Straight talk from Don Berwick, including the point I feel is most important to get across to patients:
Finally, Berwick stressed that patients need to unlearn the notion that “more care equals better care.” And U.S. patients become more “mature” (by which he means wiser, not older), they must learn to think collectively, recognizing that we are all in this healthcare system together —and that we live in a world of finite resources. The individual who is cared for at the most costly and aggressive hi-tech medical center that U.S. New & World Report “rates” as one of the nation’s “best” may think that he is getting better care, but in fact, there is no evidence that this is true.
Accepting this fact is the first step in realizing that saying “no” is a concept that patients will inevitably have to face.
Related posts:
- Again: More health care is not better health care
- Why do the world’s richest come to the US for health care?
- Health care costs
- Op-ed: What we have in health care today is a failure to communicate
- Canadian health care: At the expense of defense?
- Why patients should not be called clients
- My take: Dwindling primary care, spinal care, ratting out patients
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{ 3 comments }
It’s a cultural thing. You know, it’s interesting that americans (who are more religious) are afraid of death much more than europeans (who are less religious). I guess here is the belief that “if you want, you can”. Sure, maybe you can but should you do it ? Sometimes you just have to let go. And that is very difficult for americans.
Pretty hypocritical to point fingers at the patient here.
Previous posts to this blog have defended unnecessary defensive procedures. Some even suggest that if a patient says no, they’ll discontinue serving that patient. Who’s at fault there? Not the patient.
Meanwhile, clinics and hospitals are spending millions building and promoting specialty centers (Spine Centers, Sports Medicine Centers, Wound Healing Centers, etc.) You’re going for the bucks — I have no problem with that — but don’t point fingers when you’re running ads telling people they need this stuff.
Overall people still trust doctors and follow your leads. So lead.
Pretty hypocritical to point fingers at the patient here.
Agreed. Patients for the most part trust the doctors. If a doctor says “I’d like to order this test”, most patients believe.
Additionally, there is a lot of advertising – from “TV doctors” like Fox’s Dr. Rosenfeld or CNN’s Dr Gupta, from advertising in the local centers, etc. People listen and wonder and start asking their doctors about it.
A couple of examples – I might’ve given them before in this blog. This year when I went for my ObGyn appt, a nurse gave me a pitch about HPV test and how it can detect cervical cancer better than paps. BTW – I’ve never had an abnormal pap and I’ve had years and years of them. The nurse also gave me a little paper to mark “yes” or “no” and to sign it – just in case insurance wouldn’t pay for it. So I marked “no”. No, this wasn’t in case of abnormal pap smear, this was in addition – something not recommended currently by any organization. Was it defensive? Was it the desire of this medical center to appear good? Was it money? At any rate, I’d imagine the nurse’s pitch would’ve convinced many women that having this extra test is something they really need.
Another example – a flyer received from newly opened radiology lab offering a bunch of not-recommended imaging tests, mostly CTs and ultrasounds. They had a “special” for three cardiac tests. The text in the flyer described how bad the deseases are, how they can go undiagnosed, etc. etc. All intended to scare symptomless people and to convince them they need these tests.
If you want people to understand that more care isn’t equal better care, educate. Have websites, give interviews with examples, risks of overtesting, etc. Start with not promoting extra care that people don’t need, like the medical center where I go to my ObGyn does.
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