A patient came in to see my medical partner recently with right -sided rib pain. There were no other serious symptoms or complaints. It was a simple muscle strain but she wanted a better answer. My partner re-examined her, did a breast exam, tried to open up to more possible diagnoses, but she couldn’t find any. The patient wanted more.
In an article in the NY Times by Pauline Chen, she interviews Dr. Donald M. Berwick, a Harvard pediatrician and president of the Institute for Healthcare Improvement in Cambridge, Mass., who is a supposed to be a leading authority in health care quality. In his opinion, the control of the medical system should be transferred from the doctor to the patient. He believes that patient preference is so important that we should occasionally put evidence-based care “in the back seat”. In fact, he believes families should be part of daily rounds at the hospital as well.
Dr. Chen asked him “What if a patient’s preference is in conflict with recommendations grounded in evidence-based medicine?” He responded that he would “treat it as a challenge of information exchange”. My medical partner laughed because she tried that and her exchange with her patient went nowhere.
In an article in the NY Times by Pauline Chen, she interviews Dr. Donald M. Berwick, a Harvard pediatrician and president of the Institute for Healthcare Improvement in Cambridge, Mass., who is a supposed to be a leading authority in health care quality. In his opinion, the control of the medical system should be transferred from the doctor to the patient. He believes that patient preference is so important that we should occasionally put evidence-based care “in the back seat”. In fact, he believes families should be part of daily rounds at the hospital as well.
Dr. Chen asked him “What if a patient’s preference is in conflict with recommendations grounded in evidence-based medicine?” He responded that he would “treat it as a challenge of information exchange”. My medical partner laughed because she tried that and her exchange with her patient went nowhere.
Dr. Berwick is a pediatrician. I wonder if he would let a four-year old determine if he or she needs an ENT consult for an acute ear infection. Probably not. It is very hard for me to believe these “ivory tower” doctors when they come up with new theories on how to run the healthcare system. They are not in the trenches in rural America. They are not on the front lines of medicine. Instead, they wake up in the middle of the night and create a new term called “patient-centeredness” and now have to write an article on the subject.
Dr. Berwick believes patients are our peers. Really? Working together to solve a medical problem is not the same as being my professional peer. He goes on to recommend that a patient bring his “digital recorder into the meeting so he can listen to the conversation several times after”. I know many lawyers who would love all patients to do that.
He ends his interview by stating that “we have to fix the health care system so that it gives doctors the time to do the job they want to do”. Funny, nothing he recommends saves time or saves money or makes the job any easier. This begs the question: does Dr. Berwick actually see patients anymore and how many does he see? I called his office and it turns out that he does not. If fact, the person answering the phone states he hasn’t “in years”. Maybe it is time for him to get his hands dirty again?
I am all for radical thinking. I am okay with brainstorming on how to make our healthcare system better. I may not be the smartest doctor in the world but I do know that there still has to be some type of chain of command in this profession. Anarchy doesn’t work. That being said, it is my opinion that the best type of patient-physician interaction is when both people are focused and present in the exam room without external distractions (cell phones) or internal distractions (“I have so much paperwork to do!”). The best care comes out of those situations.
My medical partner ultimately recommended some ibuprofen and observation for her patient. My partner tried to reassure her patient as best as she could and suggested to give it a week and then have her return for a recheck. Paradoxically, if it was up to the patient, her care would be “centered” on having a CT scan or an MRI of the chest. It turns out that this would have cost thousands of precious dollars. Who is right in this scenario? Don’t ask Dr. Berwick. He is busy brainstorming.
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