Much has been said about the paradigm shift in the healthcare system, about the need to do things differently, about value as a solution for humanization, for the cohesion of professionals, for the alignment of funders and providers, and for the sustainability of a system in which without value everything is much more expensive.
I have been lucky enough to participate as a speaker precisely in one of the roundtables on medicine. Emulating a previous post, the title of the talk was “You have to value medicine”.
I have the impression that, for the development of this new model based on value, although we are all important, the weight of those who are close to the patient is crucial. Thinking about it, a few months ago, before teaching a class on value medicine in a program for health managers, I conducted a small survey. The results were surprising. That is why I considered repeating it, expanding the sample size, and studying the responses. I asked five questions about situations related to value medicine applied to clinical care. I used health professionals from my WhatsApp contacts as a distribution channel. My first surprise was that, despite being the summer period, I reached a sample size in a few days that I had not expected. 732 people answered. 87% completed the entire questionnaire. For the analysis, I considered only those who had completed all the questions, a total sample of 635 respondents. I offer you the link to the presentation I made at de the 22 Congress, where you can find the data and the details of the answers (link presentation).
Below is a summary of the data obtained in the study.
Please knock before entering
The patients of the Johns Hopkins Hospital published a decalogue about their needs. In my survey, I presented a list of options and asked them to indicate one of them. Even if, oddly enough, the latest technologies or bombastic treatments are not named, it seems that patients trust their doctor and the system more than we think. Even in a country where their insurance coverage may determine access to certain therapies, they assume that we will do what is best for them. In return, they ask us to respect their privacy; that we knock on the door, for example. One in five managers indicated the appropriate option and less than 10% of clinicians were aware of this request. Regardless of the percentage of correct answers, it should make us blush that patients comment upon this basic rule of education such as knocking on the door before coming in to visit them. A phrase from a wise person like my father comes on purpose when he told me that education opens many doors.
Don’t talk to me about "your book" but about what I want to know
In line with the recommendations published by ICHOM on the colon cancer process, I raised the second question. After a brief clinical case, I asked about which of the options was the information demanded by these patients. The majority of those surveyed believe that people with cancer value the number of clinical trials and the latest technology more than the sexual dysfunction that this disease can cause. Only 7% of respondents chose the latter option, which is correct. The group of directors tripled the success rate of the clinicians. We continue in "our movie" and we give more value to the technology than to what limits the quality of life of the patient.
Inertia is an anchor
In the next two questions, I explored whether we change some routine procedures that we know are worthless or, instead, we are dragged along by inertia as indicated in a BMJ editorial a few years ago.
The procedure of something as common as taking vital signs from admitted patients was the subject of the third question. It has been proven that taking the temperature in the morning does not provide any value. 25% of the clinicians were aware of it. The group of directors exceeded this figure by 10 points. Despite this, we continue to wake up the sick very early check whether they have a fever. I recommend rereading the aforementioned decalogue. The first request of the sick is that we respect their hours of sleep.
The fourth question focused on a common practice in hospitalized patients: routine tests. Tests are an important tool for diagnosis and clinical decision-making. Once more we sin by excess since three-quarters of hospitalized patients develop an anemic syndrome due to extractions. This would be nothing more than annoying and onerous if it were not for the fact that, in addition, in the case of cardiovascular patients it has been shown to increase mortality. One in three clinicians and managers chose the correct option. The alternative with more responses, however, avoided the risk of anemia syndrome. We are more aware of the value of diagnostic tools than of the damage that we can cause with their overuse.
We are aware that we do too many things of little value
Lastly, we polled the respondents on the number of practices of little value. More than half of those surveyed knew that an important part of what we do does not bring much value. More than 50% of healthcare doctors are aware of this and 70% of health managers also believe it. In general, we know that we do many things wrong, but it usually stays just that.
The survey may suffer from methodological errors. Sure some questions are confusing. Perhaps some responses are interpreted ambiguously, there may also be other limitations, but it's no less true that the sample is not negligible. Despite the possible errors, it gives us an idea of how far we are from the opinions of the patient who make up the first link of value towards it.
Value-based medicine brings us a new approach to medicine that I believe can help us all a lot. It's essential to generate a breeding ground in society in general and also in our leaders. Health managers seem to be more aligned with the concepts of value than clinicians, so they can be a good lever to motivate clinicians and thus together we protect the healthcare system and, above all, take better care of our main value, the patients.
Link to blog Doctor Miralles
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