Archives for July 2014

Patients can’t get a break. They may be hurting, nauseous, groggy, short of breath, exhausted, or fearful about their future, but they still have work to do. As part of the long-overdue push to make health care more patient-centered and safe, various health-care leaders have been telling patients to do this and that. “Take charge of your health care” has become a buzz phrase, as tips for what patients should do multiply like incoming emails on a sick day.

The to-do lists come from health-care organizations, government agencies, private foundations, and others. For instance, the Agency for Healthcare Research and Quality (AHRQ http://www.ahrq.gov/), the National Patient Safety Foundation (NPSF http://www.npsf.org/), and the American Academy of Family Physicians (AAFP http://familydoctor.org/) have all issued them.

To illustrate, some of the recommended tasks include:

• Gather or write a long list of questions to ask your health-care provider, and bring it along to your next visit. Prioritize your questions because you might get time to ask only a few.

• Research your condition online or at the library so that you can help your doctor or nurse make the right diagnosis.

• Ask all of your health-care providers to wash their hands.

• If hospitalized, use disinfectant wipes on “your bed rails, the TV remote control, the phone, your call button, doorknobs, tabletops, and other surfaces.” Repeat regularly.

• Make sure that all of your doctors know what your other doctors are thinking.

The lists go on and on. A study published in 2009 tallied 160 distinct suggestions as to what patients should do–and those were to enhance safety only. It found little overlap among the tasks prescribed by different organizations. The researchers, led by Saul Weingart, Chief Medical Officer at Tufts Medical Center and a leader in patient-safety efforts, wrote: “Unfortunately, there appear to be too many recommendations to be practical, and some are of dubious value.”

Indeed, scientific studies offer little solid evidence that most of the recommendations actually improve care. They might even backfire: For instance, health-care workers might ease up on safety measures if they think they can rely on patients to prevent mistakes. On top of that, many patients deem it risky to say anything that might offend their doctors. Not that they expect intentional harm, but they worry that peeved health-care providers might delay their care, take their symptoms less seriously, or berate them.

Patients may be right: In an interview study, health-care staff echoed many of the same concerns when reflecting on their own experiences as patients. At work, they felt demoralized by patients who seemed to be checking up on them and said they might distance themselves from such “difficult” patients, hardly a situation ripe for good care.

Given all of that, maybe it’s just as well that patients ignore much of the advice on how to take charge of their health care. More often than not, the tips miss the mark. They show an astonishing lack of insight into the barriers patients face and the vulnerability they often feel when they need medical attention. Likewise, the recommendations show little understanding of the humans who deliver health care. Fixing health care requires more than glib to-do lists; it requires data-driven insight into patients, doctors, and other health-care workers. That’s why I blog.

Photo copyright Elliot Burlingham/123rf.com stock photo

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Dear Readers,

Have you tried to follow any of these or similar tips when seeking health care? If so, how did it go?

If you’re a health-care provider, what do you think of the tips being offered?

If you work for an organization that dispenses such tips, please share your thoughts.

Finally, I’d love to hear from researchers who can address any of these points.

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