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Wednesday, October 23rd 2013

Healthcare Of The Rich & Famous

People sometimes try to generalize the care that famous people receive. There’s been some controversy after Angelina Jolie revealed she was BRCA positive and opted for a double mastectomy. Another example might be when other patients try to rush back to imitate the rehab of a professional athlete.

Or when we look to the care received by Presidents.

If even our most prominent and well-connected citizens can’t get the best evidence-guided care, where does that leave the rest of us? Though doctors are some of the most hypereducated professionals around, they frequently don’t deliver care that has stood up to the most rigorous research.

I would argue though that often times patients don’t want evidence-guided care however. They want the hi-tech and most informative care; the care they saw on television.

Evidence-based care is for the population as a whole. If you do it for everyone the population sized outcomes will be better. But patients are individuals and they have trouble understanding in terms of such epidemiological measures.

No that cardiac CT scan likely won’t change our individual outcome and there are low risks. But we want to know what it shows and what it adds to the prognosis and in the off chance we’re one of the unique where it finds something.

No this microdiskectomy with two weeks of pain won’t lead to a better outcome at a few months compared to being conservative but we want the chance of relief now.

I’m not sure that sometimes it’s a matter of better informed consent or communication with patients. Not just sometimes but perhaps often patients perceive more as better and no office visit or computerized informed consent it going to disuade that.