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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 | 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.



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