We live in a healthcare maze. At every turn, we face another direction that is supposed to lead us to the prize that has been so elusive: quality, affordable healthcare.
The prize is health care delivered for the right reasons, at the right times, in the right places, by the right doctors at the right costs (Kramer’s Rule). .
I recently received an email from a software company (Software Advice) that speaks to the heart of a most vexing problem in health care. It referenced a report they developed (Impact of Shared Decision-Making on Doctor-Patient Relationship) in collaboration with the Mayo Clinic’s KER (Knowledge and Evaluation Research) Unit to explore how shared decision-making (SDM) improves engagement and quality of care by utilizing the greatest untapped resource in healthcare — the patient. Think about it. At every turn in a given patient’s healthcare maze there is a constant – the patient. What prevents a patient from wandering aimlessly in a maze?
Dr Richard Young tells me that shared decision making is at the heart and soul of the way family physicians provide comprehensive care to complex patients and most family doctors don’t need any special programs or education on the subject. He goes on that the private practice doctors he has observed would do this with the first problem or two in a clinic visit with a patient. But for a patient with multiple issues (e.g., older patients), everything after that was Band-Aid medicine — quick fixes without much thinking.
Dr Young says he is flummoxed at how much experts say and write about the time required for real conversations. They acknowledge that family doctors are pressed for time, but offer nothing in their proposed solutions that says family physicians should be paid for the time to comprehensively listen to and negotiate the care they deliver to patients.
There have been numerous solutions proposed for our broken system, e.g., ACOs, PCMHs, population management, CDHPs, wellness, clinical integration, ObamaCare, etc. Sometimes, it seems we’re drilling in wrong places. In our searches for cost-effective, quality healthcare, we’ve been coming up with dry holes for a long time. As a result, patients have wandered around in their own mazes while the system keeps spinning off acronyms for the newest turns.
Imagine doctors and patients having sufficient time to deal with all of a patient’s health issues. Will a specialist be the right one to deal with complexities outside of his/her specialty?
Primary care – family physicians are the doctors who should have comprehensive knowledge of their patients – book, chapter and verse. And yet, with all of the complexities that may be present, the family doctor is financially forced to limit the time and attention that can be given to patients’ myriad health issues.
Imagine how much better our health and financial resources would fare if patients came out of their doctors’ offices well-informed and confident that they had reached comprehensive and mutually agreed upon goals for treatment. Maybe then we might not see studies which report that 48% of Americans think that more expensive health care means better health care.
Better informed patients should be able to reach better decisions. They should also be better able to save themselves and the system a lot of money en route to better care. Would an employee covered under a high deductible health plan have any interest in saving a great deal of money on a knee replacement? Would the employee consider having a knee replacement done at a top quality facility in Oklahoma City that ends up costing $19,000 for the entire surgical package (at greatly reduced employee cost) compared with the average $46,000 cost of a knee replacement in Dallas subject to deductibles and copays?
We must populate our system with physicians who comprehensively know their patients and can take the time to guide them through the mazes. We can have more patients who have a better feeling about their decisions because of shared decision making. The solution is to pay family physicians better for the time required to effectively address all health issues, instead of leaving some matters to the maze.
Next, patients can make smart, informed decisions and reduce their costs and their employers’ cost by learning where they can go for quality treatments at fully transparent prices that are far less costly.
The point to all of this is that the patient must be seen as a critical working piece of the decision making process, and not a passive entrant into the maze.