Giving Patients What They Want

The nonmedical press in particular, and many other groups, have been touting this for many years now, that this is where medical care "needs to" go. The problem with it is that it doesn't mesh well with basic human behavior and the economic problems we face in the delivery of affordable care.

People have a natural tendency to ignore their health, eating what they want, not exercising, not being aware of and controlling things like high blood pressure or diabetes. Then when something bad happens, they want it fixed. Now. Then go back to their unhealthy lifestyle.

Giving people what they want is really part of the system of marketing things so that they can be sold at a profit, so it really is about convincing people that they want something, not that they really need it. So we have a vast industry of products and services of unproven or dubious value. Look at things like NutriSystem -- as if people need a magic diet to lose weight. Or things like all these exercise devices sold on TV only to collect dust somewhere.

So I'm here to tell people things they don't want to hear, that it's their attitude, their behavior that is important, not something they can buy. It's time to stop procrastinating, time to get up each day doing what they know they should do to take care of themselves, and do it before they have some major problem that only leads to regrets.

It's part of the recursive problem of ERs. If you allow people to put off things, then go to the ER, then give them everything they want, pain pills, antibiotics, all kinds of tests, regardless of the expense, guess what? They'll be back. Again and again. It sounds a bit callous, but if someone is having frequent headaches, the role of the ER is not to have them pain-free when they leave, unless you want to create "frequent flyers", because they'll be back the next day, maybe even later the same day. What they really need is an incentive to get proper headache care outside of the ER experience. This also applies to patients with headache admitted to the hospital. It's not possible generally speaking to have these patients permanently headache-free when they leave. All I want to do is to have enough control that they have what they need for headache at home, so they're not using the ER, not calling me everyday for more and stronger medicines.

One aspect of all this is handing responsibility for healthcare squarely in the patients' laps. Taking responsiblity includes doing what you can to help yourself, and that if you won't, you pay for it and accept the consequences. In short, you become an adult rather than a spoiled child.