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The Big Fix: How to Get Patients and Doctors to Change


Implementing the Big Fix in medicine means moving it from Sick Care to healthcare. This shift will take a lot of work.

Dr Smith recently received some guidelines on the treatment of high blood pressure.

American Heart Association guidelines currently recommend a systolic pressure of less than 140 millimeters of mercury for most adults with high blood pressure, or hypertension. But doctors say these new findings support a steeper goal of 120 — a reduction that could translate into doctors putting millions more Americans with high blood pressure on additional medication.

The study found that hitting the lower 120 target reduced the risk of dying from cardiovascular causes by 43%.

After a month, there was no evidence that Dr. Smith changed her prescribing habits for her hypertensive patients.

Mary Jones is one of Dr. Smith's patients with high blood pressure. She has been receiving notices from her health insurance company providing her with her prescription history for the year as well as several educational and online resources that might help with complying with her doctor's instructions and how to save some money on her drugs (ask the doctor to order 40 mg instead of 20 mg and use a pill splitter to save money). There were several lapses in prescription refills during the year.

Implementing the Big Fix in medicine means moving it from Sick Care to healthcare. Sick Care means using resources to take care of patients when they are sick or have symptoms. That's how we spend 88% of our $3 trillion budget. Healthcare means preventing illness, achieving wellness, or using techniques to interfere with the progression of disease or manage it. Moving from one to the next will take a lot of work.

Some ideas include:

1. Change the rules. Access and reimbursement policies should reward disease prevention and health maintenance.

2. Change how we educate a 21st century healthcare workforce, providing them with the bioentrepreneurship, digital health, and population management knowledge, skills and attitudes they need to serve their communities.

3. Target research and development funds to chronic diseases.

4. Create innovative non-brick-and-mortar care delivery channels that are easy to use, cheap, and accessible.

5. Empower patients to take control of their care and information e.g. using Open Notes.

6. Encourage appropriate DIY medicine and use behavioral econometric techniques to change behavior.

7. Support patient entrepreneurs.

8. Give patients the information, resources, networks, and incentives to take care of themselves and other family members.

9. Create an integrated health information whole product solution that is patient centric

10. Use social media and other consumer-facing platforms to change behavior.

But getting doctors and patients to change their behaviors is the key challenge and how to do it has befuddled psychologists for years. Navigating participants through the last mile will be essential and many digital health companies are betting they know the answers.

Fundamentally, getting a person, an organization, or a society to change means creating tools that make people willing and able to do it. Most people are unwilling to change because they have competing commitments and diagnosing and addressing them is critical.

We won't be able to cut the rising costs of care until we get people to change, and that small change jingling in our pockets won't be nearly enough.

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