Doctor vs. Patient: Nobody Wins

During the campaign, John McCain would often say that the key to controlling health care decisions was to empower patients to be consumers, to shop around for their own individual plan and to question the treatments recommended by their doctors.  When patients are the decision-makers, he said, "they are more capable of making their own decisions, less likely to choose the most expensive and often unnecessary options, and are more satisfied with their choices."  This line makes sense politically - some voters are doctors, but all voters are patients, so it's flattery well-spent.  But what this "silver bullet" of consumerism sets up is a confrontational situation that's no more likely to produce better results.  When doctors are arguing with patients over the money, no one wins.

Nevertheless, the "patients need to take responsibility" meme is starting to take hold.  In the NY Times, an article entitled "A Hurdle for Health Reform: Patients and Their Doctors" makes the point that both doctors and patients need to change their behavior to focus on outcomes and not insist on the fanciest drugs and machines when they're not needed.  But some doctors, like blogger Dr. Mintz, are taking this discussion as a jumping-on point to rant about patients who ask for antibiotics, MRI scans, and the kitchen sink as the main culprits and needed to change their ways. Duncan Cross clearly believes this line of argument is ridiculous and offensive, equivalent to "let's blame them for being stupid, stupid patients, and demand they give up even more - more money, more control, more privacy, more dignity - to ensure the viability of our medical system."

Asking patients to be sole decision makers rather than team-players is not how you create responsibility.  That's how you create antagonism.

Yes, you're going to get some patients who actually aren't capable of making their own decisions, some who are more likely to choose the most expensive options, and some who are unsatisfied no matter what.  But let's presume they represent a minority, and that most are men and women of good will who just want to get better.

Yes, you're going to get some doctors who are, when questioned on anything, incorrigible jerks.  A column in the WSJ about patients being reluctant to question their doctors gives a humdinger of an anecdote:  "As the doctor approached him, I said: 'I have to ask you to wash your hands, according to that sign right there.' The doctor took umbrage, gave me a speech about washing her hands 15 times a day, then gave them a cursory rinse under the faucet. 'You don't use the hand sanitizer gel in that dispenser?' I ventured. 'I don't like that stuff,' was her response."  But again, let's presume that most doctors, although rushed, have some interpersonal skills and don't take umbrage to a direct question.

So if two reasonable human beings are in the room, it's on both of them to make sure their treatment is appropriate and will make them better.  That means spending more time to discuss options on the part of the doctor and doing comparative research homework, but it also means asking questions on the part of patients.  As always, the focus should be on health and side effects first and foremost, but "Which of these will cost more, and what's the difference?" should be as acceptable a question as "Is this covered by my insurance?"

What's driving up the cost of medicine is not that doctors have too much power or that patients are irresponsible - it's that there's too much ignorance, particularly on the effectiveness of drugs and technology.  That's something we all need to fix.

(Photo credit:  The Doctr on Flick.)