Sunday, August 23, 2009
The National Public Radio (NPR) Interview on Health Reform: Dr. Howard Dean, You Need to Regularly Read This Blog
When interviewed last Friday on National Public Radio's All Things Considered, Howard Dean explained the polls showing declining support for health reform by saying:
'And we do know from polling - because I've seen some polling about messaging - is that when you talk about health care reform, a lot of people disapprove of it. When you explain the president's health care reform views and his bill, then people support it overwhelmingly.' [bolding from the DMCB]
Aha! So the concerns out there are the result of an information gap.
Readers may recall that Howard Dean is not only a former Vermont Governor and former Chair of the Democratic National Committee but is an academically trained general internist. And in the quote above, he demonstrated a classic sign of the syndrome of Chronic Unremitting Insufferable Physician-Centric Generalinternistitis (CUIPCGI). This is an abiding belief that education is the single ingredient that transforms patient non-compliance into compliance. Its dysfunction becomes extreme when this delusion intrudes in other aspects of living, such as national politics or changing a spouse's mind about the merits of letting the porch go uncleaned. The Disease Management Care Blog is also similarly trained internist physician and has observed that CUIPCGI frequently among members of its specialty, in much of the academic peer reviewed literature and among many of the Brahmins advising the Obama Administration.
For the longest time, patient care was built on the notion that the transmittal of facts from Those-In-Possession-of-Knowledge to Those-Not-In-Possession-of-Knowledge was suffuciently transformative. We believed it made the dumb smart, the lazy energetic and the disinterested inspired. Accordingly, the uncontrolled diabetics would become controlled, hypertensives would become normotensive and the obese would become thin.
Unfortunately, victims of this disorder soon suffer severe consequences: 1) the subjects of their belief system often discern they are incorrectly being labelled dumb, lasy and disinterested, 2) persons with chronic conditions don't make much progress in disease control and 3) stymied by a lack of buy-in, these unfortunates paradoxically inflate their confidence in the merits of education and compensate by framing the same facts with accelerating degrees of bias.
Fortunately, for the many otherwise excellent professionals who are afflicted, there is a cure. It involves humility and paradoxically applying the same educational standard to oneself, starting by reading some of the vast amount of peer reviewed scientific literature from the last ten years that has revolutionized the science of patient behavior change. It has amply demonstrated that recounting of 'facts' are only the beginning. 'Expalining' the facts is necessary but not close to being sufficient when it comes to getting patient buy-in and behavior change. The literature on this is not hard to find and examples include this, this, this and this. There is a good review of the topic at AHRQ and the Population Health Journal has this thoroughly researched description of various approaches to behavior change. Last but not least, regularly surfing, RSSing and Twittering the modest DMCB is also a good way to keep up on care management. Regular readers know the bottom line is that when state-of-the-art patient engagement is applied, variations of shared decision making centered on the patients' knowledge and values results in a mutually acceptable care-plan.
Viewed through the prism of population-based health care, therefore, the August recess Town Halls are one stop in the process of a sort of shared decision making that could lead to a national 'care-plan' consensus on healing our broken health care system. While rancorous and sometimes loopy disagreement has slowed reform's momentum, responding by smugly 'explaining' the President's views to the opponents is insufficient, implies they are lacking in knowledge, is disparaging and damaging to our national dialog.
The DMCB is unaware of Dr. Dean's readiness to change, but if the DMCB was using motivational interviewing to help him, it would reflectively listen and offer up the option of reading this blog as one way to be a more constructive force in getting to meaningful health reform.
A less clinical way of saying the same thing is to bluntly point out that our national discourse and the listeners to NPR deserve better.