In the last few years I have dusted off my old economics texts and passionately studied the intersection of healthcare and economic policy. We can't avoid the fact that as a nation we have limited resources. Funding for one bucket means less money in the other. As citizens we directly fund the buckets through our tax dollars and along the way we have developed some healthy expectations of our entitlements, healthcare being of interest to me. A systematic review of patient expectations describing the true benefits and harms of screening/diagnostic tests, and treatments is of particular interest. Before I share the findings, think about the environment that influences these perceptions. Make a mental note about the quantity of direct to consumer advertising that reaches the population (and future client base) regarding their sex drive, cardiovascular health, diabetes, thinning hair, attention deficit, and the list goes on. This amount of marketing mind you is being targeted to a client base that will need permission to make the purchase. Obviously you can't just limp into a store and pull a new hip off of the shelf. There are numerous episodic evaluations and financial transactions that have to be launched for any of the point of sale objectives.
Is it any wonder that the recipients of these marketing messages are overestimating the benefits of the interventions and underestimating the risk?
The solution by many is to push the responsibility for accuracy and unbiased information onto the healthcare providers. It seems to me the clinician now has to counter all oppositions or resistance to diagnostics or taking medication but collectively we all shrug our shoulders at the alarming cost to our healthcare system. I heard an alarming statistic the other day. If we improved patient adherence the cost saving to the healthcare system would be the equivalent of launching a blockbuster drug every year. The Upshot in the New York Times wrote a compelling story about patient perspectives on the risk of prescribed treatments.
Why do patients err in assessments of risks and benefits? One reason could be that what they know is driven by the messages they hear. Doctors, direct-to-consumer ads and the media can skew our perceptions. They tend to focus on the benefits, but rarely quantify them. Health care centers, screening advocacy programs and pharmaceutical ads all push us to talk to our doctors about getting treatment without talking about actual gains.
Doctors also aren’t always good at communicating risks. A 2013 study published in JAMA Internal Medicine found that fewer than 10 percent of patients were told about overdiagnosis and overtreatment associated with cancer screening, even though 80 percent of patients wanted to know about harms.
I think one of the dilemmas often ignored--separate from the arguable impact of direct to consumer advertising, is the function of prognostic medicine. If you go to a healthcare provider and you have elevated blood pressure you might feel fine. It may have been elevated for years but once it is detected the current healthcare model dictates that a prescription is in order to move your blood pressure within an evidence-based acceptable range of values. Now here is where it becomes problematic. Once you take a drug you are now likely to have some level of a side effect. So once where you had what you perceived to be perfect health you now may be exposed to an assortment of potential symptoms that you didn't bargain for--you know, the part of the commercial with the tiny print or really fast talking. In this situation many patients opt to stop taking the medicine.
There is a groundswell of interest emerging in improving adherence, patient centricity, creating and identifying value, and understanding healthcare policy and governance.
I suggest you pick a parade and get in front. Develop content that matters and informs.
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In a world of "evidence-based" medicine I am a bigger fan of practice-based evidence.
Remember the quote by Upton Sinclair...
“It is difficult to get a man to understand something, when his salary depends upon his not understanding it!”
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