Thursday, August 7, 2008

Rules Doctors Need to Know

In the August 7 on-line version of the New York Time, Tara Parker-Pope contributes an article entitled "Six Rules Doctors Need to Know." She credits the source as Dr. Robert Lamberts. His blog, Musings of a Distractible Mind will not doubt be overwhelmed, but it's worth a look.
Having spent the last two weeks both in the aether of Washington and in the trenches of New York City, I find the article grounding not just with respect to its resonance with "consumer" discontent but equally as a guide for the very "why" of health care policy. It's not about white papers and legislative mark-ups, it's about people.

Here are his six rules. They are posted only as a teaser to guide the reader to the primary and secondary sources.

Rule 1: They don’t want to be at your office.
Rule 2: They have a reason to be at your office.
Rule 3: They feel what they feel.
Rule 4: They don’t want to look stupid.
Rule 5: They pay for a plan.
Rule 6: The visit is about them.

This posting has generated enormous response both in the addition of more "rules" as well as in commentary on the existing six rules. Most, this writer would argue, apply equally well to the "why" of policy more broadly. In my revision, I change the "they" to "we" since it's the "we" who are beneficiaries.

Rule 1: We don’t want policies and rules until we need them. Lambert points out that patients don't work in the office and most find the experience unnerving. They are, quite often, "naked" to the world when in the office. Ditto for policy makers and those who serve the "system." Lambert says the key to success in practice is "compassion." When was the last time one felt this in a back office or a hearing room?

Rule 2: We have reasons to want our health care system to work. No one wants to go to a health care facility. No one wants to have to think about progressive intermittent frailty, economic catastrophe from health care costs, cancer, heart disease, or the curse of obesity. Yet they are somewhere in everyone's minds. This observation may help focus policy-makers. As Lambert says: "On every visit I try to identify the real reason (or the real fear) that brings them to see me."

Rule 3: We feel what we feel. If in the public eye things don't make sense or one feels one is not being served, it's the responsibility of those serving to try even harder. As Lamert says, "you have to trust your patient...only the really crazy patients up symptoms."

Rule 4: We don’t don’t want to look stupid. Dr. Lamberts describes this from the perspective of the patient who is viewed as over-reacting. I would phrase this from the perspective of an individual seeking answers and and finding acronyms. Just try to understand the long-term care you or your loved ones need. Explain CHHAs, NORCs, SNFs, and the many other acronyms and terms designed, one imagines, to evade actually solving human problems. Acronyms are a symptom of unnecessary complexity. Their use promotes the degradation of the "lay public" and further isolates the voter from those charged to execute in the political realm. Request to those who work in government: successful candidates (from any party), don't use acronyms; neither should you!

Rule 5: We pay for a plan. We don't pay for orders and rules without a rationale that makes sense to us as tax payers and as individuals who will place our lives in the hands of the health care system policy creates. How well does our system actually prepare a plan to help someone adhere to medications and change behaviors rather than just drop the whole thing into the lap of the individual? How well do the components of our system work together on behalf of the individual? Sadly, we know the answer to this question; We should not feel proud.

Rule 6: Policies are about "us" - the beneficiaries - and the services we need; they are not about the policy-makers, lobbyists, health plays, employers, or other intermediaries.


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