Your Health: Whose Responsibility Is It, Anyway?
This week a couple of articles came to my attention that focused on the following issues: the chronic disease epidemic, how health care can be reformed, over-burdened doctors, who is going to pay for prevention and just who is responsible for keeping you healthy.
In “The Doctor’s Office”, a column in the Wall Street Journal, Dr. Benjamin Brewer clearly describes the problems involved in delivering high quality primary care in today’s world. This honest appraisal from an obviously caring physician is very much worth taking a few minutes to read. His key point: “Teaching patients to take care of themselves effectively should be paramount because it works. It’s also cheap compared with a lifetime of drugs. Self-management makes all the difference in preventing long-term complications or avoiding a disease in the first place.”
I also came across this announcement from The California HealthCare Foundation. “The California HealthCare Foundation will award grants [under a $2.37 million, three-year initiative] to California health care providers for experimenting with ways they can interact with patients to improve their self-management of chronic diseases, including better use of IT and online resources.” (This one caught my attention because I have designed exactly such an IT tool but, alas, it’s still in development.)
Dr. Brewer makes the point in his column that, “Online sites, like WebMD and others, help with general information. But they only go so far. I’ve found patients need specific [my italics] information tailored to their condition. How much weight should I lose to make a difference in my blood pressure? What exercise makes sense for me? What should my heart rate be? What foods should I buy at the store? How do I prepare those foods in a hurry? A 15-minute office visit with me isn’t enough time to deal with the sheer volume of important information. And in any event, patients don’t often remember more than a few key items from any visit.”
Then I visited Dr. Brewer’s forum and found these interesting thoughts in response to his column:
“The day of the nagging, nudging, all knowing family doctor is over. Dr. Brewer is a heroic remnant of the past, but there are fewer like him every year.”
“As a Medical Director of a small HMO, I see this dilemma only getting worse. On the one hand, primary care physicians are constantly being pressed to do more and more to monitor their patients’ health status and to give advice on a large variety of topics. Screening for alcoholism, spousal abuse, and depression, advising the patient to improve their diet, lose weight, to exercise more, to sleep more and reduce stress… oh, and don’t forget to ask if they use their seat-belts and bicycle helmets, and look both ways before they cross the street. On the other hand, they have less and less time to do it in, unless of course, they are happy earning less and less each year. Meanwhile, the population gets fatter, more sedentary, more diabetic with every passing year. Physicians cannot be expected to cure all of what ills our society.”
“I agree wholeheartedly with those who have said that monitoring the patient’s lifestyle is not the job of the physician. But there is a need for someone to help patients manage lifestyle issues.”
“Physicians are largely uneducated/untrained/inexperienced as behavior change agents.”
“Since most employers who offer so-called ‘health’ benefits (which are in reality sickness benefits) pay most of the costs of coverage for their employees’ health insurance, it behooves employers to incentivize their employees to change personal health habits (e.g. exercise, weight management) to measurably decrease health risks. Best practices in innovative employer-sponsored health benefits, offering these kinds of financial incentives to employees for ACCOUNTABLE results, have proven to save big money and, more importantly, significantly improve the health and quality of life of employees. This is a win/win approach for all.”
“At a certain point it’s about personal responsibility and personal choices. If someone chooses to be overweight (by not taking advice to exercise more and eat a more healthy set of foods), shouldn’t they have some consequences?”
“Doctors literally cannot be responsible for patient behavior. Four 15-minute visits per year cannot counteract the effects of the remaining 8,759 hours of individual failure to manage these eminently controllable risk factors.”
“It takes a Team… As an internist, I hear Dr. Brewer’s pain. Sadly, if the physician takes the time to work with the patient toward health and wellness, in the US, uncompensated care is the norm. I always wonder why, however, we physicians appear to be so resistant in accepting help from other health professionals who are highly capable of supporting the plan of care AND to using technology to streamline our methods of patient support. Physicians have long been guilty of “telling patients what to do”, rather than supporting shared decision making and working with individuals to understand their barriers and help them move to self-management. The overall goal is to produce a disease/health-state knowledgeable, self-supported patient, who knows their body, when they are getting into trouble, and when to get in touch. This doesn’t take a physician – it takes a team of committed professionals working [smarter].”
Are you catching the drift here? Forces in the universe (and the marketplace) are moving responsibility for your care away from your doctor and on to you.
Do you feel capable, ready and willing to take on the job?
This information is offered for educational purposes only and is not intended to diagnose, prescribe or treat. For that please seek direct care from a health professional.
Add Your Comments
Comment Rules: All comments are monitored before being posted. Please use either your personal name or initials and not your business name. Do not use links to your website in either your name or your comment text as it comes off like spam and so will not be published. Thanks for visiting and adding to the conversation!
