We often say here that clinicians should welcome activated patients. Hand in glove with that, we must also say: Yo, patients: get activated! Know what works, and act on it!
Huzzah to Swedish SPM member and Parkinson’s patient Sara Riggare for this, on Facebook, which she got from SPM member Mighty Casey. (Notice a pattern?) It’s by John Mandrola MD, “a cardiac electrophysiologist practicing in Louisville KY. I am also a husband to a palliative care doctor, a father, a bike racer, and a regular columnist at theHeart.org | Medscape.”
A snip from the blog post:
Nary a day goes by that I don’t see an example of how good-intentioned active management of a patient causes problems. (BTW: My son, a grammar prescriptivist, says I shouldn’t use that word, nary.) Emergency rooms overflow with elderly patients who have fallen because of BP goals. Last week, I saw a patient admitted (for confusion) with dangerously low sodium levels because of high BP treatment. It’s the same story with aggressive blood sugar control, statins in the elderly, NSAIDs, and we have already discussed the limits of screening for disease. The good-intentioned-but-harmful-treatment list is a long one.
The success of managing chronic disease does not turn on doctors or nurses. It turns on the patient and his or her choices. One of the wisest doctors in my hospital once gave me unforgettable advice: he said doctors don’t control outcomes.
Note: the above words come from a post that says that this shows why the PCMH concept (patient centered medical home) can’t work, because it gives patients more frequent management. I don’t know enough about the details of PCMH regulations; in my limited knowledge, the GOAL of PCMH is to give patients a “home” as in Cheers, “where everybody knows your name,” as opposed to a stream of providers you’ve never seen before. My comments here are limited to what I said above, not about the PCMH concept.
My impression (half-informed at best) is that if patients are suffering those consequences as a result of doctors’ instructions, then the doctors were getting it wrong. THAT would be the problem – along with, I’d bet, insufficient instruction to the family on what to watch out for. But as I say, I’m just pointing to the paragraphs above. Delivering lots of medications and instructions is not a sure path to health.
To add to your last sentence, I would add the statement that, contrary to popular belief, more data is not always a key to better health. Although this may be upsetting to supporters of “executive physicals,” recreational genomics, unnecessary testing, total body MRIs, and quantified self, these can form lead to anxiety, more unnecessary and often uncomfortable testing and treatments, and sometimes physical harm.
That said, judicious and directed testing with explanations of why it is being done is an essential part of good health care.
Thanks, Danny. Somehow this comment was stuck for two days in the “might be spam” queue, and it didn’t notify me. Computers: ugh. :-/
Your “more data is not always better” evokes one of the analogies the OpenNotes people have been using: OpenNotes is like a new medicine. It has indications, contraindications, and side effects; different people benefit most from different doses, etc.
I recall in 2002 when you first brought up prostate testing with me, on my first physical with you. As I recall, you pointed out that one big question mark about the test is that if it comes out positive it’s not clear whether it actually indicates a problem, which can lead to more testing and possible injury when there actually isn’t a problem. Little did I know how top-notch that advice was. Cool.