Thursday, March 07, 2013

Health Care Reform's Inattentional Blindness

Dr. Lisa Rosenbaum politely hits the nail on the head in today's New England Journal of Medicine:

When it comes to health care, we have embraced a story that, by promising the delivery of high-value care, has become as easy to believe as it is to tell. The value framework for physicians means being held accountable for patient outcomes and resource consumption, whereas patients are reminded that value simply means getting what matters to them. By fostering divergent foci for our attention, this narrative allows us to continue ignoring the tough choices facing our health care system.

If we want to simultaneously improve quality and cut costs, we must first stop creating incentives that effectively split patients and physicians onto different teams. We must acknowledge that shared decision making is just that: shared. We must admit that turning health care into a customer-service industry may to some extent undermine the delivery of evidence-based care. And we must admit how little we actually know about patients' values and about how they should or might influence our decision making, the delivery of evidence-based care, rising costs, and patient outcomes.
Read the whole thing.

-Wes




2 comments:

  1. Wes,

    Thanks for pointing out this essay to us.

    I'm impressed with Dr. Rosenbaum's reasoning and vision. After an online search, I came across a couple more essays that may be of interest to you and your readers.

    In NY Times she writes about the unintended downsides of emphasizing interpersonal skills in choosing a doctor:http://www.nytimes.com/2011/11/01/health/views/the-downside-of-doctors-who-feel-your-pain.html?_r=0

    In Huffington Post she writes about the challenges of both pleasing your patient and giving them quality care: http://www.huffingtonpost.com/lisa-rosenbaum-md/are-antibiotics-over-pres_b_813199.html

    We doctors have lost control of our own narrative. Messages that arise from the empowered patient movement, healthcare reform, and heathcare IT run the danger of demeaning our profession and pointing us to places that we should not go. It is encouraging to hear strong contrarian physician voices like Dr. Rosenbaum (and Dr. Wes, of course) fighting the good fight for us all.

    Jay

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  2. All true. A consumer model of health care suggests that the patient, as the buyer, can get whatever they want. However, unlike the real world, the patient expects to get whatever they want WITHOUT knowing or paying the cost of what they want. The seller, or the physician, is being asked to cut costs without knowing what the costs are. I refer to the recent Time magazine article about the opacity of cost in medicine. You can't run medicine like a business.

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