Tuesday, March 03, 2009

Doctors, Patients and Health Care Reform

There’s been a lot of talk about the economic stimulus plan, comparative effectiveness and health care reform lately. And with good reason—health care reform is integral for our physical as well as our fiscal health.

But in today’s Well column, Tara Parker-Pope raises an important point: in all this talk of methods and outcomes, where is the doctor-patient relationship?

The column touches on a core critique of our medical system, one that right now is better equipped for acute care then prevention and wellness. Specifically, it explores our propensity to want prescriptions that might be unnecessary, or to favor newer or more expensive treatments or procedures when older or less expensive ones might suffice:

“Whether it’s invasive back surgery, medical scans or expensive drugs, patients and doctors alike often refuse to believe that costly treatments aren’t worth it.”

What I find interesting about this column is that it doesn’t posit the blame on just the patients who ask for drugs or the doctors who write the scripts—rather, it points towards the need for both parties to work together to achieve the best outcome.

I’ve written a lot about the doctor-patient relationship, and while I have much more to say about this particular manifestation, I can’t help but feel so much remains true—in the end, mutual trust and respect is fundamental to a healthy relationship and thus a healthier outcome.

The medical education our providers have and the experiential wisdom we have about our own bodies are not at odds with each other. If we combine them and ask the right questions of each other, hopefully we can filter out the unnecessary treatments and tests.

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Another great edition of Grand Rounds is up at Health Business Blog. Check it out!


Anonymous said...

I also appreciated Parker-Pope's even-handedness; in fact, it seemed like by the end she was mostly talking about doctors' responsibilities. To me this reflects the one-sided nature of most doctor-patient relationships, and the fact that patients aren't typically regarded as equal partners. Reforming that imbalance is key to any functional health care system, but I don't hear a lot of people talking about how we can do that.

Kairol Rosenthal said...

I too read Tara’s post but was struck by what I thought was her short-sightedness on this issue. There are many behind the scenes influences working on my doctor’s choice of one drug over another (Does he have time to review new clinical trials when he slogs through the grist mill of seeing as many patients as possible? Is the information he uses to review medication that which is handed to him with a pen and a mug from a cute pharma rep? Is he making choices about my need for scans based on how his paycheck will be cut if he over prescribes testing for HMO patients?)

Last month, it took five days and over ten phone calls for my doctor, the insurance company, and the pharmacist to figure out what acid reflux prescription would be covered under my plan. I’m an extremely pro-active and responsible young adult cancer patient, yet much of the information I’m given comes in splintered, patchwork formation and never the same answer twice. While I believe trusting doctor-patient relationships are ideal, I do not think they are the root of this problem.

I was also disappointed that she paid the 100 bucks and didn't just handback the RX to the pharmacist without paying, have it removed from her insurance claim, and call her doctor to discuss alternatives. You never have to take and pay for a prescription just because it has been filled.

blog: http://everythingchangesbook.com/

Laurie said...

I hear you about the many competing agendas behind the scenes in offices, Kairol, and have been in a similar Rx scenario myself--$10 co-pay turned into $80 med. Not fun.

A larger point I did think was a valuable one is that in all this talk of reform and budgets and policies, where is the doctor and the patient? I've heard concern from physician-bloggers that practicing docs are not as involved as they should be, and I think the point about the relationship makes sense. Behavior--both from patients who come in asking for meds, and docs writing scripts to meet their demands--needs to change in order for any reform to move forward.

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