Tuesday, July 10, 2012

"Automated Hovering"– A Concept for Improving Americans' Health
Automated Hovering in Health Care – Watching over the 5000 Hours
David Asch, MD, et al, title of article in New England Journal of Medicine, July 5, 2012
It requires a very unusual mind to undertake the analysis of the obvious.
Alfred North Whitehead (1861-1947). Science and the Modern World
July 10, 2012  -   There’s a new concept  in health reform. It’s called “automated hovering.”  It’s basically about changing health care culture by changing the way people behave outside the reach of the health  professions.
Too many things detrimental to health, the concept goes,  are explained by individual patient behaviors, not by what doctors or nurses do
“Indeed,” say the authors from the University of Pennsylvania, “even patients with chronic illness might spend only a few hours a year with a doctor or a nurse, but they spend 5000 waking hours each year engaged in everything else, including deciding whether to take prescribed medications or follow other medical advice, deciding what to eat and drink and whether to smoke, and making other choices about activities that profoundly affects their health.”
So much for the obvious – that what patients do to/for themselves may be more important than what the health professions do to/for them.
How do the authors propose to "automatically hover" over how people behave?
·         Pay doctors to be accountable for health outcomes,  for example, by  preventing readmissions and bundling payments around the goals of care rather than encounters.
(My comment:  This strikes me as a weak argument. It may influence how doctors behave, but not how patients behave.
·         More deeply understand behavioral economics and why people do not change even though they want better health and know  how to achieve it 

 (My comment: This too sounds weak to me. Isn’t this what the system has been doing for years?)
·          Deploy and expand the reach of sophisticated and simple technologies – cell phones, wireless devices and the Internet- to help experts connect to people during their everyday lives

 ( My comment:  This has been going on for 20 years; 70% of people now have home computers, and 80% of them use the Internet to search for health information.
The authors are honest enough about the pitfalls of hovering – too much hovering may erode patients’ sense of personal responsibility; too much hovering may be too intrusive and paternatalistic;  too much hovering may results in our do-gooders being seen as “self-defeating nags.”

I question whether "automated hovering" is the right way to improve the health of Americans.

"Hover," According to my dictionary, means: 1) to float in the air without moving from the same spot; 2) flying in one spot by rapidly beating the wings; 3) to wait near someone or something in expecting something to happen; 4) to be in an unstable condition; and 5) to stay about the same level, changing only slightly.

I do not find these definitions helpful.

Maybe, "automated brothering," as in Big Brother is watching you, or "automated mothering, " as practiced in Nanny states, would be more appropriate than "automated hovering."
Beyond all these considerations,  we should realize that Americans  now feel free to  do what they want to do, to do what feels good, to follow what their peers do, to keep on doing it until they feel bad, and to dislike being told what not to do. It's irrational, and it may not be good for your health.  But that's human nature for you.
Tweet:  A new approach, “automated hovering,” designed  to improve health is evolving  to help people become healthy while  away from doctors.


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