December 30, 2011

The Medical Mind In The ACO PCMH Schema by Jim Bloedau

The professional practice of Medicine is a highly stylized and creative pursuit that is shaped by what your doctor recently read in medical journals, how and where he was trained and just plain empirical sense gained from years of doing their job that includes a lot of trial and error. It is the practice of an art.  Treatment protocols, clinical pathways and the like have all tried to reduce this creative side of medicine into a more precise manufacturing of medicine where doctors merely become providers of standardized care most of the time.
Much of the pushback by professionals to these attempts at standardizing care comes from the understanding that the magic and mystery of the human body precludes two human bodies always responding to the same treatment regimes in the same way. No one is arguing against trying to optimize outcomes, but perceived “cookie cutter” medicine seems not to consider a key influencer in developing a protocol - the patient’s “medical mind” and those around it and the collective influence on outcomes.

Doctors Jerome Groopman, an oncologist and writer for the New Yorker, and his wife, endocrinologist Pamela Hartzband, have taken on the job of illuminating the patient’s influence on treatment regimes and resulting outcomes.  In their recent book “Your Medical Mind: How To Decide What Is Right For You” they review the many influencers and decision styles patients employ when trying to make the “right” medical decision:
  • Minimalist versus Maximalist: Minimalists - believe less is more and want to do just what is absolutely necessary.  Maximalists are the people who want to do everything possible and more to take care of the health issues they have.
  • Naturalist versus Technologist: Naturalists want to use natural remedies. Technologist wants the latest, greatest cutting-edge technology.
  • Believer versus Doubter: Believers think there's a good treatment for whatever they have and is going to go for it. Doubters are risk averse and tend to focus on unintended consequences and thinks the cure might be worse than the disease.
What additionally confounds the idea of set treatment protocol for all is their observations that all of these types of "minds" interact to contribute to the compliance, or lack thereof, to a prescribed treatment regime. 
As we move into an era of escalating accountability for quality under the ACO and PCMH models and the resultant increased responsibility being put on the patient to optimize their own health, the stylized thinking of the patient becomes critical to healthier outcomes.  Influencing strategies for each of these "mind types" (buyer types too) must be deployed .

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