Dr. Victor Montori used this image to illustrate what he, as a physician, sees as the biggest problem in healthcare.
It depicts a tactic that coal miners used to use to detect when dangerous gases were present in the air. When a canary sent into the mine stopped singing, they knew toxic gases had leaked into the mine.
In this Mayo Clinic doctor’s mind, patients are the canaries, and when they stop singing – or in this case, when they stop complying with what their doctors have recommended or stop going to the doctor to begin with — the healthcare system has become toxic.
Non-compliance is frequently talked about as a cost and a burden put on the healthcare system by patients. But Montori’s theory is that really, it’s the healthcare system over-burdening the patient.
“We have to be very careful not to blame the patients,” Montori said during his closing keynote at MedCity’s ENGAGE on Thursday. “A lot of the conversation (around patient engagement) has been, how do we get them to do stuff? To me, that’s not engagement.”
When a patient doesn’t follow the treatment protocols issued by his doctor, the tendency today is for physicians to intensify the treatment. What’s really wrong, Montori said, is that the treatment wasn’t right for that patient to begin with, and asking him to do more of it is only going to make matters worse.
“Everyone has a given capacity to take care of your role in life,” he said. “If you are sick, you have that same capacity but you also have to deal with being sick.” Increasing the burden of treatment, then, isn’t the solution.
What happens so often now is that patients take the prescription the doctor gives them, fill it, read the information about the side effects when they get home and then decide they don’t want to take the medicine after all. Real patient engagement happens when doctors can give that information to patients before writing a prescription, help them understand all of their options, listen to what their priorities are and then help them choose to the solution that best fits their lifestyle.
That also shifts the dynamic of care from treating a disease to enabling the patient to achieve his number one goal, which is to be able to fully play the role he plays in his life.
Montori closed by asserting that the U.S. healthcare system will be the best in the world only when it begins to shrink. “Healthcare right now is all about itself. Healthcare right now is about how do we get bigger, more market share,” he said. “That means that patients have to take more medicine, have to monitor themselves more often […] We will have the best healthcare system in the world when it becomes the first healthcare system that shrinks.”
My daughter has multiple diagnoses, sees multiple MDs and receives incredibly conflicting treatments, the doctors do not communicate with each other, her conditions are very complex, and require integrated care, which seems to be impossible. Everyone agrees that she should go to Mayo Clinic, but here's the problem, she has been banned from the Clinic because of her negative reaction to a gastrologist's recommendation that she see a psychiatrist for her stomach and bowel issues. Subsequently she has been diagnosed with Dysautonomia, which includes her gastric system. What is she supposed to do?
In the sage advice of Jerry Maguire: "Fewer clients, less money". Not a memo, "It was a mission statement".
All nicely said and done but how do you spend time as athe treating physician, trying to build that alliance with a patient if all you get is 15 minutes per patient visit and 60 minutes or less per new patient visit.
You hit on part of the problem. Here is one aspect that is NOT mentioned,taught or discussed in medical or RN schools. What do these drugs cost? Healthcare providers routinely look up what is on the formulary cross refernce with disesae (hopefuly read the chart for what the patient is already on) and write a RX. Do you ever ask. .how much do these drugs cost.. Oh insurance will cover it.. no.. not in all cases or not at 100%. So if you wonder why the fixed income patients don't take the new WonderDrug that the pharma rep just touted (but did not leave pens anymore)./ Maybe just maybe it is becasue they CANNOT AFFORD IT.. not just that they don't want to take it.
Hey Doc how about an article on this as a follow up to this topic? I look forward to seeing it.
Thank you, Dr. Montori. As a retired health care professional myself, who chose - and loved - providing excellent, high-quality medical services to my patients, which I did for 40 years, I am so relieved and thankful that finally, at long last, at least some of our current doctors and allied health care professionals are beginning to speak up publicly and tell the TRUTH to the American public about our badly broken and dysfunctional health care system.
This same kind of candor and TRUTH from all of our health care professionals is vitally necessary, going forward, if we ever hope to correct the many problems within our service profession today, and if we want to exemplify the highest ideals and goals of our service profession to our patients.
Please keep speaking only TRUTH to your current patients, to your potential patients in the public marketplace, to your fellow health care providers, to all intermediaries/payors, and most importantly, to yourselves.
In any high-quality, responsible, health care service profession, the PATIENT always comes first.
