Wednesday, July 27, 2011

Shared Decision-Making is a Two-Way Street

There is one word in ACO that stands out to me – Accountability. Physicians are held to be accountable for coordinated patient care. Likewise, patients must be equally accountable for their own health and personal decisions. The success of our future ACOs may depend upon the mutual interplay between these two circumstances. Negligence on either side will necessarily result in failure. The effort to reduce health care costs starts and ends with the patient – under the guidance and support of a focused and committed family physician.

Education: Simple education – the distribution of information and materials – will not be sufficient. Education is useless without empowerment. Even the greatest teacher will struggle to connect with a lackluster and disengaging lesson plan. Patients must become owners of their own health and outcomes must be linked as much to medical care, as personal choice. Presently, the Institute of Medicine is working to develop guidance for just such an educational venture.

As it stands, CMS has mandated that all marketing of ACOs must be approved by their internal office. Considering the, as of yet, purposefully vague definitions of ACOs – this is a misstep. In commentary to CMS head Donald Berwick, the AMA offered that, “The requirement that CMS approve all ACO marketing materials is an unprecedented, unnecessary, inappropriate, and unworkable requirement.” Wow. That is harsh and bold language. But, I believe that speaks to just how important it is that robust patient education be featured on the nature of their role within ACOs.

Think of shared-accountability as an analogy to a car owner. Most patients aren’t necessarily the best drivers or caretakers of their own car. Everyone that owns a car must get some regular maintenance, inspections, and repairs – this keeps the automobile running well (hopefully). The provider of these services is usually a specialist in that area of car care. However, between these visits, it is up to the owner to ensure the car is maintained. It would be ludicrous if someone were to suggest putting water in the gas tank – yet Americans struggle coming to terms with the right type of fuel to keep their own bodies running and energetic.

Some cars look nice, others are maintained well – and these are always perceived as reflections on the owner. No one looks to the Jiffy Lube guy that changed the oil as being responsible for the well-tuned car. He is certainly an important, and necessary part of the process. But it is the owner’s responsibility to see through the spectrum of car and maintenance. Why, then, do we often view health care and our own bodies in such a different light? Why can’t a physician be viewed as a specialist mechanic that is ready for a quick tune-up, or even an overhaul every once in a while?

At any rate, I certainly understand and appreciate that our bodies are much different from our cars. However, I do believe that the relationships and care can be viewed in parallel. Doctors can teach us how to drive our cars - perhaps even read us the owners manual – but then hand over the keys and let us drive solo for awhile. That is true accountability.

Take the Accountability out of ACOs, and the Care Organization will falter. But, this accountability falls as much on the role of the provider, as it does the patient. Be vigilant that our patient population not fall into complacency, or expect anything less than a working and actively cooperative relationship with their family physicians.


  1. Well said. Doctors are fantastic resources but they are not Gods. I believe that most of our nation's citizens rely far too heavily on their doctors' recommendations and the medications they are prescribed. Why? Perhaps it is because patients pay so much so they expect that what they are told/recommended is always accurate. Perhaps it is because our society likes to thwart taking responsibility for themselves, so they put it on someone else to make the calls. It certainly makes it easy to blame someone else (like a doctor) when a medication doesn't work as opposed to shouldering some of the burden yourself by proactively making lifestyle modifications, for example.

    Patients should take ownership of their health by becoming educated about their condition(s) and keeping tabs on how they feel in response to certain variables (foods they eat, things they do or don't do). In my opinion, doctors should be viewed as guides rather than Gods. We all need to take the time to realize most of us are more in control of our overall wellness than any other person, no matter what you pay them or how often you see them.

  2. That's right Matt I agree with you, nowledge is power, if the patient has appropriate knowledge about the disease, the patient can stay immune to the doctors because not every time the doctor is right but on the same extent we need to get checked up by a physician.