Medicine: blood pressure treatment "pays for itself"
I try not to mess too much with health care as a right vs. a privilege (though you wouldn't be surprised that I appreciate the former more than the latter). Instead, I just stick to the idea that good preventative care is a hell of a lot cheaper than waiting for people to get sick. Good public health and fiscal conservatism sleep in the same bed, and this article seems to agree that they should be snuggling more often.
8 comments:
isn't compliance the real issue here? i mean the effects of fibrosis.. scratch that... a lot of patients don't come in to the hospital until they're horribly sick. the last three paragraphs of the article really hits the nail on the head. (see, i do read some of the articles). preventive medicine is largely affected by patients being responsible with their own health. and americans are irresponsible people whose best friends are personal injury lawyers. but let's not get off track.
mikey
First of all, compliance in itself is a paternalistic term that we would be best to leave in the 20th century. For patients to comply, we're saying that they owe us something, that our recommendations are final, that we control their lives, and that is not the case. So if we're not getting "compliance." We go to med school so that they don't have to, and we are doctors, straight from the latin doceo, docere, docui, doctus: to teach! We would be better off to see "non-compliance" as an issue of doctors failing to educate. Now, I am saying this is ALWAYS the case? Of course not. But we can't modify our patients having hard heads. We CAN modify our own efforts and our public health policies. So let's not bitch about how our patients are stupid and "non-compliant" when we are light years away from meeting them half-way. Is that our duty? Well, we expect to get paid a good living for delivering good quality healthcare. If we're not educating our patients properly, then we're not delivering good quality healthcare, and so we're getting paid for delivering poor quality health care. And nobody deserves to make a good living delivering poor quality health care. We need to stop looking at good patient education as something that is above and beyond our duty, and start seeing it as requisite to the job we are already doing.
I'm sure Henry would LOVE this post.
compliance can be a paternalistic term but doesn't have to be. instances in which patients agree to an advised treatment plan and yet fail to stick to it is non-compliance, without any connotation of paternalism. (unless you want to argue that you can be paternalistic with/against yourself, which seems to be a contradiction of terms.) i don't have evidence and i don't have experience, but my hunch tells me that most times patients fail to stick to the plan not because they disagree with it or are uneducated about it, but because they can't motivate themselves to do what they agree is best for them. i mean i guess you can say that we should be motivating them and finding ways to educate them about possible ways to be more compliant (i'm not going to stop using that word), which is true, but in the end, i will be wearing a white coat and not a pleated skirt with two-color pompoms.
education and motivation can only take things so far. i don't understand why you refuse to accept that personal responsibility is an important factor in healthcare.
mikey
Because I don't have any control over anyone's personal responsibility except my own. And if people have problems with motivation, which they most certainly do, then our public health efforts need to work towards improving that motivation? Why? Because we can't afford not to. It's not so much that I disagree with you, it's more that I think what you're saying doesn't give us any way to improve what we're doing. So what's the point of talking like that?
hey you make a good general point. it's not useful to just bitch about stuff. but aside from all that, i think i raise an important question with compliance.
we are in agreement that preventive medicine is better and possibly cheaper in the long run. but it makes no difference if people won't do anything about their health until they have chest and left arm pain with shortness of breath.
and i don't know if most of that is due to lack of education or whatever. certainly, part of our job is to educate patients and encourage them within reason to follow through with preventive care, like smoking cessation. and i have every intent of incorporating that into my practice. (and i still don't like dr. heisler's take on my view as "bio only" hahaha) but we need to be aware of limitations of preventive medicine, and a huge part of that is non-compliance.
i guess the apparent conflict here is your emphasis on physicians not advocating preventive care enough, whereas i see this advocacy as a natural part of being a doctor and thus i tend to focus on something else. in other words, you're preaching to the choir, with me at least, and i'm going beyond "preventive care is good and we should encourage it" and asking "will that do any good?"
mikey
well, i get about 50 hits a day right now from unique users, and most of those i imagine are not in med school, so you might be in the choir, but there's plenty of congregation left to preach to :)
i guess i just think we should be doing things to lower that motivational threshold... i want to say "give tax breaks to everybody that takes their ACE-inhibitor!" Or something like that. Talk to me about it after i do my mph year.
are you referring to this article?
http://story.news.yahoo.com/news?tmpl=story2&u=/ap/20040917/ap_on_he_me/fit_britain_obesity
mikey!
(i get about 5 hits a day, from the same 2-3 people, and that's on my "i took a poo and wiped my ass at 10:58am to 11:05am" page. the others are top secret and get zero hits.
wow, i hadn't seen that article, but yeah, i think that sort of thing is the sort of innovation that might be part of a larger solution.
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