How Passive Patients Hurt Themselves

We need a fundamental redesign of the role of both consumer and doctor — and more accountability all around

When you need medical attention, you call your doctor’s office, make an appointment, see your physician, and pay your bill. Simple, right?

The authors of a recent article in the Harvard Business Review aren’t so sure. “The U.S. health care system rarely feels like it’s been set up to help us succeed,” Len Schlesinger and John Fox say in an article titled “Giving Patients an Active Role in Their Health Care.”

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“What’s needed is a fundamental redesign of the patient’s role — from that of a passive recipient of care to an active participant charged with defined responsibilities, equipped to dispatch them, and accountable for the results,” the two argue. “In other words, we need to view the patient’s role as a job and then design that job in such a way as to drive the best health outcomes possible.”

Technology, they believe, is the key. They suggest increasing the use of wearables, an online portal that better walks people through their health care, improved reminders for appointments and medications, and a more fluid data exchange between patients and their health care team.

All of this sounds fine — but the authors presuppose all patients can easily navigate health IT, and that everyone is highly motivated and capable of making difficult lifestyle changes. It also assumes physicians can fit more — meaning more patients, more information, more interaction — into their day. Doctors and other front-line health care providers are already experiencing record rates of burnout.

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Patients can do a few very simple things to drive the best health outcomes possible:

1.) Know your medications.
Keep a typed list of all doctors, medications, and procedures with you at all times. Others will not do this for you.

2.) If you have a question, ask.
Come prepared with a list already in hand. Also, ask your doctor for reliable websites.

3.) Avoid alcohol. Take your medications. Stay physically active.
Follow all of this. Then ask your elected representatives why drugs and procedures in the U.S. are so expensive compared to those in Canada and Europe. Ask them why doctors and hospitals elsewhere are required to post their prices.

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In the meantime, Schlesinger and Fox are wrong in their assessment of what it will take to improve our fledgling health care system — even if it were achievable.

A well-functioning health care system provides three things: prompt access to care, high-quality care, and low-cost care. In the best of all possible worlds, patients can get two of the three. This entire “health care debate” is about how to dole out a very finite amount of medical resources (medical personnel, drugs, facilities, etc.) against an infinite demand for it. It is also about respect and empathy — not rapid sharing of medical information.

Related: It’s Time the Health Care System Serve the People

Health IT has some of the poorest return on investment of any IT. And private practice, which we lose more of every day to major health care systems, is the most financially efficient practice model.

Besides a lower overhead in my private practice, I’ve found that simple things work. For the first five minutes, I let patients do the talking. They are there because of their own concerns, not to fulfill electronic health records’ “meaningful use” criteria. I promptly answer questions and phone calls. When patients are sickest and admitted to the hospital, I see them and offer appropriate support — that way, as their doctor, I’m ensuring true continuity of care and not playing catch-up when they see me in the office.

In short, I’m meaningfully invested in my patients’ good outcomes. My patients know it, and it’s reflected in a busy waiting room and top internet scores from patients.

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Of course, patients still need to embrace behavior change and take accountability for their own care. But technology doesn’t accomplish that. Why? There are no immediate adverse consequences to bad lifestyle decisions. And not all patients are tech-savvy “consumers” who make the right decisions for the good of society, let alone themselves.

Costs are high because medical drugs and procedures cost four to 10 times more in the U.S. than in most other countries — not because we haven’t effectively deployed health care IT and other technology.

Controlling costs is imperative. The fiscal impact from Medicare and Medicaid has to be reversed, not just halted, right now or it will detonate the federal budget at some point before 2020. Lowering costs of drugs and procedures doesn’t require any new laws or encouraging some tortured “innovative” health care delivery model.

It requires enforcement of existing antitrust consumer protections laws that have been around for 100 years. We simply need a Department of Justice willing to enforce existing law.

Dr. Ramin Oskoui, a cardiologist in the Washington, D.C., area, is CEO of Foxhall Cardiology PC and a regular contributor to LifeZette.

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