Friday, February 26, 2010

When is Consumer Health Care Choice Rational and When Does it Become Irrational?

When taking an intercontinental flight a person has many choices – which airline, where and at what time to leave. When boarding the plane she can choose to deplane at any time before the doors are closed. She can choose among many options that are offered by the cabin staff. When technical issues arise however, i.e. when flying through a storm, the pilot is expected to choose the correct option for safely completing the flight. Why in this situation is it the pilot and not the passenger who makes the choice? This is because the complexities involved are quite sophisticated, requiring years of training and experience.

The situation is similar in health care; the patient has many choices in many situations. The patient can choose a physician, primary care or specialist, who appears knowledgeable and caring and has a personality in tune with that of the patient. Patients can choose to be compliant and learn as much as possible about their medical situation. The patient can always choose to refuse any or all treatments. The reality is when accepting treatment for a complex situation like the airline passenger flying through a storm, the expert, in this case the physician, is in the best position to chart the course.

One of the major problems in today’s medicine is that frequently even in very technical situations the patient/family is given the responsibility to determine the appropriate action. Sometimes patients are given options which they are not trained to understand and sometimes the choices contain options that are inappropriate in light of the patient’s overall condition. In other instances patients/families wish to receive treatments that are also inappropriate because of the patient’s medical condition. These too should not be offered. The problem is an unrealistic sense of patient autonomy which is among the major reasons why our health care is so outrageously expensive. To deal with this problem and avoid irrational care I have suggested a team of other professionals to assist the physician and patient to choose among beneficial treatment/s.

During the current health care debate many noted experts have suggested several reasonable reforms. They have mainly focused on changes in the payment system and some have suggested reforming medical malpractice laws; however, missing from the present discussion is the much needed change in the way we practice medicine. Until we as a society are willing to create a mechanism to clarify the role of patient choice and physician responsibility, successful health care reform will elude us.