Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments

Fixing Healthcare: Bring Shared Decision Making To A New Level

Last week the New York Times reported that some health insurers have applied to regulatory agencies to push premiums sharply higher – usually double-digit increases, while citizens are suffering.  This falls on top of the 11 year history reported last year by the Kaiser Family Foundation: wages and inflation are up ~40%, while health costs and worker contributions were up 138% and 159%:

Kaiser Family Foundation slide on care costs

No wonder we feel squeezed. (Last week’s announcement comes on top of this history.)

This has enormous human impact. SPM advocate/painter Regina Holliday’s husband died partially because of inability to get care. My own life-saving visit was delayed until I had insurance. This month’s news is that 15% of Americans (45 million!) are in poverty, and this week a tweet from some conference said sixty million Americans are now uninsured.

Who will be able stop this? As Al Mulley said at TEDx Dartmouth, who can fix healthcare?

Mulley says it’s up to us.

The SPM members’ listserv

This summer on our members-only listserv a hot discussion took place about whether healthcare is headed in the right direction. We noted that managers and policy people often arrive at policies and decisions without consulting the people who ultimately suffer or benefit from the wisdom of those acts: the patients. (And, often, the clinicians trying to accomplish care.)

I flipped back to May, when, as we noted here, SPM member Jessie Gruman’s Center for Advancing Health published its Engagement Behavior Framework. (See PDFs at bottom of that post.) Her team methodically identified 43 engagement behaviors: ways every patient will engage with the system, eventually, or have someone do it for them. CFAH groups them into ten categories:

  1. Find Safe, Decent Care
  2. Communicate with Health Care Professionals
  3. Organize Health Care
  4. Pay for Health Care
  5. Make Good Treatment Decisions
  6. Participate in Treatment
  7. Promote Health
  8. Get Preventive Health Care
  9. Plan for the End of Life
  10. Seek Health Knowledge

All good and relevant – but what about making sure the system itself is what we want??

I thought, perhaps there’s an 11th category of patient engagement:

  1. Design and create a safe, decent, patient centered healthcare system.

That’s participatory not just in care, but at the level of management, culture, and responsibility for care. Our definition shifts to:

Networked patients shift from being mere passengers to active drivers of their care system, and providers and leaders encourage and value them as full partners.

It would bring SDM (shared decision making) to a new level, way beyond the individual care episode. Patients and clinicians would start to define what care is.

And that just might alter our focus, as we make tough decisions about care in the era of unaffordability.

*This blog post was originally published at e-Patients.net*


You may also like these posts

Read comments »


Comments are closed.

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »