I recently ran across health policy researcher and physician Allan Detsky’s article entitled “What Patients Really Want from Health Care.” I found it very disheartening, since if Dr Detsky is correct our society will soon go the way of the Mayans. As David Nash summarized (using the Affordable Care Act as a point of reference):

  • Dr. Detsky reports that what a majority of us want is a healthcare system that relieves our symptoms when we’re sick and restores us to “good health” by our own definitions. He observes that we understand, but are less interested in, healthcare services aimed at preventing future illness. The implication is that wellness programs and population health initiatives may be a hard sell without sweetening the pot.
  • He found that a majority of us want to be given “hope” and to be offered options that “might” help even when our health is unlikely to improve. In essence, we are likely to demand more tests and treatments even when these are unlikely to be effective.
  • Most of us want private rooms without paying anything out of pocket.
  • We want clinicians who are judged “the best” by other patients or our doctors rather than by objective information (e.g., quality data contained in HHS’ Physician Compare website). In other words, we are less likely to use the tools that are available to make better healthcare decisions.
  • We prefer treatments that require little or no effort on our part (e.g., medications and/or surgery) rather than strategies that require us to change our behavior (e.g., dieting, exercising). Because our clinicians will be judged, in part, on their ability to influence our behavior, we are likely to impede their success.
  • On the bright side, most of us agree with the Act’s recommendations concerning continuity, choice, and coordination. We want to build better relationships with our clinicians and we expect them to communicate with one another.

Dr Detsky goes on to point out that Americans do not care how much we spend in aggregate nor do they care what the real cost of their own care is when presented with the information. The current debate regarding the federal deficit is clear proof of this.

In an attempt to put a better spin on American’s apparent irrationality about health, physician and medical informatics expert Joseph Kvedar looked at the information using  a  different lens. His take on American’s desires can be read here. He feels that focus on “patient satisfaction” was flawed, well, because it focused on patients. If we were instead to focus on folks who are not yet sick and are interacting with the health system on a limited basis, he believes we will find a different set of goals. He believes that folks want to have meaningful interactions involving interpretation of their own data in light of a desire to live long, full, and rich lives. He believes that folks that suffer from chronic ailments want to be gently guided back to full health in as painless a manner as possible. He believes that in general, people want respect and control of their own situation.

I would like to believe Dr Kvedar. I precept Family Medicine residents, however, who present patient after patient whose diabetes is poorly controlled and who are asking the resident to give them yet another stab at a pharmacological fix (maybe if we add Byetta) to what is a behavioral problem (did you know that if you lost 30 pounds I wouldn’t have to add this medicine and could probably remove one?). My experience tells me that Dr Detsky has his finger on the pulse of our patients and future patients. A colleague sent me a recent paper entitled “The Cost of Satisfaction.” Patients were followed over time and those who were more satisfied in this study spent more on drugs and were more likely to die. How do you empower folks, change attitudes, and make people feel responsible for their own health? It will likely take something different than giving people what they want.