Dispatch October 2009

Power to the Patients

The mantra has always been: Doctor Knows Best. But consumers need to seize control of their own health care. And they can, thanks to advances in science and technology.

While other industries take as their focus such shallow concerns as the making of money, the health care profession prides itself on dealing with matters of life and death. But that’s not the only thing distinguishing health care from other industries: it is also unique in the extent to which it excludes consumers from important decisions. Employers predetermine which health plans are available to you; insurers select what network of physicians you can see. Bring your own health research to the doctor’s office, and you might be labeled a nuisance patient. Question your doctor’s recommendations, and you could be called noncompliant or difficult.

Doctors and patients alike are accustomed to the firmly entrenched Doctor Knows Best status quo. But it is only by empowering patients – entrusting them with greater responsibility and putting opportunities for self-directed care into their hands – that health care can be made significantly more efficient and effective. It's a bit late, of course, to work patient empowerment into the various proposals now wending their way through Congress. But anything that can be called true reform may be impossible without it.

Already, advances in scientific knowledge and medical technology are enabling some patients to monitor their health and control their own diseases. Insulin-dependent diabetics, for example, quickly learn how to manage their blood glucose levels at home by matching their insulin dosage to changes in their diet and physical activity. Many diabetics have also joined online communities to share information and advice, sometimes viewing each other as more trusted advisors than their own doctors. Diabetics who take their health in hand in this way find that the cost of care decreases dramatically, while the quality increases: it’s far more effective than relying on experts whom they may see only every few months.

This kind of consumer empowerment has similarly transformed a number of other industries. Rather than hiring accountants, for example, many now turn to software programs like TurboTax and QuickBooks to do taxes or manage small business finances. And instead of calling a stockbroker or visiting a bank branch, many routinely do trading and banking online.

Likewise, while travel agents still provide valuable assistance with complex arrangements, most people now plan and book their trips themselves. Rather than using real estate agents, many homebuyers and renters turn to Craigslist or other “For Sale By Owner” web sites. Instead of visiting multiple dealers, car buyers, too, now do most of their research and comparison shopping at home. This pattern of cutting out unnecessary middlemen by empowering non-experts, sometimes called "disintermediation," is part of a process we’ve termed “disruptive innovation,” and it’s vital to making costly products and services much more affordable over time.

Given all this, shouldn’t the health care system be able to do for all patients what it’s already done so effectively for diabetics?

An obstacle thus far has been an entrenched set of paternalistic attitudes on the part of health care providers. The health care system, after all, is designed to address our most complicated medical problems, which is why becoming a doctor requires such rigorous, sophisticated training. But this leads to a general sense on the part of physicians that health care of any kind is too delicate a matter for non-experts. And while there’s no question that complex medical procedures and assessments should remain in the hands of professionals, there is much that could be effectively dealt with by patients themselves.

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