Wednesday, November 14, 2012

Can you hear me now?

The Brits' Much Vaunted National Health System© (MVNHS©) has long been a passion of ours, for (mostly) obvious reasons. The latest installment in the long-running joke that is the MVNHS© demonstrates what happens when physicians answer to bureaucrats:

"Doctors are failing to really listen to patients' views on how they want to be treated ... Involving patients in discussions about treatment could cut the cost of healthcare around the world"

Now, I'd take issue with that last - after all, "the world" is a pretty big place, and that which works in one country or culture might not translate so well to another - but the greater point is that docs in government-run health care schemes are accountable to the government, not their "patients." Indeed, since the government pays the bills, the patient really has little (if any) say.

The problem is that the payer (government) isn't the patient, who may well know best what it is that needs to be done:

"[P]reference misdiagnosis" - misinterpreting or ignoring the patient's wishes - is a significant problem which is damaging to both doctors and patients ... it can lead to, what they call, "silent" misdiagnoses - when doctors choose the wrong treatments because they fail to assess their patients' preferences correctly."

This was one of the most important aspects of consumer-driven health care (now outlawed under our own Not So Vaunted Health System©): transparency and financial empowerment (the premise and promise of Health Savings Accounts) did, in fact, rely to at least some extent on the patient's engagement with their provider.

As under the British system, the absence of this interaction can lead to devastating consequences:

"In one study they looked at, doctors believed that 71% of patients with breast cancer rate keeping their breast as a top priority, but the figure reported by patients was just 7%."

Of course there are trade-offs (life is, after all, a series of them), but divorcing the patient from his or her own care decisions seems a pretty drastic one. Of course, the person (or institution) with the gold makes the rules (cf: IPAB Death Panels).

[Hat Tip:Dr Dino Ramzi]

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