Friday, January 22, 2016

Wisdom of Patients
Sir William Osler (1849-1919), the patron saint of medicine,  once said, “Listen to the patient.  He is telling you the diagnosis.”  And a mother advised her son, “ You have one mouth, and two ears.”
The message is the same.   Listen before you open your mouth.  Listen before you leap to conclusions.  
In the case of medicine,  listen to the wisdom of patients.    Hospitals across the country are doing just that.  They are forming advisory councils of patients  to tell them how to improve care (Laura Landro,  Hospitals Form Advisory Councils to Learn How to Improve Care, “  WSJ, November 29, 2015). 
What hospitals  are learning is this:  Patients have solid, practical ideas that not only improve care but  bolster hospital scores on patient satisfaction surveys.   Hospitals are learning patients want first of all to put the hospital experience behind them, and second, never to come back again.   They are learning patients want to give families 24/7 access to families,  and amenities to families and intimate visitors, like Ipads, sleeper chairs,  comfortable redesigned quarters, and friendly nurses and doctors to whom they can talk  conveniently, openly,  privately, and at greater length.
This business of listening closely to patients has not gone unnoticed by doctors.   It is the basis of direct primary care and concierge medicine, wherein doctors set aside more  time to talk to patients,  at any time by email or by phone,  to help patients understand what is going on,  and to aid doctors in understanding the patient’s point of view in a personal,  social, and cultural context.
This patient wisdom phenomenon  is not new to me.  I wrote about it in a previous blog post in 2012, in another context,  reducing health costs.

Wisdom of People: The Key to Reducing Health Costs
No one in the world, as far as I know, has ever lost money by underestimating the intelligence of the great masses of plain people.
H. L. Mencken (1880-1956),  Social Critic, known at the Sage of Baltimore

Why the Many Are Smarter Than the Few and How Collective Wisdom Shapes Business, Economies, Societies, and Nations.
James Surowiecki (born 1967), American journalist, in  subtitle to The Wisdom of Crowds, Doubleday (2004)

April 21, 2012 -  I believe the great masses of people – be they patients,   employers, employees, those in the streets, and in their houses – are wiser than politicians and even doctors when it comes to their health.
People know what is good and bad for their health.  People know good care from bad care.  People know a good medical deal from a bad medical deal.  People know that what people do outside doctors’ offices, where they spend 99.99% of their time, is more important to their health than what happens inside those offices.  People know,  as my doctor told me, “It is not what I can do for you, but what you can do for yourself.” The exception, of course, is when you are sick. That’s where doctor skills and knowledge come into play.
People  instinctively know these elemental  things. So do employers. That ‘s  why people-driven care, aka consumer-driven care, is taking off in the workplace. A Towers Watson and National Business Group survey indicates 59% of companies with over 1000 employees are now  offering health savings accounts with high deductibles, or equivalent plans, to employees,  either as stand-alone plans or as a choice between HSAs and PPOs.
Savings accounts jumped 35% in 2011.  People are wise. Employers are wise .   Both know these accounts save 15% in health costs, and premiums are lower, sometimes 30%- 50%  lower.  People know when it comes to spending their own money, they make wiser more prudent choices.  People know the money they spend on these new account plans is tax-free.   They know this tax-free money rolls over into the next year and serves as retirement money. They know out-of-pocket responsibility leads to wiser and more careful spending of health dollars. And they know what they pay for and  do,  for and to themselves,  is the single most critical factor contributing  to their physical and economic  well-being.  Employers offering health-savings accounts with high deductibles,  and their various equivalents, increased by 35% in 2011.  That's proof of the patient wisdom pudding.

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