In April I posted about my thoughts on the Wall Street Journal’s report on Quest Diagnostic’s Chief Medical Officer Dr Jon Cohen’s TedMed 2012 talk about “why patients don’t behave like wise consumers when it comes to choosing Doctors”.
Without documentation is gut instinct all we have to go on?
I’m still convinced that it’s the lack of documentation that’s hampering good decision making rather than patients being “poor healthcare consumers” but it’s helpful to see the actual talk as you get to see that Dr Cohen’s most definitely referring to the US’s undocumented sickcare system:
“Let’s say i have a fever and a cough, i could go to 3 physicians on my health plan. Physician A makes the wrong diagnosis and gives me the wrong treatment, he gets paid a $100. Physician B gets a chest X-Ray done and figures out I have pneumonia, but gives me the wrong antibiotic. He gets paid a $100. Phsyician C she makes the right diagnosis that I have pneumonia and she gives me the right antibiotic. She gets paid a $100. The Physician who made the wrong diagnosis and the physician who probably saved my life get paid the same. You see patients can’t shop using price to determine differences about who’s the better Doctor”
When you have a situation as dysfunctional as this (eg. where you’re not even going to your family Doctor for your primary care needs) I think there’s even more reason to think his father might have done the right thing in asking the guy selling hot dogs in the atrium – after all if he wants to use his local hospital isn’t the smart guy on the ground going to be well placed to work out where all the nurses and Doctors go when they/their kids are sick?
Are cosmetic surgery patients wise consumers because it’s all so well documented?
When outlining the success of the cosmetic surgery market I think Dr Cohen’s inadvertently highlighted the potential that documentation has to automatically create the desired outcome:
“Not only do people not want healthcare but in fact we have to give it away, or incent people to get it. Now there’s one huge exception. Where people shop around for the best Doctor and price, we’re talking about the fountain of youth cosmetic surgery. Straighter noses, less wrinkles, bigger breasts, smaller breasts, higher breasts flatter tummies, last year Americans underwent 9.5 million cosmetic surgeries for a consumer cost of $10.7 Billion. People willing to pay the money you see there they can see good quality results they just have to look at their friends, they can also see bad results crooked eyebrows, lips four times the size of Angelina Jolie, breasts pointed in the wrong direction”
Wouldn’t we all have a better chance of differentiating the quality difference between the Physician A and Physician C experiences that Dr Cohen described if they both provided us with full documentation of the consultation?
I think it’s quite easy to imagine that when patients (or carers) are coming home with a comprehensive written report it’s going to be nearly as straight forward as looking at their friends nose or chest to determine who’s selling snake oil eg. “It says here I told the Doctor I had more shortness of breath than usual, a cough that was productive of a deep green sputum, fatigue, fever, chest pain during deep inhalation… When you punch that all into WebMD isn’t it a bit odd that Physician A didn’t even examine my chest or take my blood pressure?”
Should we first try to create desire for healthcare OR vote with our feet for Doctors who are prepared to document their care?
Perhaps I’m out of touch because what we’re seeing here at 3G Doctor is obviously at the complete other end of the scale from what Dr Cohen is referring to eg. patients paying to consult with us are all capable of shopping around and the offer/price is clear: A documented consultation with a registered Doctor on your video mobile for £35.
What do you think?