Comments on: Berwick On Patient-Centered Care: Comments And Responses http://healthaffairs.org/blog/2009/07/09/berwick-on-patient-centered-care-comments-and-responses/ The Policy Journal of the Health Sphere Fri, 20 Nov 2009 20:04:42 -0500 hourly 1 By: MBMundorff http://healthaffairs.org/blog/2009/07/09/berwick-on-patient-centered-care-comments-and-responses/comment-page-1/#comment-28723 MBMundorff Thu, 16 Jul 2009 20:11:37 +0000 http://healthaffairs.org/blog/?p=1521#comment-28723 My experience with lay publications like the New York Times (or the Washington Post, for another example) is that they frequently do not "test the edges of civility" but pretty much trample it into the dirt. Congratulations to Dr. Berwick on persisting in his vision in the face of such reactions. As always, there is a rational middle ground. Obviously impaired patients cannot make reasonable decisions about their care. But perhaps family members can. Or advance directives already did. If doctors were indeed the best judge of patients' desires, then why the many-fold difference in the incidence of, say, spinal surgery, as Wennberg at Dartmouth and others have revealed with their research. It is said that every cliché has some underlying experiential base to justify it. With that in mind, it is not for nothing that surgeons (and other procedural practitioners) are sometimes regarded as people with hammers who are looking for nails. Conversely, as long as DTC advertising is allowed (unlike most other nations), patients must accept responsibility for what they get if they ask for it. My experience with lay publications like the New York Times (or the Washington Post, for another example) is that they frequently do not “test the edges of civility” but pretty much trample it into the dirt. Congratulations to Dr. Berwick on persisting in his vision in the face of such reactions. As always, there is a rational middle ground. Obviously impaired patients cannot make reasonable decisions about their care. But perhaps family members can. Or advance directives already did. If doctors were indeed the best judge of patients’ desires, then why the many-fold difference in the incidence of, say, spinal surgery, as Wennberg at Dartmouth and others have revealed with their research.

It is said that every cliché has some underlying experiential base to justify it. With that in mind, it is not for nothing that surgeons (and other procedural practitioners) are sometimes regarded as people with hammers who are looking for nails. Conversely, as long as DTC advertising is allowed (unlike most other nations), patients must accept responsibility for what they get if they ask for it.

]]> By: Raymond Carter http://healthaffairs.org/blog/2009/07/09/berwick-on-patient-centered-care-comments-and-responses/comment-page-1/#comment-27706 Raymond Carter Mon, 13 Jul 2009 17:40:03 +0000 http://healthaffairs.org/blog/?p=1521#comment-27706 I was pleasantly surprised at the civility and thoughtfulness of the replies. I don't object to the notion of a "partnership" as Dr. Berwick does, and his comment made me think of Dr. Jay Katz, who argued so eloquently for a fair, open, and balanced conversation between physician and patient. I also liked Katz's version of patient primacy when he talked about "having patients play a more vital role in deciding whether to undergo tests and treatments that need not necessarily be performed. ‘Second medical opinions’ may be one answer, ‘first patient opinions’ may be a better answer.” Finally, although I wonder if sometimes the term "patient centered" isn't viewed as the patient being the center of someone else's attention, rather than being "at the center," I do think that the medical home movement will take us down a path we very much need to travel and move us further along a patient-centric continuum. Raymond Carter, Edtor, Medical Home News I was pleasantly surprised at the civility and thoughtfulness of the replies. I don’t object to the notion of a “partnership” as Dr. Berwick does, and his comment made me think of Dr. Jay Katz, who argued so eloquently for a fair, open, and balanced conversation between physician and patient. I also liked Katz’s version of patient primacy when he talked about “having patients play a more vital role in deciding whether to undergo tests and treatments that need not necessarily be performed. ‘Second medical opinions’ may be one answer, ‘first patient opinions’ may be a better answer.” Finally, although I wonder if sometimes the term “patient centered” isn’t viewed as the patient being the center of someone else’s attention, rather than being “at the center,” I do think that the medical home movement will take us down a path we very much need to travel and move us further along a patient-centric continuum.
Raymond Carter, Edtor, Medical Home News

