By Evan Falchuk

When software is bad, it’s often because the designer built it in a way that made sense to him, but not to the user.  It’s a little like that in health care.

Our system is the result of years of design by governments, health plans, employers and others.  Its features make sense to those designers.  But to the primary users — patients and doctors — the system is confusing, frustrating, and doesn’t seem to work.

Two studies show how these design flaws are seen, and how important it is that we listen to to doctors and patients before we get too far on today’s efforts at reform.

According to the NPR/Kaiser/Harvard study released this week, patients are very happy with their doctors.  The Wall Street Journal’s Health Blog went so far as to say that patients think their doctors are “perfect.”  Things change when patients are asked about the hottest new design trend, comparative effectiveness.  When asked if there is usually “clear scientific evidence” to choose one treatment over another, 72% disagreed.  When asked if they would trust a government-affiliated entity to “referee” this kind of effectiveness, a quarter said they would trust it “just a little” and 30% said they wouldn’t trust it “at all.”

Doctors expressed similar dissatisfaction in a study released last year by the Medical Society of the State of New York.  Ninety-five percent of doctors said medical decisions should be made “by the patient’s doctor and not by the health plan or insurance carrier.”  Ninety percent said they had to change the way they treat patients based on restrictions from an insurance company, with ninety-two percent saying that involvement “may not be in the best interests of patients.”

Patients and doctors have the most at stake, we need to listen to them.