Patients Aren’t Consumers and Should Not Manage Their Own Healthcare

We should be focusing on how to stay healthy. Managing our healthcare is something best left to the professionals:

We see three main reasons why treating patients as consumers can create problems.

1. Patients don’t want to be there: People don’t seek out healthcare without a reason. Something is wrong and patients want to solve it and get back to normal. When patients are required to be proactive decision-makers, the health care system is often casting a very reluctant hero into the role.

2. Patients aren’t equipped to be there: Even when patients are willing to be decision makers, they may not have the tools. At a time of unusual stress, the system asks them to absorb technical information and make difficult decisions that require specialized expertise.

3. Patients aren’t in it alone: To design for patients alone is to forget that they are part of a complex system and aren’t often independent decision-makers. Decisions are shaped by other stakeholders: friends and family who support the patient, the insurance company who foots the bill, practitioners who provide care and expert advice, the hospital administrators who inform system-level protocol, and so on.

describing why I had a recent trip to the ER, I noted:

It was a serious infection: the day before I went to the ER (on the doctor’s orders), after walking a block, my temperature spiked about 1.5 degrees F and I was exhausted and utterly drained (when healthy, I hit the gym most mornings). I had no appetite and, in retrospect, I realize my judgement was beginning to become impaired (more so than usual, anyway)–the latter can be a symptom of a severe infection. If you want to know why I didn’t seek attention sooner, the expected post-surgery symptoms mimic the initial stages of a UTI. And for the wonks who argue patients have to manage their care, I am an expert on UTI, and I missed the symptoms for at least a day (in hindsight, it was embarassingly obvious). What chance would most non-experts have?

As Meill and Ericson conclude:

As health-care delivery undergoes a profound transformation, the reflex to put patients in the driver’s seat can result in poorly designed delivery systems that don’t necessarily improve care or reduce costs. Health-care systems, providers, policy makers and designers need to take a step back and assure that in their eagerness to “consumerize” the medical experience they don’t undermine the quality of care by demanding more of patients than they should be expected to deliver.


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2 Responses to Patients Aren’t Consumers and Should Not Manage Their Own Healthcare

  1. Matt says:

    This reminds me of a situation last month. I’d had major inner ear surgery, and a few days later I woke up with lower esophageal pain when I swallowed. I know enough about anatomy (and the classical languages) to describe the area of the pain, but I’m no doctor. So the surgeon wrote a half-assed prescription for CT scan when he told me it’d be an xray. Then the radiology staff grilled me on the diagnosis and proper procedure. How the hell should I know? Call the damn doctor. I don’t expect you to know how I do my job; don’t expect me to know how to do yours. I said as much, more politely, to the tech who was on me for the bad prescription. Her tone changed after I pointed that out to her.

    Fortunately it was acute esophagitis and not an aneurysm as had been suggested.

    Love the blog, btw. I read it every f’ing day.

  2. joemac53 says:

    I was a truly ignorant patient. I stayed away from doctors for 30 years, even though I had insurance. I wasn’t sick, so I never went. When my abdomen had some strong, localized pain I did the smart thing and ignored it. When I could barely get through the day, I called the colonoscopy doc’s office but never got past the lady on the phone. Some craziness about “primary care physician” and “referral”.
    I knew I had cancer. I wanted someone to tell me I didn’t. When I finally got a doc to see me, got scanned and had bloodwork, I had a big tumor and blood that didn’t say for sure I had cancer. Only hitting .500 was enough to say leave well enough (sick enough?) alone. What a dope. Don’t expect me to do the right thing.

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