancipation to educational empowerment to responsible direct engagement in their own health decision making. During that same period, the patient-physician relationship has shed much of its paternalism and moved toward partnership models marked by mutual decision making. Finally provision of care is increasingly delivered by a team, rather than by an individual. The teams are more diverse, multi-skilled and both technologically enabled and more mobile.(2)
All that said, further progress will be tied to adjusting biases of both providers and consumers to align with what appears to be an emerging age of “health enlightenment”. The sparks of this movement are largely being driven by two bands of women. The first are young mothers and mothers-to-be who are information and resource focused, and who rely on the Internet and social networking to advise, plan and execute healthy environments that maximize the human potential of their now and future families. The second band are a group of women, age 40 to 70, who are managing frail and disabled parents and grandparents while remaining engaged with children and grandchildren. These family caregivers seek a simpler, more efficient, more effective home-centered delivery system.(3)
In many ways these two bands leading the ‘health enlightenment” movement are mining the same simple fundamental truth – “less is more”. Less drugs, less fake food, less eating out, less stress, less sleep deprivation, less office visits, less hospitalization. They see low hanging fruit all around them. But how best might they execute this current revolution?
Here are three steps that would go a long way toward resetting a century of health provider driven bias that limits quality of life in a modern society.
1. Be Biased Against Medications. Ever since doctors returned from WWII flush with the joy of access to the “wonder drug”, Penicillin, our physicians have embraced the prescription pad as their best friend. Pharmaceutical reps happily fed the frenzy, and patients embraced what they saw as “easy fixes”. The reality is that many of these drugs are based on an incomplete understanding of human basic science, over-marketing of benefit and under-marketing of risk, and complex inter-drug interactions that create as many problems as they solve. The two critical questions consumers need to ask are, “Do I really need to take this drug?” and “How can I adjust my daily life to avoid having to take this drug?” The two critical questions the health professionals need to ask (think statins or anti-hypertensives) are “Has the ratcheting down of protocol driven ‘normal ranges’ been effected by expert witness/pharmaceutical conflict of interest?” and “Is the basic science underpinning for this drug I’m about to prescribe as well understood as the powers that be portray?” or stated in another way, “Have I properly weighted the downside of putting everyone with a diastolic blood pressure of 90, or a total cholesterol of 220, on a lifelong drug regimen?”
2. Be Biased Toward Self-Management. With the support of Obamacare, we are seeing major expansion of insurance coverage and conversion to electronic medical records. These changes will hopefully improve continuity of care and elements of health planning. Some consumers have interpreted this to mean that, if they can only find the right doctor and health system, the doctor will “keep track of keeping them well”. But health consumers need to understand that no health professional is as motivated, focused and undistracted when it comes to the health planning for them and their families as they are. They need to maintain a file of their own medical records and results. As important, they need to plan forward and organize a system that will reliably flag them when certain preventive milestones like mammograms, colonoscopy, annual flu shots, childhood immunizations and more are due.
3. Be Biased Toward Learning. Deeply embedded in the psyche of America’s patients is the belief that medicine is too complicated for them to understand and is better left to doctors and nurses to learn and communicate to us. Nothing could be farther from the truth. The basics – including normal and abnormal function of organs, basic disease entities, basic approaches to safety and prevention, and basic techniques to promote family wellness are well within the reach of everyday people. We have come to understand that poor financial knowledge places individuals and families at risk. Well the same is certainly true for medical science knowledge. Now this knowledge is at our fingertips, and it is only going to get better. And in certain areas, such as home-based nutrition, stress reduction, and life balance, the consumer is often far ahead of the health professional.
In the modern patient-physician relationship, we will rely on the health professional team to analyze data, coach, and advise on our performance against customized, well thought-out, personalized health plans. That trusted team will also be called on to ease access to specilized care, complex diagnostics and hospitals if and when these are required. As important, in an era of “health enlightenment”, we seek out their knowledge, judgement, and counsel, and in return we adjust our behaviors to reinforce the health professionals success and well-being. To do all this, we must bring knowledge and good will to the table, and must be well informed, prepared, alert, engaged and enlightened.
Foe Health Commentary, I’m Mike Magee.
1. Weber T, Orenstein C, LaFleur J. Strengthening Medicare’s Drug Benefit: 8 Recommendations. ProPublica published in Washington Post. May 11, 2013.http://www.washingtonpost.com/national/health-science/strengthening-medicares-drug-benefit-8-recommendations/2013/05/11/6998fdd6-b8f5-11e2-aa9e-a02b765ff0ea_story.html
2.Magee M. “Connecting Healthy Homes To A Preventive Healthcare System: Leveraging Technology.: The Populist Transformation of American Health Care”,Harvard Health Policy Review, Volume 8:7, Fall,2007. http://hhpronline.org/publication/previous-issues/fall-2007-part-1/
3. Magee M. “The Patient – Provider Relationship” in Connecting With The New Healthcare Consumer, McGraw Hill, 1999. http://www.amazon.com/Connecting-New-Healthcare-Consumer-Defining/dp/0071346724