Do Nice Patients Finish First?

As the authors of a commentary published by the Journal of the American Medical Association note, there’s been plenty of research on how to deal with difficult patients. So they decided to look at the flip side: how do physicians treat nice patients? Do they get better care?
It all depends on how you define “nice” and “better,” one of the authors, Allan Detsky, a professor in the departments of medicine and of health policy, management and evaluation at the University of Toronto. Generally patients who “communicate well, understand their problems, are able to make decisions, adhere to diagnostic and treatment plans, are pleasant and express gratitude for the services they receive” are more pleasant to treat than those who don’t, the commentary says, but the definition of niceness is still pretty subjective.
(Physicians know it when they see it — those are the patients to whom they give their home phone numbers.)
Moreover, “what’s nice in a social context may not be the same in a clinical” one, Detsky tells the Health Blog.
“Better” care might also mean a bunch of things, the commentary says. “It could include more care, less care, appropriate care, extensive follow-up, diligent searches for abnormalities or implementing a strategy of watchful waiting,” the authors write. In some cases a physician who felt she was going the extra mile for a patient she particularly liked could actually be doing harm, say, by looking so hard for problems that she turns up something that proves to be nothing but requires invasive tests.
In an ideal world, patients would choose a doctor with whom they had good chemistry, for lack of a better word. In the real world of limited choices and time, that doesn’t always happen.
Nor are physician preferences likely to be managed away with the same type of guidelines offered to physicians regarding difficult patients. All doctors (and patients) can do is be aware of the likelihood that patients perceived as “nice” may be treated differently from those who evoke the opposite reaction.
“Human nature is human nature,” says Detsky.

Doctor and Patient or Provider and Consumer?

We wince when journalists are called “content providers,” so we sympathize with a perspective piece in the current New England Journal of Medicine bemoaning “the new language of medicine.”
The two physician-authors, Pamela Hartzband and Jerome Groopman, do not wish to be called “providers,” thankyouverymuch. Nor do they want their patients to be called “customers” or “consumers.” Instead they prefer specific job titles: doctors, nurses, physical therapists, etc., to describe specialized medical professionals.
The root of the new vocabulary, as they see it, is a focus on the industrialization and standardization of medical care in the pursuit of cost control. They write:

The relationships between doctors, nurses, or any other medical professionals and the patients they care for are now cast primarily in terms of a commercial transaction. The consumer or customer is the buyer and the provider is the vendor or seller. To be sure, there is a financial aspect to clinical care. But that is only a small part of a much larger whole, and to people who are sick, it’s the least important part.

(We’ve seen this debate before, specifically with regard to high-deductible health policies and other proposals that urge making patients into more cost-conscious consumers of health care.)
Groopman and Hartzband — here’s a review by the WSJ’s Laura Landro of the most recent book they wrote together — also mourn the replacement of “clinical judgment” with “evidence-based practice” in the medical nomenclature. Data, on its own, will never indicate one clear way to proceed even with many common conditions or diseases, they say.
To wit: conflicting guidelines over things like prostate-cancer screening, even when everyone is looking at the same studies.
“When we ourselves are ill, we want someone to care about us as people, not as paying customers, and to individualize our treatment according to our values,” they write. To that end, they urge a return to “doctor,” “nurse” and “patient.”

Reader Consult: What Could Take the Place of the 510(k) Process?

Medical-device regulation is a tricky balancing act. Consumer advocates say the current process doesn’t ensure the safety and efficacy of devices on the market, while the device industry says the FDA’s process is inefficient and expensive and keeps products from reaching patients in need.

Today, as the WSJ reports, the Institute of Medicine weighed in with its own much-anticipated report on device regulation. Notably, an 11-member committee recommends scrapping entirely the streamlined approval pathway known as 510(k), under which a device such as a joint replacement or heart defibrillator can be approved …

A.M. Vitals: Killer Hospital Germs and Autism

Here is what’s making health news this morning:

Killer Bug Is Traced at NIH Hospital (WSJ)

Researchers stalked a deadly strain of antibiotic-resistant pneumonia that killed six patients last year at the National Institutes of Health’s elite research hospital in Bethesda, Md., demonstrating that gene sequencing can help in the fight against hospital-acquired infections.

Autism Risk Rises With Fathers’ Age (WSJ)

Older fathers pass on more new genetic mutations to their children than younger fathers, increasing their children’s risk of autism, schizophrenia and other diseases, says new research published in Nature.

