Patient preferences may not be rational, but they are not irrelevant

Everyone in our industry — policymakers, clinicians, healthcare facility administrators, public and private payers, technicians, pharmacists — shares concerns about the state of healthcare in the U.S., each of us from a slightly different viewpoint.

The thread that joins us all is that one day each of us will be a patient.

As its title suggests, patients are central to almost every provision of the Patient Protection and Affordable Care Act (Act), and we stand to benefit from more patient-centered, high quality, safe healthcare from our providers.

But, we’ve also been “empowered” — and power comes with responsibility.

In some ways, the success or failure of efforts to “fix” the healthcare system reform will rely on our collective engagement and cooperation as patients.

This means that all of us must become better informed about our health, more engaged in our healthcare, and more attuned to the value proposition when we make health-related decisions.

I hadn’t given this much thought until I read an intriguing commentary by Allan S. Detsky, MD, PhD, in the Dec. 4, 2011, issue of the Journal of the American Medical Association.

Drawing on his 30 years of experience as both practicing physician and health economics researcher, Dr. Detsky shares what he sees as our collective patient preferences in a piece entitled “What Patients Really Want From Healthcare.”

Here is a summary of a few of his observations about those priorities:

  • Dr. Detsky reports that what a majority of us want is a healthcare system that relieves our symptoms when we’re sick and restores us to “good health” by our own definitions. He observes that we understand, but are less interested in, healthcare services aimed at preventing future illness. The implication is that wellness programs and population health initiatives may be a hard sell without sweetening the pot.
  • He found that a majority of us want to be given “hope” and to be offered options that “might” help even when our health is unlikely to improve. In essence, we are likely to demand more tests and treatments even when these are unlikely to be effective.
  • Most of us want private rooms without paying anything out of pocket.
  • We want clinicians who are judged “the best” by other patients or our doctors rather than by objective information (e.g., quality data contained in HHS’ Physician Compare website). In other words, we are less likely to use the tools that are available to make better healthcare decisions.
  • We prefer treatments that require little or no effort on our part (e.g., medications and/or surgery) rather than strategies that require us to change our behavior (e.g., dieting, exercising). Because our clinicians will be judged, in part, on their ability to influence our behavior, we are likely to impede their success.
  • On the bright side, most of us agree with the Act’s recommendations concerning continuity, choice, and coordination. We want to build better relationships with our clinicians and we expect them to communicate with one another.

From a health policy perspective, I found Detsky’s observations at the low end of the patient preference scale downright depressing.

As patients, we have virtually no interest in statistics concerning our nation’s healthcare costs, the percentage of our gross national product devoted to healthcare, or how our nation compares with other First World countries in terms of population health and healthcare.

It turns out that we patients are a pretty egoistic and self-serving lot.

So, how should we use this information?

Detsky’s piece makes it clear that our patient priorities work against some important wellness and population health initiatives and, on an even more fundamental level, against acceptance of evidence-based medicine in general.

While patient preferences may not be entirely rational, they are not irrelevant.

I’m certain that marketing experts would agree with Detsky that policymakers must understand and take into account public preferences as they continue to plan and undertake reform efforts.

David B. Nash is Founding Dean of the Jefferson School of Population Health at Thomas Jefferson University and blogs at Nash on Health Policy.

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