Author: David Chang, MD
Internalizing the concept of value in medicine can be difficult for both the patient as well as the physician.
When it comes to his/her own health care, I think that the average consumer is medically schizophrenic. When it comes to paying the bill or selecting insurance, they may want “value.” But when it comes to receiving care, they feel better knowing that no expense was spared. No one goes to “Taj Mahal” Hospital expecting to get “Big Mac” medicine; they want Ruth’s Chris. How do we change or modulate patient perception of the “value” of their care? Making metrics public is possible, but these metrics sometimes are difficult to interpret. Chasing after patient satisfaction does not always lead to the most “value” oriented medical decisions.
This also shoots both ways. As physicians, our duty is to the patient in front of us. It is often difficult to think in a population medicine paradigm, where selecting a treatment based on population evidence means that a proportion of your patients will be “cured” and a portion will “fail.” While this may “look good”/”cost less”/ “demonstrate value” as an aggregate, a physician inherently cares and empathizes most about the individual patient sitting in front of him/her at that moment, and perhaps less about the whole. Sometimes it feels that making decisions based on population medicine is like acting as a military general in headquarters while at the same time acting as an officer on the battlefield. Commanding in headquarters and commanding on the battlefield is often at odds with the success of any one soldier/patient. As physicians, we don’t like to think of losing any soldiers/patients. As evidence become more refined, hopefully we better be able to make recommendations on a personalized evidence based medicine, rather than on broad population assumptions.
It is easy to pontificate about value intellectually, but sometimes more difficult to enact in practice.