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“Less Is More” In Medicine: Why Patients Aren’t Buying It

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.

Here are some examples of those reasons and how people come by them:

Direct personal experiences with current or previous providers

  • Doesn’t seem to know who I am or what problems are from one visit to the next
  • Doesn’t have lab test results at time of visit
  • My doctor can’t know everything
  • Medications don’t work for me
  • Too busy, feel rushed
  • No time for questions, frequently interrupted

Indirect healthcare experiences of family or friends

  • My aunt died from diabetes…insulin didn’t help
  • My friend with cancer received radiation and lived…that’s what I want

What people read or hear

  • 50 percent of U.S. adults don’t get recommended care
  • Guideline always changing (Example: mammography screening)
  • Medical errors/quality problems
  • U.S. healthcare system broken
  • Rationing of care and death panels
  • Doctors don’t have enough time and aren’t paid enough

In truth, before physicians can change a patient’s mind about what constitutes “needed care” they need to understand the patient’s health beliefs and expectations. But that’s not something physicians are very good at. Nor are they paid to do it. So until we can create the right incentives for physicians and patients to talk about such things, patients are welcome to and entitled to their own expectations of needed care.

REFERENCE:How Less Health Care Can Result in Better Health,” Archives of Internal Medicine, May 10, 2010.

*This blog post was originally published at Mind The Gap*

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One Response to ““Less Is More” In Medicine: Why Patients Aren’t Buying It”

  1. As this is a problem of beliefs, this is really not an activity in which doctors should be spending considerable time. Far too often, people believe ideas with little need for scientific proof. As a result, doctors trying to approach the problem through scientific education can be wasting considerable time on patients with fixed beliefs. Instead, this effort is an educational activity and should be undertaken by governments on an ongoing basis. While it is not the role of the government to brow beat the public into passivity, such educational activities can help to reduce some of the waste that results from some aspects of poor health education.

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