Can Bureaucrats Train Doctors to Train Patients to Manage Their Own Care?

Need I even ask?

In this study the patients had diabetes, chronic obstructive pulmonary disease, and irritable bowel syndrome…The researchers were hoping to pull off a three-bank shot: The intervention was to train primary care practices in techniques for training patients in self-care behaviors that would improve the patients’ health.

…[W]hat Kennedy and her colleagues found was that in the real world…training the primary care providers didn’t help patients at all.

Bill Gardner at the Incidental Economist.

Comments (13)

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  1. Dewaine says:

    “The problem is that primary care providers work in highly constrained environments. Their routines of care have been set by years of training and decades of tradition, and are adapted to cope with a fire hose of patients and tasks. It takes more than brief training to change what docs do.”

    Doctors provide a valuable service that may not need this change. The advent of the internet has ushered in the ability for patients to get health information instantly. Preventative care can and is being learned by proactive patients taking their futures in hand. Regulating doctors to do something that can be done much more efficiently on an individual level will result in worse healthcare outcomes.

    • Dewaine says:

      “In that new system, promotion of patient self-management becomes the primary responsibility of a nurse or other physician extender.”

      I disagree. The best way to improve healthcare outcomes is for people to take responsibility for themselves. The more that happens, the more the free-market will free up resources to provide optimal services.

      • JD says:

        But can’t we nudge people toward good decisions? I agree that people should take responsibility for themselves, but we can provide the resources for them to do that.

        The internet has made health information more available, but having doctors provide it also can only be beneficial.

        • Dewaine says:

          Performing redundant tasks takes away resources from other areas. A doctor who provides unnecessary training in self-care can spend less time doing his traditional activities. Meaning health care will cost more time and money at the expense of health.

  2. JD says:

    I wonder if this failure has to do with incentives. Doctors are there to make money. Why would doctors consult themselves out of future patients? Something like this would only work if the government offered subsidies for providers that perform to a certain standard.

    • Dewaine says:

      It does have to do with incentives. This study failed because it is in a vacuum. There was no ability to build reputation based on providing the far cheaper self-care consultation vs. traditional service. In the real world, doctors have a long-term incentive to provide the best, most accurate and cheapest care available. Subsidies would just incentivize doctors to provide the wrong care.

  3. Randall says:

    It does seem that the nurse or the doctor’s assistant is the one that tends to the patient’s needs. Doctors are too limited in what they can do these days…

  4. JO JO says:

    I don’t think this is going to happen!

  5. Samuel says:

    I think providing resources, such as easily accessible websites and other readily available tools for patients to practice preventative care is necessary.

  6. Tom says:

    Perhaps not to teach doctors but I do think some incentive for doctors to have a more proactive relationship with their patients is a good step in the right direction. Oftentimes I don’t find enough incentives and competition when observing the medical world because patients usually don’t have many options and often don’t question doctors.

  7. Buster says:

    I have read that diabetes self-care training doesn’t reduce medical costs or improve health status. It’s hard to imagine why this wouldn’t be the case. Maybe the doctors are the problem; maybe the patients are the problem. This may be yet another example of an intervention that doesn’t actually improve health.

    I have not read anything about irritable bowel syndrome self-care training. I would think patients themselves would go online and look for answers considering how uncomfortable it could be to not have answers. I remember the movie Along Came Polly where Ben Stiller suffers from IBS that’s set off by spicy ethnic food and agrees to go eat Indian food because his beautiful date wants to. That was a funny scene, but the point is that the Stiller character had identified what triggered problems.

  8. Hubert says:

    “The primary care providers changed their behavior only to a limited degree.”

    Perhaps hitting them while they are training could have long term effects.

  9. Erik says:

    I think JD said it all, “Why would doctors consult themselves out of future patients?”

    It would seem greed is more important than the Hippocratic oath to some.