Good News "The pendulum is moving back."
William Wagner
Patients Turn to Advocates, Support Groups and E-Mail, Too
By JAN HOFFMAN
Published: August 14, 2005
Battle-hardened by the medical system, patients have become pretty good
at taking care of one another. If they are not learning enough from
their doctors about diagnoses and treatment options, they can turn to
organizations that offer support and education programs for specific
illnesses. Doctors can often make recommendations about which of these
groups are reli
Another worthy resource is the patient advocate, a relatively new role
with fluid responsibilities. Many hospitals employ advocates to resolve
disputes between patients and staff members, including doctors; they can
also help patients who face difficult treatment decisions.
Privately hired patient advocates can, among other things, research
medical options, make appointments and negotiate with insurance
companies. The advocates, who include doctors, nurses and lawyers,
charge anywhere from several hundred dollars for a consultation to the
$30,000 initiation payment and $25,000 annual fee for a soup-to-nuts
service for the wealthy. There are also nonprofit advocacy centers.
Patients can find advocates through the Internet or through support
programs for their conditions.
But the practice is not regulated, so patients should "check credentials
and find an advocate who will empower them rather than push them in a
specific direction," said Marsha Hurst, director of the health advocacy
graduate program at Sarah Lawrence College in Bronxville, N.Y.
Insurance companies also want to help patients manage their health care
more efficiently, in order to keep costs down. Many companies use
"disease management teams" who contact patients directly, largely
bypassing the physician, a gesture that some patients view with
skepticism. Typically, nurses from the team periodically call patients
with chronic conditions like asthma, diabetes and back pain, and send
reports to the doctor. The nurses can answer questions and monitor
adherence to a treatment plan, tasks that most physicians do not have
the time to do themselves.
Reviews of disease management teams are mixed. Jean Faber, a patient in
Verndale, Minn., with back problems, credits her insurer's team,
American Healthways, with her turnaround. Ms. Faber said her internist
told her that gastric bypass surgery was needed to alleviate her back
pain, but she refused the surgery. A disease management nurse helped her
figure out a diet and exercise plan instead. "The nurse called once a
month," Ms. Faber said. "I felt like I had a partner."
She lost 178 pounds in two years and is now pain free.
But Richard Roberts, a family physician in Belleville, Wis., has
misgivings. Insurance company teams can leave a doctor out of the loop,
he said, and the quality of their reports is uneven. He referred one
patient with multiple health problems to her insurer for help. A year
later, she called him, complaining because she had to deal with a
different team for each of her problems: "It's like having four
full-time jobs. And I already have a job. I felt better when it was just
you and me."
Doctors are keenly aware of the rift between themselves and their
patients. A series of critical reports from the Institute of Medicine,
an arm of the National Academy of Sciences, urged doctors to embrace
"patient-centered care," an approach that respects the patient's
background and preferences. As of last year, all graduating medical
students must pass an extensive exam in patient communication to
complete their licensing requirements.
Doctors who do not have the time to talk to patients are increasingly
turning to e-mail. But patients need to be aware that the
confidentiality of e-mail messages is not assured, and, given the hectic
nature of people's lives, a timely response may not be, either.
More profoundly, many doctors have been trying to reconnect with
patients through a philosophy of conversational engagement known as
shared decision making, in which doctor and patient work together to
choose a treatment.
Shared decision making presumes that there are two experts in the
consultation room: the doctor may know best about medicine, but patients
are the experts about their own priorities. Patients who feel
intimidated in medical settings need to learn to speak up, even as
doctors are being trained to gently elicit information that will help
lead to a decision about treatment.
"What options are covered by your insurance?" a doctor might ask. "Can
your job or family obligations permit a short-term but time-intensive
treatment?" "Do you prefer a strategy of watchful waiting or a
scorched-earth medical approach?" "What outcome do you want from knee
pain treatment - to run four miles a day or just to sit comfortably at a
desk?"
Lonely, overwhelmed patients seem to hunger for these conversations as
much as doctors do. Patients are proud to be independent-minded
consumers, said Debra Roter, a medical sociologist at the Johns Hopkins
Bloomberg School of Public Health, but they also value the guidance of a
caring doctor.
Professor Roter said, "The pendulum is moving back."
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William Wagner
<Nonsence_here_B2wagner...@news.supernews.com>,
William Wagner <Nonsence_he...@Snip.net> wrote:
.......................
> Lonely, overwhelmed patients seem to hunger for these conversations as
> much as doctors do. Patients are proud to be independent-minded
> consumers, said Debra Roter, a medical sociologist at the Johns Hopkins
> Bloomberg School of Public Health, but they also value the guidance of a
> caring doctor.
> Professor Roter said, "The pendulum is moving back."
Speaks of the family, community and neighborhood in decline.
"Lonely.overwhelmed patients " and medical interventions in the same
sentence ? I'm confused. I never thought of my doctor as my friend
just a service provider with a rich history of helping folks. Still I
prefer the old Chinese Ideal of paying your doctor when well and not
when I you are sick.
Dream on I guess.
Bill