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.”