The Big Fix: How to get patients and doctors to change

Dr Smith recently received some guidelines on the treatment of high blood pressure.

AHA guidelines currently recommend a systolic pressure of less than 140 millimeters of mercury for most adults with high blood pressure, or hypertension. But doctors say these new findings support a steeper goal of 120 — a reduction that could translate into doctors putting millions more Americans with high blood pressure on additional medication.

The study found that hitting the lower 120 target reduced the risk of dying from cardiovascular causes by 43 percent.

After a month, there was no evidence that Dr. Smith changed her prescribing habits for her hypertensive patients.

Mary Jones is one of Dr. Smith's patients with high blood pressure. She has been receiving notices from her health insurance company providing her with her prescription history for the year as well as several educational and online resources that might help with complying with her doctor's instructions and how to save some money on her drugs (ask the doctor to order 40 mg instead of 20mg and use a pill splitter to save money). There were several lapses in prescription refills during the year.

Implementing the Big Fix in medicine means moving it from sick care to healthcare . Sick care means using resources to take care of patients when they are sick or have symptoms. That's how we spend over 90% of the $3.8T. Health care means preventing illness, achieving wellness or using techniques to interfere with the progression of disease or manage it. Moving from one to the next?will take a lot of work?. But, how do we do it?

In her book, Lead the Planet: Five Practices for Confronting Climate Change, organizational psychologist Rae Andre recommends five steps :

1. Get the truth
2. Assess the risks
3. Weigh the stakes and the power of the stakeholders
4. Define the business of business i.e. resolve the conflict between social justice, equity and the ethics and purpose of business
5. Engage global leadership.

These ideas are applicable to changing sickcare to health

Here are some more:

1. Change the rules. Access and reimbursement policies should reward disease prevention and health maintenance.

2. Change how we educate a 21st century healthcare workforce, providing them with the bioentrepreneurship, digital health, and population management knowledge, skills, and attitudes they need to serve their communities.

3. Target research and development funds to chronic diseases.

4. Create innovative non-brick and mortar care delivery channels that are easy to use, cheap and accessible.

5. Empower patients to take control of their care and information e.g. using?Open Notes.

6. Encourage appropriate DIY medicine and use behavioral econometric techniques to change behavior.

7. Support?patient entrepreneurs.

8. Give patients the information, resources, networks, and incentives to take care of themselves and other family members.

9. Create an integrated?health information whole product solution?that is patient centric

10. Use social media, social science discoveries,behavioral economic techniques and other consumer facing platforms to change behavior

11. Wicked problems require a different approach

12. There is value in negative optimism (expect the worse but hope for the best) and the power of negative entrepreneurial thinking

But, getting doctors and patients to change their behaviors is the key challenge and how to do it has befuddled psychologists for years. Navigating participants through the?last mile will be essential?and many digital health companies are betting they know the answers.?

Fundamentally, getting a person, an organization or a society to change means creating tools that make people willing and able to do it.?Most people are unwilling to change because they have competing commitments and diagnosing and addressing them is critical.?They are driven by self interest.

You can lead a horse to water, just like you can lead patients and doctors to WATER (willing, able, triggers, expectancy and other theories of motivation, and rewards), but, in most cases, that won't make them drink.

When efforts to improve health care fall short, the failures are often blamed on leadership and culture. But the main problem often is the underlying systems. To generate better outcomes, increase safety, and improve efficiency, health care organizations should shift their focus to designing systems that facilitate delivery of the highest-quality care

We won't be able to cut the rising costs of care until we get people to change, and that small change jingling in our pockets won't be nearly enough.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs and on Substack