By Evan Falchuk
I gave a speech yesterday at the Midwest Business Group on Health’s 30th Annual Conference. The MBGH is one of the country’s leading organizations on health care, and its members include the leading innovators and thought leaders on health care in America. It was a privilege to present to them.
I spoke about why health care just isn’t a consumer business, in spite of all of the efforts to turn people into health care “consumers.”
Read the text of my remarks below the fold, it was a very interesting day.
At Best Doctors, we have a close up view of what happens to people when they try to find their way through the health care system. It’s not a pleasant picture.
Health care consumers – if you can call them that – are often lost, confused, frustrated, alone.
There was a time – perhaps – when your doctor could help you work your way through.
Some doctors still can. But the truth is that time has largely passed.
I want to talk to you today about what it means, then, to be a health care “consumer.”
There are three major barriers to health care “consumerism.”
According to the latest National Ambulatory Care Survey the majority of doctor visits feature face to face time with the doctor of 15 minutes or less.
Fifteen minutes. I think we all know what it is like.
In some ways, health care reform will make this worse. In Massachusetts, where I am from, we passed a reform that some people think is the model for what just passed nationally. Today, for the first time, we have waiting lists to see doctors in Massachusetts. In part, it’s because of newly insured people trying to use the system. It’s hard to predict what will happen as we add 40 million new people onto the insurance rolls.
The second barrier is this: patients don’t know what questions to ask.
There is no practical way for a patient, faced with a new illness or even one they’ve had for a while, to get the level of training, experience and judgment that their doctors have.
Dr. Jerome Groopman, from Harvard, wrote a terrific book which you may know. It’s called How Doctors Think. In it he says patients have to partner with their doctors, ask them insightful questions, interrupt their normal thought process. It sounds good, but it’s a very difficult thing to do.
Now, at Best Doctors we help patients do this. But doctors will tell you that working with patients who are trying, on their own, to make sense of their situation is one of the biggest challenges they face, too.
Patients show up with reams of stuff printed off the internet. Doctors want to help, but it’s difficult to spend that 15 minutes sifting what’s relevant and what isn’t. It’s a recipe for frustration and dissatisfaction for both doctor and patient.
And it’s part of the third major barrier: how do you know what doctor to see?
It’s hard to know if a doctor is good or not. There are lots of ways to ask around and find things out, and people do this all the time. And of course, we do this at Best Doctors, too. But you know what I think? I’m not sure if it’s even the right question.
I mean, if your cancer has been incorrectly diagnosed, what does it matter if you are getting treated by the best surgeon in the world? The wrong treatment is the wrong treatment.
And so there are consequences of these barriers to consumerism.
There is a growing body of research that isn’t getting the attention it deserves. It’s being done by doctors you probably haven’t heard of, like Patrick Croskerry and Mark Graber. They are publishing ground-breaking studies that show that 20% or more of patients end up with the wrong diagnosis. The leading cause? Cognitive errors – mistakes in thinking – that happen when doctors make important decisions with limited information and not enough time.
Everyone’s familiar with other studies, that show that half or more of patients don’t get the recommended treatment. At Best Doctors our data, across millions of people is almost precisely the same. We see that about 20% of people get the wrong diagnosis and about 60% have something wrong with their treatment.
I believe the problem is the way care is delivered in the United States is broken in ways that are not easy to solve. And if you’re you’re sick, you don’t have time to wait for the system to change.
Let me tell you a story that gives you an idea of what this is like.
You know the movie the Wizard of Oz. There’s a scene where Dorothy gets to a fork in the road.
Everyone said, just follow the yellow brick road. But no one warned her there might be a fork. When she got to one she had no idea what to do. The only person she could ask was the scarecrow, but he couldn’t offer much help.
He said he had seen lots of people go by, but he had no idea how to get to the Emerald City. Still he offered to help. But he warned Dorothy- look, you need to understand, I don’t have a brain.
Dorothy didn’t have much choice, so she took his help.
It’s like this if you are trying to be a consumer in health care. You’re going to reach points where you have to make a decision. Maybe your doctor is great and can help you. Or maybe you have a family member or friend who is able to help you. But most people aren’t so lucky, and so they end up trying to get help from whoever happens to be there. And that’s not good.
Now that’s a Hollywood story. But let me give you another Hollywood story.
This time, it’s a real one, and it’s about my brother, Brad. You may have heard of him, or at least his show. He is the co-creator of the Golden-Globe winning show Glee. But about 2 years ago he almost died.
One day he woke up with numbness on one side of his body. He went to his doctor who told him he probably hurt himself working out. When it didn’t get better, he was sent for an MRI. It brought bad news – there was a malignant tumor in his spinal cord. He went to see a leading neurosurgeon, who told him how these kinds of tumors are treated. Radiation first, then a delicate surgery to take out the tumor. You face a likelihood of being paralyzed from the surgery, he was told, but you have to do it, because otherwise you’ll die.
That scared him, and he called me. I guess it’s because I’m the President of Best Doctors and don’t have my own TV show. But we treated him like we do anyone else. We collected all of his medical information, and we had doctors review it all.
Now, if you ask a neurosurgeon, how do you treat a malignant tumor, he is going to tell you something very much like what my brother’s neurosurgeon told him. What we do is to say, wait, before we start talking about tumors, let’s make sure that’s what’s really going on.
When our doctors reviewed my brothers records, they found that he – well, we – have a family history of a kind of malformed blood vessel. It’s possible, with this history, that this is what was showing up on the MRI. We asked an expert in this kind of thing and he said don’t radiate or operate. Do a different test to make sure it’s not one of these malformations.
We sent that information to my brother and his doctor, and they did the other test. It proved that he didn’t have a malignant tumor. The thing in his spinal cord was one of these blood vessels.
Now, he still needed surgery, but it was very different from what was planned. And in fact if they had radiated this blood vessel, it ran the risk of making it bleed – causing a potential catastrophe while he got completely unnecessary treatment. The work we did saved his life.
So, when we talk about being a health care consumer, remember Dorothy. And remember my brother.
Remember that when someone is faced with an illness, they find themselves in a new and unexpected place.
In a situation where they aren’t sure which direction to go, and to whom they can turn.
In a world in which the consequences of their decisions can be very costly to their health, and, as employers, to your pockets.
But as people – and all of us here are people, I need to give you some advice. If you or someone you love gets sick advocate for them, and for yourself. Ask questions. Use every resource are available to you. Don’t let yourself fall through the cracks.
If you’re here, and you’re listening, for your own sakes, for your families, and for your employees, know that you can make a difference.