Not your Father’s Healthcare (7)
Larry Ozeran, MD, FAMIA
Strategic Consultant for Health Informatics, Organizational Governance, Health Policy and Software Development
From having discussions with patients about their views on end-of-life care to understanding how patients feel about quality of life with a damaged shoulder to allowing patients to read all of their medical record, healthcare is changing. Paternalism has been a key tenet of healthcare for over a hundred years, the idea that the doctor knows best and the patient should be compliant and do what their doctor says. Even the idea of compliance is slowly disappearing. If a patient does not take their medication for hypertension, they can be labeled as non-compliant. And yet, we now realize that patients may be unable to afford their medication, so maybe they only take it every other day to reduce the number of refills. Patients may experience significant side effects, so they reduce their dose or stop the medication altogether. Is this really noncompliance? Isn’t this prudent management that clinicians need to understand and discuss rather than dismiss? Part of the changing healthcare dynamic is a recognition that if we want healthier patients at lower cost, we need to see each patient as a collaborator in their care. (Even mentally incompetent patients and children can collaborate to some extent.)
To be effective collaborators, it is the job of clinicians to provide enough information to patients in a form they will accept and understand. As noted in a comment on the second post in this series, patients don’t have enough context to understand pricing. It is the job of healthcare professionals to provide the context, either verbally, in videos, or in writing (paper or digital). The message has to be clear to patients. Simply stating the information in a way that is easy for healthcare organizations to create is not sufficient. The information must be clear to someone who has no healthcare knowledge and may have less than a college education.
Why discuss paternalism in a series of posts about transparency? There are two primary reasons. The first reason is that paternalism plays a role in our unwillingness to make the effort to become transparent. Paternalism evokes the idea that the patients should just “trust us.” They don’t need this information to make a choice. The second reason is that, as mentioned above, when we do finally get to the point of sharing useful quality and price data, clinicians also need to provide enough context for patients to be as fully informed as we can make them. Clinicians should be experts, teachers, facilitators and guides, not parents.
Prior post: Transparency Requires Healthcare Outcomes – Next: Can Transparency Start Today?
Retired at Mercy Health
6 年Paternalism isn't always bad. I understand our current society has become "anti-paternalistic" in favor of wanton individual "freedom." Reality is-- for some patients, no amount of "data" will motivate them to do what's right. Do you really think someone will stop smoking if you tell them about lung cancer risk? It's the elephant, not the rider. Also, there are many patients who are OK with me making some decisions for them. With good collaborative discussion, that's OK. The new PC term for non-compliant is non-adherent. Sorry, but if you don't do something, for any reason, albeit good, you are non-adherent. We need to be better at helping address the causes of non-adherence. Social determinants of health are important, and as a society we are not at a point where those in power are ready to seriously deal with this.
Promoting personal growth and wellness throughout the lifespan
6 年As a corollary to this post, we as a society need to do a better job of promoting patient participation in health care decision making, beginning in early adolescence.? This would require training both parents/guardians and adolescents in some body basics and in advocacy as well (including asking about price and quality).? The American Academy of Pediatrics (AAP) has many policy briefs and research documenting the value of the process of helping younger patients gradually take over these important responsibilities.? If, in some ideal world, all adolescents were to receive training and support in this process, then more adult patients would be prepared for these crucial conversations as well.