July 13th, 2010 by StevenWilkinsMPH in Better Health Network, Health Policy, News, Opinion, Research
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Anytime you come across a healthcare article that implies that every patient wants access to this or that — i.e. their medical record, patient-centered care, etc. — you can safely assume that the claim is wrong. Why? Patients are not a monolithic group –- they don’t all share the same motivations, preferences, beliefs or experiences when it comes to their health.
But let’s face. If you are trying to push an agenda, just saying some people want this or that is not the same as implying that everyone wants it.
Take the issue of patient access to physician notes in their medical record. Robert Wood Johnson (RWJ) recently announced their OpenNotes study. The OpenNotes project will evaluate the impact on both patients and physicians of sharing, through online medical record portals, the comments and observations made by physicians after each patient encounter. Okay…so far, so good.
Things begin to fall apart, however, when RWJ cites “a recent study“ in the Journal of General Internal Medicine, as part of the basis for the OpenNotes research. According to RWJ, the study found that “most consumers want full access to their medical records.” Since when did six focus groups (64 people) constitute a representative sample, e.g. most people? Read more »
*This blog post was originally published at Mind The Gap*
June 28th, 2010 by StevenWilkinsMPH in Better Health Network, Health Policy, Opinion, Research, True Stories
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Probably not yet. I think everyone would agree that Group Health of Seattle probably has a pretty good “take” on issues dealing with primary care redesign and the patient-centered medical home (PCMH). That’s why I surprised by a recent comment on a Group Health blog from by Matt Handley, M.D., in response to an earlier post here about patient question-asking. Dr. Handley is an Associate Medical Director for Quality and Informatics at Group Health.
Dr. Handley writes:
“While doctors often take pride in how open they are to patient questions, our self assessment doesn’t match up very well with empirical evidence. A recent post on Mind the Gap summarizes a small study that is relatively terrifying to me –- the take home is that doctors spend very little time explaining their recommendations, and that patients rarely ask questions.”
I picked up the phone and talked with Dr. Handley about his comments and work being done on PCMH at Group Health. Read more »
*This blog post was originally published at Mind The Gap*
June 22nd, 2010 by StevenWilkinsMPH in Better Health Network, Health Policy, News, Opinion, Research
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The New York Times reported recently on efforts by providers and payers to increase patient medication adherence through the use financial incentives paid to patients. The article cited the use of small financial payments (<$100), awarded via lotteries, to patients that take Warfarin –- an anti-blood clotting medication.
There is certainly nothing wrong with financial incentives. Incentives have been proven successful in changing selected provider (quality and safety improvement) and patient behavior (stop smoking, weight loss and taking health risk surveys). But paying patients to take their medication is different. Actually, the evidence suggests that it is a just plain stupid idea for a whole lot of reasons. Read more »
*This blog post was originally published at Mind The Gap*
June 14th, 2010 by StevenWilkinsMPH in Better Health Network, Health Policy, News, Opinion, Research
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In a recent article, the editors of the Archives of Internal Medicine make the case that too much unneeded care is being delivered in physician’s offices these days. According to the authors, “patient expectations” are a leading cause of this costly problem.
Their solution? Get physicians to share with patients the “evidence” for why their requests are crazy, wrong, ill-informed or just plain stupid. But getting patients to buy into the “less is more” argument is a daunting task as most physicians already know. The problem is complicated by the fact that patients have a lot good reasons for not buying it. Read more »
*This blog post was originally published at Mind The Gap*
May 26th, 2010 by StevenWilkinsMPH in Better Health Network, Health Policy, Health Tips, Opinion
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What if the average patient (person) knew what healthcare insiders, providers and expert patients know?
Take the process of looking for a new personal physician. Conventional wisdom tells people that when looking for a new physician they need to consider things like specialty, board certification, years in practice, and geographic proximity. Online services like Health Grades allow you to see and compare the satisfaction scores for prospective physician candidates.
But industry insiders know different. Consider those patient satisfaction scores for physicians. In reality, “one can assume that the quality of care is actually worse than surveys of patient satisfaction would seem to show,” according to a 1991 lecture by Avedis Donabedian, M.D.:
“Often patients are, in fact, overly patient; they put up with unnecessary discomforts and grant their doctors the benefit of every doubt, until deficiencies in care are too manifest to be overlooked.”
Given the constant drumbeat about the lack of care coordination and medical errors, it would seem that some people (patients) are beginning to reach the breaking point alluded to by Dr. Donabedian. The empowered among us are starting to compare physicians (and the hospitals that employ them) to a higher standard — a higher standard that reflects the nature and quality of the medical services physicians actually provide. Empowered patients today are “being taught to be less patient, more critical, and more assertive.” Read more »
*This blog post was originally published at Mind The Gap*
