Eat Your Raisin Bran: Transparency Counts for Nada if You Don't Follow Docs Orders

Results from a Medscape survey indicate less than a quarter of patients with hypertension followed docs orders and stuck to a recommended high-fiber, low-fat diet (results here).

Hmmm...my long term cardiac/BP health or another Cinnabon?

What good does quality/cost data do us if we don't follow a prescribed treatment plan?

Consumers cannot keep expecting to deliberately sabotage our long-term health for short term gain and have the miracle of modern, multi-billion dollar American medicine fix our mistakes. Over. And over. And over.

Something's got to give. (Primary care? Emergency room waits? Medicare caps? Episodic, costly end of life care in hospitals but not at home?)

Demanding transparency in our healthcare system means we must also be transparent about our role as purchasers of goods and consumers of services - we must take some responsibility for our own wellbeing, and how our decisions affect our health.

End of story, right? Baaad patients. Baaad consumers. Follow your doctors orders!

Unfortunately, no. Docs are also giving up too easily.

In concert with the recommended diet plan, only 15 percent of the Medscape respondents followed-up with patients at 1 month, almost half followed up at 3 mos, 9 percent at 6 mos, and only 6 percent followed up a year later.

Now, the survey is fraught with challenges - a small sample size (76 self-reporters), no info on how many hypertensive patients switched out of a participating docs practice within that year mark, etc.

Still, 23 percent of docs reported NOT following up with patients after prescribing a dietary change.

Why are outfits like Jenny Craig so popular?

Because dietary change is challenging. Lifestyle changes are tough.

Aggressive follow up by caregivers is needed, as are repeated communications about the importance of sticking to the plan (and the benefits of doing so).

Docs -be transparent with us about the gains and risks we face as a result of our dietary decisions.

Consumers - if we're calling on hospitals and docs to be transparent and reveal complex outcomes data (infection rates, etc)., we damn well better get on board with being transparent about our difficulties with following treatment plans, and discussing the importance of following 'simple' non-hospital based treatment plans.

And docs, it's ok to remind us, more than a few times, every time you see us, if need be, why this is important. After all, transparency means we're partners in care decisions.

According to this survey, both docs and patients get a failing grade.

My gym used to have a lump of disgustingly congealed plastic that was equivalent to just five extra pounds of body weight sitting at the front desk. It was a very good deterrent. Usually I had a strange craving for a Subway Veggie sub after passing the desk after a workout.

If my doc held up 3 of those babies (or more) and told me that was what I was carrying around my midsection, I may be more likely to rethink not choosing that bowl of Raisin Bran.

Then again, maybe not.

Part of being a consumer means dealing with the consequences (net gain, net loss) of my purchasing behaviors.

Unfortunately, in the US we tend to bail out consumers who make poor decisions, rather than reeducating them on how to make better ones.

So what plans, as healthcare providers, administrators, and practitioners, do we have in place to educate consumers on how to make better choices?

How do we open the conversation with patients surrounding a proactive engagement with their health management processes?

How do we keep the conversation going, even when it's time to talk tough?

One step at a time...and transparency is the inevitable next round in healthcare market development.

Transparency is the 'next step' in allowing patients to feel more empowered to make healthcare and wellness decisions based on the items, goods, and services we want and need.

Health 2.0 is helping us figure out where we go next.

But if we can't communicate openly, talk transparently about data, outcomes, expectations, faults, and failures with each other, as patients, as providers, as partners in care, what good is all this data?

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