]]> By: David Witt http://healthaffairs.org/blog/2009/07/09/berwick-on-patient-centered-care-comments-and-responses/comment-page-1/#comment-26339 David Witt Thu, 09 Jul 2009 22:39:07 +0000 http://healthaffairs.org/blog/?p=1521#comment-26339 Doctor Berwick brings to mind a conundrum that has bothered me for several years. Many doctors take the opportunity to spend their vacation in a third-world country providing services for free. One version of their motivation is that these doctors enjoy treating patients and can do so in a third-world without the paperwork and fears of litigation attendant with practicing in the US. This limited view supports Doctor Berwick's view that many doctors are indeed concerned with the patient. My view is that our systems incentives are problematic. Take evidence-based medicine, previously mentioned here. What do you suppose would happen if a safe-harbor rule was created that protected physicians from malpractice if they used EBM? Perhaps many more providers would use EBM and enjoy practice more. The extra tests and procedures also mentioned here might disappear along with their costs. Align incentives with best-practice and we can use human nature to our advantage. Doctor Berwick brings to mind a conundrum that has bothered me for several years. Many doctors take the opportunity to spend their vacation in a third-world country providing services for free. One version of their motivation is that these doctors enjoy treating patients and can do so in a third-world without the paperwork and fears of litigation attendant with practicing in the US. This limited view supports Doctor Berwick’s view that many doctors are indeed concerned with the patient. My view is that our systems incentives are problematic. Take evidence-based medicine, previously mentioned here. What do you suppose would happen if a safe-harbor rule was created that protected physicians from malpractice if they used EBM? Perhaps many more providers would use EBM and enjoy practice more. The extra tests and procedures also mentioned here might disappear along with their costs. Align incentives with best-practice and we can use human nature to our advantage.

]]> By: They Don T Really Care About Us | All Days Long http://healthaffairs.org/blog/2009/07/09/berwick-on-patient-centered-care-comments-and-responses/comment-page-1/#comment-26338 They Don T Really Care About Us | All Days Long Thu, 09 Jul 2009 21:35:16 +0000 http://healthaffairs.org/blog/?p=1521#comment-26338 [...] Health Affairs Blog By Don Berwick “Patient-centered” is a PR term used by those who don't really want to change. It allows them to say, “We are fully focused on the patient,” while they are thinking about what they will do to the patient rather than for the patient. … Finally, let's remember that every penny spent on health care comes from us as consumers. There is no other source. And every penny is supposed to be used for our benefit. All of the interests are welcome to participate if they add value … Health Affairs Blog – http://healthaffairs.org/blog/ [...] [...] Health Affairs Blog By Don Berwick “Patient-centered” is a PR term used by those who don't really want to change. It allows them to say, “We are fully focused on the patient,” while they are thinking about what they will do to the patient rather than for the patient. … Finally, let's remember that every penny spent on health care comes from us as consumers. There is no other source. And every penny is supposed to be used for our benefit. All of the interests are welcome to participate if they add value … Health Affairs Blog – http://healthaffairs.org/blog/ [...]

]]> By: Berwick On Patient-Centered Care: Comments And Responses | HEALTHY LIFE GUIDE http://healthaffairs.org/blog/2009/07/09/berwick-on-patient-centered-care-comments-and-responses/comment-page-1/#comment-26334 Berwick On Patient-Centered Care: Comments And Responses | HEALTHY LIFE GUIDE Thu, 09 Jul 2009 15:33:40 +0000 http://healthaffairs.org/blog/?p=1521#comment-26334 [...] here to see a original: Berwick On Patient-Centered Care: Comments And Responses Share and [...] [...] here to see a original: Berwick On Patient-Centered Care: Comments And Responses Share and [...]

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