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Are patients making things worse?

Scott Jagow Oct 12, 2009

NPR had a story this morning that grabbed my attention. It’s something I’ve thought about for years. Every time I go to the doctor, in fact.

From “How the modern patient drives up health care costs:”:

The fact is that the behavior of patients in our health system has changed dramatically over the past couple of decades. They’ve transformed from passive “patients” who almost blindly follow the doctor’s orders — until the 1980s, patients regularly took pills without even knowing what they were for — into active and aggressive “consumers” of health services.

People read things on the Internet. They see prescription ads on TV. They become convinced they have an ailment. They tell the doctor. The doctor doesn’t think the patient needs the test, but they’re afraid to say no. And there’s not much time to argue about it:

“There is a drive to get people in and out because insurance reimbursement is very difficult,” (Dr. Teresa Moore) says. “So even though it is absolutely wonderful to say we could spend 30 minutes with each patient and explain these things fully, sometimes you just don’t get to do that in real life.”

So doctors will order you tests you don’t need. And they will write you prescriptions for pills you probably shouldn’t take — which is a huge problem with antibiotics, for example.

And, (Dr. Joseph) Zebley says, doctors even do operations, like back surgery, that they probably shouldn’t do. They do it, he says, because you want it, have become convinced that you need it, and doctors fear that if they don’t give it to you, they’ll lose you.

But not all doctors are like that. I went to mine recently complaining of shoulder pain. I had been living with it for a while. A massage therapist warned me about frozen shoulder. I did some research online, and it sounded horrible. I went to the doctor convinced that I was well on my way to frozen shoulder and that I might need surgery.

He said: “Scott, you don’t need a hammer to kill a fly.” Instead of ordering expensive tests, he told me to take prescription strength Alleve for a week.

A week later, the pain was gone. I’m glad the doctor stood his ground.

I can think of other examples where I’ve resisted tests because I thought they were unnecessary, and I was right. I like being a more active patient. I remember the days of thinking, “the doctor will fix it,” and I’m glad I don’t have that attitude anymore. At the same time, patients need to be part of the solution for keeping health care costs down.

NPR’s story ends with this:

If you ask Moore if she would rather have an old-fashioned, passive and pliant patient or a new, demanding and modern one, she really has to think about it.

“It depends on the phase of the moon,” she says. “Passive is much easier to treat. But I do like an educated patient who’s willing to read about their health issues. So I guess I’d like someone in the middle.”

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