This is the inviolable principle which we health care service providers ever so slowly began to ignore - and finally abandoned - in our American health care system. And once we began to compromise our own integrity, by ignoring this principle, very, very, bad things began to happen throughout all aspects of our profession - and the consequences of our abandoning our duty to always place our PATIENT first, are now cascading negatively throughout our society, our government, and our entire national economy.
We can do better than we've done previously. And we have an obligation to do better, starting right now. We only have to re-commit to always speaking only TRUTH - and to always placing our PATIENT first.
Thank you, Dr. Montori, for having the courage to start leading us out of the impossible, deceitful, quagmire we flounder in today, and for focusing us in the only direction we must go ourselves, in pursuit of our chosen service profession.
Dr. Montori did in fact provide a compelling presentation when that chronic patient has been thrown into the swim lane of a fragmented health care delivery system with conflicting messages, half-understood clinical directives, and no life guard on duty to keep them from drowning at their most vulnerable. They are at the mercy of the functional integrity of their provider's clinical structure. However, patients are not completely blameless. In fact, they're most to blame before they become patients. I'm talking about the 75% of all chronic care costs that are avoidable through lifestyle modification. Yes, the processed foods industry is to blame, so is the chronically stressed lives that so many Americans live leaving little time for self-reflection and self-improvement. But, I'm afraid those life constructs are no longer a valid excuse, and we must as a nation take control of the one thing we still can, our well-being. As Dr. Montori said, the success of our health care system will be defined when it begins to shrink.
I believe that this entire article could be summarized in two words. Therapeutic alliance. Other professions (non-MDs) realized this years ago and have changed the treatment approach because of this ideology. Welcome aboard.
Vince Gutierrez, PT, cert. MDT
Having just spent two weeks in the role of caregiver for my senior mother after minor surgery, I also became acutely aware of another serious problem affecting non-compliance. Not non-compliance of prescribed drugs, but of wound care after surgery. After the surgical procedure, my mother was only given verbal instructions on what to do until a followup appointment, not written ones. So it was up to me, her daughter to write them down for her to follow. At subsequent followup appointments with the doctor, he blessed his work, then handed us over to his nurse for instructions on her wound care. Once again, nothing was given to us written down, leaving a gigantic opportunity for memory lapses and/or misinterpretation of the prescribed care. Dealing with seniors, this is downright dangerous — both for the patient — and for the doctor who may end up with infections caused by inadequate home care.
As our population ages, we had better figure out how to be efficient with our medical professional's time, but not at the expense of our patient's health. We ALL suffer when things go wrong.
The health care system must embrace diet and life style as the most important factors in health maintenance and health recovery and disengage from the pharmaceutical industry, if it ever is to be useful to Americans.
The commentator is correct that Healthcare has become just another supermarket, looking for purchasers. Once for profit systems were constructed, and the reason anyone got into Healthcare was to have a paying job, career, profession, then all bets were off that the patient would matter as more than just someone who passed through to collect their treatment (prescription, test, inoculation, referral). Once MD/OD's became gatekeepers to Healthcare services, (through HMO's, PPO's, and now ACO's and Medical Homes), any economist would have predicted that volume sales, especially with USGovernment- or StateGovernment-provided services offered, became the name of the game. Finally, Publicly-funded Education does NOT instruct students in how to care for themselves; there is no general curriculum requirement that teaches sufficient detail about how all environmental substances, pharmaceuticals, and nutrition directly effects the way the HUMAN CELL responds and functions, Honestly a course in A&P in 9th Grade should replace "Health" which is mostly agenda-items like birth control/sexual conduct, substance abuse (consumption of illegal drugs or banned substances), whatever the latest USGovernment 'health' initiative is. Personal Healthcare Management - should include the costs according to Hospital Master Charge lists. Most Students, starting at age 13, need to LEARN that MONEY is what drives Healthcare Services, not an individual's condition - in the same way a hairstylist or an auto repair tech provides as service. Children-recipients in most States don't even know they are covered by SCHIPS; they should and they should be TOLD how much the Government spends on them each year.. There is way too much mystery what Healthcare means for the average person...and the AMA, the American Hospital groups and all the other feeders on/workers in this INDUSTRIAL SECTOR like that opacity too.
@Doctor How about scheduling more time per patient and making less money overall? You're a doctor. You are perfectly capable of giving your patients more time.
@ShereneChenSee That's an incredibly simplistic view that is not in line with reality. There is a physician shortage in this country and in order to treat all in need, doctors are required to see greater numbers of patients. Furthermore, given the growth of healthcare conglomerates, it's not as though doctors are dictating their own schedules.