Less light, more heat; 'masterful inaction' in health care

  Hot, humid and mid-summery today,  with the water condensing on the windows with air conditioners sticking out of them. But I already notice that it's getting darker earlier in the evening. The older you get, the more you seem to notice such things.  Meanwhile, the heat is wilting some plants that were exploding with growth a few weeks ago.  They have reached their maximum prosperity for the year. And the southwest wind makes its summer sounds through the tall trees.




Effective health care depends on self-care; this fact is currently heralded as if it were a discovery....The medicalization of early diagnoses not only hampers and discourages preventive healthcare but also trains the patient-to-be to function in the meantime as an acolyte to his doctor. He learns to depend on the physician in sickness and in health. He turns into a life-long patient.

--- Ivan Illich


I was at a conference in Hanover, N.H., called the Summer Institute for Informed Patient Choice  last week. It was about getting the healthcare system to help patients make better choices on their health care through encouraging and formalizing shared clinician-patient decision making.  SDM, as it's called, emphasizes "evidence-based medicine'' over the more anecdotal kind that's still popular. The rise of "Big Data'' is giving a huge boost to evidence-based medicine.

The choice will often involve  a patient not having a course of treatment or  specific individual procedure or medication but working on lifestyle changes (or maintenance) while the clinician and patient engage in  ''watchful waiting'' for problems that tests or genetics might suggest will appear.

Not quite  "benign neglect'', but a relative.

Moving toward this less procedure-driven approach is an uphill battle. For one thing,  doctors and hospitals are still overwhelmingly paid by volume of procedures. The more they do, the more they get paid. For another, Americans are people who traditionally seek out solutions; they are activists, or at least they want their professionals to be.

Many will find inaction frustrating, even if  inaction is the healthiest way to go. (J.P. Morgan had a great phrase for avoiding bad decisions in the stock market: "Masterful inaction''.  ) And too many will miss the clarity and authoritativeness of the old way -- in  which the doctor would set out treatment with little give or take. Many patients will find it very difficult to take more responsibility for their own health.

-- Robert Whitcomb