Contributor: Elizabeth Ferguson – Graduate Intern, Emmi Solutions
“Reason itself is fallible, and this fallibility must find a place in our logic” –Nicola Abbagnano
Healthcare is becoming more patient-centered, and patients are responsible for an increasing portion of the cost of their healthcare.
Neither of these statements are news, nor do they adequately describe the magnitude of the shifts occurring in the healthcare industry that lead to them. What both points do highlight, however, is that patients—or really, consumers—play in increasingly important role in determining what and how much care is appropriate for them. Locating this authority with the consumer drives many of the outcomes healthcare reform hopes to achieve, and results in measurable improvements across metrics that everyone can agree are desirable. However, like the statements above, it’s not that simple.
Humans have evolved what is, by any standard an awe-inspiring ability to perceive and interpret the world. We observe and internalize patterns of occurrences and other human behaviors that then guide our own actions and reactions, we unconsciously weigh and balance potential outcomes, and we constantly learn and build on our comprehension of the world around us.
But, we’re also emotional. Molded by the culture in which we are raised and our individual experiences, humans reach subjective judgments that inform their perception. Despite our incredible aptitude for logic and reason, we are still emotional—think “fight or flight” response—before we are Vulcan-like logic machines. As Dr. Joseph LeDoux, author of “The Emotional Brain,” explains: “the wiring of the brain at this point in our evolutionary history is such that connections from the emotional systems to the cognitive systems are stronger than connections from the cognitive systems to the emotional systems.” In essence, emotion informs our logic more than logic informs our emotion.
One subject on which the primacy of emotion can dramatically affect judgment is accurate perception of risk. Humans are terrible at assessing how dangerous something is, and are very easily manipulated and biased. Consider the social media explosion of concern over Ebola here in the United States. Ebola is trending, and often the tweets and posts reflect fears and reactions, not reality. In reality, a host of diseases endemic to or common in the United States (meningitis, tuberculosis, West Nile Virus, hepatitis, influenza) pose a far more significant risk to Americans than two closely monitored and extremely isolated patients at Emory. But none of those other diseases are a hemorrhagic fever. Now that is scary.
What does this have to do with patient-centered healthcare or paying more out of pocket?
Actually, quite a bit. If we’re asking patients to be informed consumers of their own healthcare—to weigh pros and cons, to assess risk and reward, and to accept the ramifications of their decisions—then it’s essential that they really understand their options, and the risks inherent in each. We need to take people who may have little to no experience in healthcare and explain complicated topics in ways that are meaningful and relevant to them. Truly patient-centered medicine requires an educated consumer who carefully weighs options and makes a choice based on their preferences. Informed consumers also weigh the economic trade offs between quality and cost, experience of physician and appointment availability, and seeking out or delaying preventive care. We cannot expect to reap the rewards of patient-centeredness and cost sharing without providing support for these new decision-makers. They must be educated, and thus far, our healthcare system hasn’t proven adept at doing so. Continue Reading »