As often happens, a Susannah Fox post has led to lingering questions. This time I’ve figured out what I want to say.:-)

Last week, in a side note on her World AIDS Day post, she inserted this:

… Let’s review the basic math of health services delivery in the U.S., beautifully, devastatingly summarized by Peter Margolis of Cincinnati Children’s and the C3N Project:

.5 x .5 = .25

As he recently explained:

The dominant paradigm of chronic care delivery in the US is characterized by health “services” “delivered” to relatively passive patients or “consumers” in clinician-mediated encounters using knowledge that is produced by researchers and clinical experts.  In this current system, physicians provide only 50% of indicated care and patients adhere to about 50% of what is recommended.  The result is a system where only about 25% of patients achieve optimal care, despite spending that far exceeds other industrialized countries. What would outcomes be like if doctors and patients got what they needed 90% of the time?

Let’s break apart the first part of that quote:

The dominant paradigm of chronic care delivery in the US is characterized by

  • health “services” “delivered”
  • to relatively passive patients or “consumers”
  • in clinician-mediated encounters
  • using knowledge that is produced by researchers and clinical experts.

And:

In this current system,

  • physicians provide only 50% of indicated care
  • and patients adhere to about 50% of what is recommended.

The result is a system where only about 25% of patients achieve optimal care, despite spending that far exceeds other industrialized countries.  [Italics added]

Lots going on here.

  • The first sentence is about today’s paradigm about healthcare: “all knowledge arises in the profession and is dispensed onto patients.” (“services delivered,” mediated by clinicians, to passive consumers)
    • On this blog (and in our Society) we know otherwise. But most people running hospitals and doctor offices still presume their job is to “do things to us,” including giving us instructions.
  • The second is about the often-observed reality that neither providers nor patients stick to plans.
    • One might guess that this is a human failing.
    • And note that he phrased the result in terms of patient impact:  “only 25% of patients achieve optimal care.”

I wonder: what else does he envision, when he first talks about our current model, and then talks about “.5 x .5 = .25”? Does he assume that part 2 is a consequence of part 1?

I don’t think so – I think they’re two different problems. But I do think that part 1 causes both parties to feel hopeless about part 2.

Or is part 2 a consequence of part 1?  Do we perform more poorly if our assumptions about who has the power are fundamentally flawed?

Donate