Should Medicare’s Eligibility Age Be Raised?

With tens of millions of baby boomers heading into retirement, Medicare’s long-term financial prognosis is grim. One proposed solution is to raise the eligibility age gradually to 67 from 65.

Proponents of this idea note that we are living longer now than we were when Medicare began in 1966, and that the new health-care law will ensure that older Americans have access to affordable insurance even if they can’t get coverage through an employer.

Others say that making Americans wait two extra years to get Medicare would be unfair to the poor, increase the ranks of the uninsured and, most importantly, end up costing Americans more than it saves them.

Vote: Are ADHD Medications Overprescribed?

The number of children being treated with prescription medication for attention deficit hyperactivity disorder has soared in recent years.

Some doctors, parents and child advocates have become concerned that many children are taking medication unnecessarily. These critics suggest that ADHD is a mistaken diagnosis in many cases. And even when the diagnosis is correct, they say, many children who are taking medication for ADHD could do as well or better with alternative treatments.

Others say the critics greatly exaggerate the number of incorrect diagnoses. Heightened awareness of the disorder has fueled the rapid growth of ADHD cases, they say, not a rush to judgment. And ADHD medications have proved effective, their proponents say, to a degree that alternative treatments have not. What do you think?

Vote: Should men get PSA tests to screen for prostate cancer?

Prostate cancer hits one in six American men in their lifetimes, though in most cases it progresses so slowly that it would never cause problems. PSA tests can give an early warning of prostate cancer. But PSA tests also give many false alarms, prompting more than one million unnecessary biopsies every year. And when prostate cancer is found, more than 80% of men opt to have surgery, radiation or hormone therapy that sometimes leaves them incontinent or impotent, even though their cancer was probably never life-threatening.

How Often for Mammograms?

Changing recommendations for when women should get mammograms have created conflict and confusion. Not only do recommendations from different sources vary, but some have moved in opposite directions.

The U.S. Preventive Services Task Force scaled back its recommendation in 2009, saying women at average risk should begin screening at age 50 and repeat the test every two years. The group, the government’s independent panel of preventive-health experts, said women in their 40s should discuss the pros and cons of screening, including possible false positives and follow-up tests, with their physicians. Previously the task force had  recommended mammograms every one to two years starting at age 40.

In contrast, the American College of Obstetricians and Gynecologists increased its recommendation in 2011, saying women should be offered a mammogram every year starting at age 40. The group previously advised women to get the test every one to two years in their 40s and then annually starting at age 50.

What do you think? Register your vote and leave us your comments. We may use them in print in a coming special report.

Vote: Do You Want to Know What’s in Your Genes?

Are you better off knowing or not knowing?

For healthy people, is there a compelling reason to know if your genes make you susceptible to a specific disease or condition? Or are there some things you’re better off not knowing? As the cost of sequencing a person’s genome plunges, these are no longer hypothetical questions.

How Companies Can Foster Healthy Employees

Many employers offer wellness programs to contain their health-care costs—and perhaps also improve morale and productivity.

There is evidence that the programs lower health-care spending and reduce absenteeism. But participation rates tend to be low, limiting the benefits to companies and employees. In one survey, a majority of companies reported that 20% or less of employees took advantage of a health coach or weight-management program.

What do you think? Register your vote and leave us your comments. We may use them in print in a coming special report.

How Well Does Your Doctor Communicate with You?

Patients have long complained that doctors are rude, they’re bad listeners and they don’t explain things clearly.

Those complaints are finally being taken seriously, as poor communication is increasingly understood to be at the root of many of health care’s failures—and a leading culprit in rising costs. Research shows that when doctors don’t listen to patients, they miss important health cues and misdiagnose illness. Meanwhile, patients who don’t understand what their doctors say fail to follow their regimens, leading to preventable hospitalizations, complications and poor outcomes.

With new Medicare payments tied to patient-satisfaction scores, and concern growing over malpractice costs, medical schools, health systems, malpractice insurers and hospitals are trying to help doctors bolster their bedside manner. They’re setting up education programs for everyone from medical students to seasoned pros who have spent years talking to patients.

Are you satisfied with how your doctor communicates with you and your family? If not, what is your biggest concern? Vote and let us know what you think. Your comment may be included in a special report we’ll be publishing in The Wall Street Journal.