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Not In My Name: Real Patient-Centeredness Means Sharing Power


February 26th, 2013

It is as natural for doctors, hospitals, health plans and others to aggressively affirm their “patient-centeredness” as it is for politicians to loudly proclaim their fealty to the hard-working American middle class. Like the politicians, the health care professionals no doubt believe every word they say.

The most accurate measure of “patient-centered” care, however, lies not in intentions but implementation. Ask one simple question ­– what effect does this policy have on patients’ ability to control their own lives? ­­­– and you start to separate the revolutionary from the repackaged. “A reform is a correction of abuses,” the 19th-century British Parliament member Edward Bulwer-Lytton noted. “A revolution is a transfer of power.”

With that in mind, which purportedly patient-centric policy proposals portend a true power shift, and which are flying a false flag?

Falling Short Of Shifting Power

The two most prominent examples of initiatives whose names suggest power sharing but whose reality is quite different are so-called “consumer-driven health plans” (CDHP) and the “patient-centered medical home” (PCMH). Both may be worthy policies on their merits, but their names are public relations spin designed to put a more attractive public face on “defined contribution health insurance” and “increased primary-care reimbursement.

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The Toll Of Preventable Errors: How Many Dead Patients?


March 9th, 2012

Here’s a quiz for Patient Safety Awareness Week (and after): The number of Americans who die annually from preventable medical errors is: . A) 44,000-98,000, according to the Institute of Medicine B) None, thanks to the Institute for Healthcare Improvement’s “100,000 Lives Campaign” C) 90,000 D) No one’s really counting The correct answer is, “D,” […]

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Why We Still Kill Patients: Invisibility, Inertia, And Income


December 6th, 2010

A recent front-page article in the New York Times conveyed grim news about patient safety. The first large-scale study of hospital safety in a decade concluded that care has not gotten significantly safer since the Institute of Medicine’s 1999 estimate of up to 98,000 preventable deaths and 1 million preventable injuries annually. What for me […]

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Remembering Jay Katz: The Enduring Voice Of “The Silent World”


December 28th, 2008

By the fourth sentence of the preface to The Silent World of Doctor and Patient, Jay Katz has quietly issued a startling challenge to a fundamental principle of the doctor-patient relationship. He writes: It took time before I appreciated fully the oddity of physicians’ insistence that patients follow doctors’ orders. During my socialization as a […]

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Eight Days: A Health Care Diary


July 10th, 2008

PAIN (Chicago, June 19 – June 21) I sit down at a circular table in the high-ceilinged meeting room and conversationally ask the two women already there what brought them to this three-day conference. The first replies that she had a daughter die from a medical mistake. The other, a nurse, lost a son to […]

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HUCKABEE-STYLE HEALTH REFORM: Morally And Physically Fit


January 31st, 2008

Back in November, Republican presidential candidate Mike Huckabee wrote a remarkably candid essay for a special election issue of the trade journal Modern Healthcare. Since then, the former Arkansas governor’s campaign has morphed from single-digit obscurity to mainstream prominence, and the candor on health care has mostly been scrubbed clean from his Web site. Nonetheless, […]

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