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Take 'Healthcare 101' and See the Doctor

Cheryl Clark, for HealthLeaders Media, September 27, 2012

The accredited patient

I ran the concept by John Santa, MD, MPH, director of Consumer Reports Health Ratings Center, publisher of hospital ratings. "It’s an interesting idea," he says. "It sounds like you think folks should have to get a healthcare license to get healthcare."

Yes, in a hypothetical, modest proposal sort of way, that's where I'm heading. An accreditation process for the patient.

Santa then started to play off the idea. "Imagine if a health system or a government organization asked you: In return for a better benefit, we want you to understand how the system works. Look at this booklet. Take a drive through your healthcare system to make sure you understand what to do in an emergency. How do you prevent disease."

Some of this activity might happen through the soon-to-be-launched healthcare insurance exchanges. "Do you want to drive on the health exchange highway? Well, you need a license," Santa jokes.

The difficulty, he says, is that when he was in medical practice in Oregon, he realized many of his patients "are more comfortable placing their total faith in their doctor...They say 'I don't want to think about anything but that I have the best doctor and he or she is doing the best thing, and this will all turn out well.'"

The truth is, I think, that patients don't feel competent to learn what they should, or they just don't feel up to it.

The other concern, of course, is that many doctors paternalistically think many of their patients can't absorb this information, and they don't have time to explain it anyway. Maybe it’s a version of the phrase spoken by Col. Nathan R. Jessep in A Few Good Men: "You can't handle the truth."

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4 comments on "Take 'Healthcare 101' and See the Doctor"

Eve Harris (10/1/2012 at 8:28 PM)
This strange (facetious?) suggestion is NOT patient-centered and does not actually empower patients or do much of anything to fix the broken healthcare delivery system.

Bart Windrum (9/28/2012 at 8:41 AM)
I have long suggested a similar thing around end of life, since 90% say they want to 'die in peace' yet roughly 15% do, according to the commonly held definition. What the nascent 'conversation' around end of life really addresses is dying AT peace; dying IN peace is an obstacle course littered with impediments to dying both in and at peace. A 3-hour day would position people to add a range of things to "the talk". A 6-hour day would give them a depth of understanding that might truly empower them and change the future course of their, and their loved ones', demises. Since end of life is the caboose on life's train, I think Cheryl's car will get going first. Just be sure that the training (hey, that's a pun) includes more than describing what is; it must provide empowering guidance for how to manage.

deb (9/27/2012 at 5:59 PM)
This looks like yet another way the current system is going to exert control over what people do and who is allowed to provide "services." The insurance industry exerts control by their contracts - what they pay for and how much they pay for - is a means of controlling actions. "Responsibility" as it is currently used really means did a patient do what they were told to do - with little regard for whether those directions achieve what the patient may want to achieve. How about instead the control is actually shifted to the people seeking support for their well-being? (and yes, some people won't care, and for some that may be a viable choice) The concept of stewardship would go a long way here. Stewardship shifts control. Equip and empower people to be stewards, to make effective decisions for themselves for the sustainability of well-being - from a range of decisions available, not just a small list from the allopathic world. That's like teaching someone to fish . . . and offering the world of lakes and rivers.