Will patients or doctors be the biggest obstacle impeding health care reform?

If both patients and doctors don’t accept the changes required of their behavior, no amount of comparative effectiveness studies will cut health care spending.

Two prominent medical journalists write as much in their respective blogs.

First, the NY Times’ Tara Parker-Pope notes that patients have to realize that, yes, they should demand the best care possible. However, that means, “we will have to accept that ‘best’ doesn’t always mean the newest drug or the latest treatment. The looming question is whether patients are ready to embrace the realities of reform.”

Publicizing the findings of comparative effectiveness research can help, but not always, as evidenced by the $130 million ALLHAT trial. Despite finding that cheaper diuretics worked as well as more expensive drugs, the study didn’t really change anti-hypertensive prescribing patterns much. (I have my own reasons on what the ALLHAT findings were ignored.)

Next, Newsweek’s Sharon Begley comments on how patients can refuse to adhere to the findings of comparative effectiveness research by suing doctors who try to do so. As she points out, “What are [doctors] supposed to do when a patient demands antibiotics for a cold? for a child’s ear infection? when a patient demands an MRI for back pain or knee pain? If they refuse, several doctors told me, they can expect a call from the patient’s lawyer that afternoon.”

Duncan Cross takes the patient perspective, and like most progressive health reformers, blames doctors: “By all means, let’s nobody examine the role the medical profession has played in creating and sustaining dysfunction in our health care system. Let’s all ignore the effect of physician licensure rules, prescription drug laws, and training that inculcates physicians to believe they are their patients’ superiors; let’s ignore all the myriad ways medicine disempowers and diminishes patients, and gives them over to alienation and disaffection with the medical profession.”

Yes, physicians are the ones ultimately responsible for ordering unnecessary antibiotics or MRIs. But, the threat of malpractice is indeed a cloud that hangs over every decision a doctor makes. Just because Mr. Cross disagrees with that doesn’t make it any less true, or any less of a factor.

(As an aside, Duncan Cross, along with having the best written patient blog on the web, demonstrates a level of patient empowerment that, unfortunately, is representative of a minority of patients. If every patient shared his attitude questioning whether every test a doctor orders is really needed, it will make my job much easier.)

Throwing billions of dollars at comparative effectiveness research is all well and good, but if both doctors and patients refuse to abide by the findings, you might as well flush that money down the toilet.