Monday, 23 October 2017

The Patient Revolution according to Victor Montori

In 2016, Victor Montori, a professor of medicine and diabetes doctor at the Mayo Clinic, launched The Patient Revolution, a foundation whose mission is to help make truly patient-centred treatment a reality. In his new book, Why We Revolt, Montori argues that “industrial medicine” has corrupted the mission of medicine to the point where doctors are now incapable of caring for the people who place their trust in them (for further information about the author in this same blog, search for “Montori, V." entries in the tags [top-right-hand column].

The problem

Montori gradually builds up the argument on which Why We Revolt rests through an original, precisely-constructed narrative. The story begins with the cruelty inflicted by many doctors, hidden behind their computer screens, routines, targets or desired impact factors. Next, the author discusses the existence of a blurred view of patients as they are lumped into groups. Many doctors try to classify their patients, he says, as this offers them greater certainty. Montori, however, believes that we should abandon codes and forms and that clinical interviews should take place in a carefully personalised environment. Rather than labelling patients, the author argues that if each is treated as a single individual, this will take on clinical meaning and will be reflected in results. After these reflections, Montori proceeds to unmask the greed that lies behind the interests, not always obvious, of the related industry, which benefits from the connivance shown by many doctors in their methods. This greed, he says, has helped to persuade society to see technified medicine as a consumer good. Moreover, it encourages a situation in which decisions taken at many consultations are based on the idea of “the more the better”, a misguided approach that undermines the value of clinical work. The final problem described in Why We Revolt is the burden that therapeutic procedures can place on patients, particularly those with chronic illnesses and the more fragile. According to Montori, nearly half of all elderly people report that following the advice and treatments prescribed to them by doctors is highly onerous to them, and they also note that they often do not remember clearly what they need to do.

The recipe: elegance, solidarity, love and integrity 

Doctors must find the time that their patients indispensably require. To enable such dedication, their excessive workloads should be lightened, and they should regain control of their agenda. Caring for people who are ill also requires elegance, the elegance that is generated in doctor-patient relationships that are conducted with due consideration. Being in a hurry indicates a lack of respect, especially for those that most need care. Love is another element that Montori stresses that without a loving environment, patients do not feel inclined to discuss some of their more intimate concerns. A doctor who is satisfied with the superficial results of a conventional consultation may be led to make mistakes, in both diagnosis and therapeutic procedure. On the other hand, in a climate of trust and productive communication, both doctor and patient can advance together to share decisions that make intellectual, emotional and practical sense.

The practice of industrial medicine has become a degraded version of the evidence, because it is forcing clinics to classify patients and then apply the guidelines that have proven, in theory, to work for a particularly group. Montori, who is highly critical of this medicine by manual, insists that the time has come for patient revolution, and that doctors need to change their attitudes, throwing away their forms and focusing their clinical practice on providing individual care for each different person they treat. This will force them to find more time for listening, discussing, understanding and involving patients in their own clinical processes.
Víctor Montori concludes that doctors have become technicians who can barely understand the real problems of the people they treat. Accordingly, he says, a revolution is required to take us back to basics. We should abandon medical efficiency indicators and encourage the art of conversation, the only possible way of enabling us to match scientific evidence to each individual’s personal background and, thereby, achieve greater clinical effectiveness. Thank you so much, Víctor, for writing Why We Revolt.

Jordi Varela

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