My friend, Dr. Gurpreet Dhaliwal, has a most interesting opinion piece in the Wall Street Journal, “If Only Health Care Would Focus On This One Thing“.
In this post he suggests that we should not worry about multiple aims (the triple aim or the quadruple aim), but rather focus health care design and delivery from a patient perspective. He writes, “In health care, our keystone habit should be taking the patient's perspective. If we could develop the habit of always seeing health care from the perspective of the patient, we would have one guiding principle – not four – for the tough decisions and trade-offs that need to be made as we reform health care. How long should patients have to wait to make an appointment? It is worth investing in e-mail communication systems with patients? If the response is governed by balancing patient experience, quality measurements, costs considerations and worker satisfaction, the answer gets complicated. If instead we habitually ask, ‘What do I want when I'm a patient?’ the answer is clear.”
In general I agree with his major point, however, it does need a major caveat. We see too many patients who make unreasonable demands: overtesting demands or inappropriate medication demands. As professionals we have a responsibility of primum non nocere (First, do no harm). Opiate overprescribing is a great example. How many patients demand opiates, when their use has great danger.
I have written recently that we must strongly consider the patient's perspective on value in health care. However, we must temper our patient centeredness. When 1 patient's concerns impact our ability to help other patients, then we must make the choices.
So bravo to Dr. Dhaliwal, with these cautions.
db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.