- The communication gap between physician and patient
- Encouraging full participation by patients
- The complexity of the healthcare system itself.
Talking to my doctor
In an article in the New York Times’ “Health” section, Pauline Chen, M.D., describes talking to a friend informally about her friend’s health condition and the latest research in the area. But when Chen suggested her friend discuss options with her primary care provider, her friend went quiet.
When she finally spoke again, her once-confident voice sounded nearly childlike. “I don’t really feel comfortable bringing it up,” she said. While her doctor was generally warm and caring, “he seems too busy and uninterested in what I feel or want to say.”
“I don’t want him to think I’m questioning his judgment,” she added. “I don’t want to upset him or make him angry at me!”
For many, including this writer, doctors are so highly regarded that it borders on intimidation. Couple that with a reimbursement system that necessitates seeing as many patients as possible in order to be successful, and you have a recipe for the physician-patient relationship demonstrated above. Recent efforts to make the healthcare decision making process a joint effort has improved medical visits, but it has failed to take into account the patient’s perspective. A recent study using patient focus groups sheds light on why some patients are reluctant to speak up for themselves:
- Even well-educated and well-to-do patients feel pressure to conform to social expectations, trapped into responding in certain ways to doctors
- Some physicians can be authoritarian
- Patients fear being labeled as a “difficult” patient
While most of the participants in this study were over 50 and lived in relatively affluent areas, it stands to reason that others from different socio-economic backgrounds would feel the same way.
Chen effectively sums up what’s needed:
Care organizations and doctors’ practices must be restructured to allow more in-depth conversations; clinicians need to be reimbursed for the time required for more meaningful conversations; and health care systems must adopt rigorous quality standards that measure and value real patient engagement in decisions.
Supporting healthy lifestyles
As we work to transform our healthcare system to improve patient-doctor communication, it must also undergo radical change to support wellness, rather than profiting by the quantity of sick people treated. As noted recently in The Atlantic, more research is needed on how to successfully motivate people to live healthier lives.
This is not as easy as it seems, for it requires walking a fine line between encouraging behavioral change and individual freedom. “For example, a program could let diabetic patients earn points toward more affordable insurance coverage by completing a self-taught module on diabetes” (from article in The Atlantic). There are even mobile tools to help manage diabetes, as previously noted in this column. Such methods for improving health literacy show promise, yet need confirmation by research with large samples over long periods of time.
Yet some people will not change their behavior no matter what positive incentives are offered. For these patients, it would be all-too tempting to tie insurance rates to blood test results obtained while visiting one’s primary care physician. While no one is currently suggesting turning doctors into health police, if it could be made profitable, somewhere it would be tried.
In a sense, what is needed is a kind of health literacy for physicians and insurers. They need to know and understand what works and what does not in encouraging healthier lifestyles in patients: modes of education, treatment regimens and combinations, incentives and more. Redistribute profitability so a greater share of reward is earned for wellness, rather than sickness.
A better system
No matter your political persuasion, most seem to agree that the current system should be made better. Simplifying the process of obtaining, utilizing and keeping health insurance coverage. We pay far more for healthcare than other industrialized countries, and yet our system is ranked 37th in the world. Reforms to the health care system are a step in the right direction, and more are needed. T. R. Reed’s book, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, shows five different systems in other countries that provide a better healthcare system than we currently offer. Many in this country pride themselves on their ability to “go it alone.” It’s time we started learning from others successes.