Another WSJ article that makes my blood boil: How Doctors Rate Patients: Patient Activation.
Concepts like “patient activation” are misleading, manipulative and even dangerous. Doctors do not want activated, engaged patients. They want docile patients who will do as they are told without asking probing questions. They do not want patients who ask why published research seems to contradict their recommendations. They do not want to hear that they are reporting statistics inaccurately. They want patients who will follow their instructions (often incomplete and poorly worded) yet they regard their patients as irresponsible children.
For example, this article writes, “They [i.e., those who are not “model patients”] fail to take their medications, skip preventive screenings and end up back in the hospital soon after discharge.”
Taking medications isn’t always straightforward. I am an educated professional who’s given my cats everything from antibiotics to sub-cutaneous fluids to insulin shots. Yet after eye surgery I’m struggling to comply with vague instructions and poorly designed eye drop dispensers.
The term “preventive screenings” is nonsense. By definition, screenings detect disease or treatable conditions. At best, screenings allow early detection and risk reduction. Screenings do not prevent disease or even death. You can get colonoscopies and mammograms as directed and still die from colon or breast cancer. Flashy numbers like “50% reduction” refer to relative rather than absolute difference; the actual impact is usually very small and the cost of false positives very large. The Society for General Internal Medicine has questioned the usefulness of annual physical exams for asymptomatic adults. If doctors really want patients to be engaged, they will interpret statistics accurately and share *all* the research.
Finally, if doctors really want engagement, they need to treat patients like adults. Following eye surgery, I’m entrusted with a complicated regimen of eyedrops and I’m told to fast the night before surgery; my non-compliance will lead to negative outcomes that are expensive to fix. Yet though I live a few minutes away from the hospital, I’m not trusted to make sure I have transportation home. The hospital wants to call my ride the morning of surgery to make sure they’re really coming. I find this call degrading and insulting.
Yes, I know the risks, but I also know how to manage those risks intelligently. I will be alert and ambulatory after surgery and if I feel unable to leave on my own I know how to get help.
“Patient activation” is just another scheme to get more money by blaming patients for mistakes, carelessness and heavy workload. If doctors spent less time on meaningless “prevention” and more time working with people who really need help, many of these issues would go away.
I’m also disgustingly healthy, eat reasonably, have good genes and exercise. I rarely see doctors. Recently, when I asked a handful of questions, a doctor said with a straight face, “Your problem is you don’t have experience with the system. You don’t know how to be a patient.”