> My own story is one of overcoming obesity and, at times, nearly crippling depression using that ability to gain knowledge to learn how to feed my body. In the process, I've stopped medications and have had to teach my doctor certain things (like why I'm not gong to either worry about my cholesterol or take any drugs for it).
> As people take control back...when they realize they have some control...they will become more healthy.
Your story is great, and a good example of the upside of patient control and involvement in care.
However, the downside also exists, and is very real. For some patients, having control over their care means demanding unnecessary tests and treatments, which leads to phenomenal increases in costs to the insurer and/or provider, as well as a reduction in compliance with medication and treatment regimens[0] - this has implications both for public health and the patient's own health. Or, worse, demanding medications that they think are helpful but are actually harmful (this happens all the time).
The problem is that control isn't very meaningful without an appropriate level of knowledge to supplement it, and even when the resources are available, very few patients are willing to take the time to educate themselves to the extent necessary to make informed decisions about their own care.
> Once patients become knowledgable, the doctor moves from a pillar of all knowledge to a (hopefully) trusted, knowledgable advisor. That change frightens many in the medical community[1], but it will yield better outcomes.
To be blunt, it's more likely that the doctor will move towards being the person who enacts the wishes of the insurer (or whichever entity is acting as the insurer). This isn't a particularly bold prediction - it's already happened, in that doctors are increasingly beholden to the pressures of insurers. Once you take into account the massive costs that arise from mismanagement of long-term conditions (whether from the patient or the doctor), it's not hard to understand why insurers are taking increasingly active roles in patient care.
[0] This isn't always bad, but think of diseases which require adherence to antibiotics (or, worse, diseases like HIV, which are chronic and for which compliance is a matter of public health) and you'll see why this can get problematic very quickly.
The problem you describe is an economics problem. Doctors and patients are shielded from the costs associated with their health care. Having insurance act as a group savings plan is catastrophic for all aspects of healthcare.
If, on the other hand, people were paying out of pocket for those tests, who cares? What is the downside of a person being more knowledgable and involved?
Unfortunately, the ACA took a step in the wrong direction by hiding more costs from the consumers. If we want a healthy health care system, we need price tags (and insurance for catastrophic events!).
I would hope no doctor would prescribe anything without agreeing to the medical benefit of said treatment (I've asked for an off-label prescription before and my doctor pushed back until he understood and agreed it was worthwhile).
A patient can't just start taking an antibiotic; the doctor has been given that gatekeeping role, and that is as it should be. Just because patients are involved doesn't mean doctors abdicate their responsibilities as well.
(Off-shore pharmacies add a whole new twist to this, and I'm not sure how you address that. I wonder, though, if antibiotic usage in industrial animal husbandry is not a bigger problem than somebody's hypochondriac relative.)
I completely agree with you. I'm pretty picky about what tests I'll take for exactly that reason: stress is dangerous to one's health and many tests have abysmal false-positive rates.
My hypothesis is that people, on balance, would be healthier if they took a more active role in their healthcare. I've seen it in a lot of people's lives, but there is a strong confirmation bias there. You don't see the people that tried and wound up worse off.
Fortunately, this is easy to study. We could find an answer to whether people are better off, and, more importantly, how to ensure they are better off.
> As people take control back...when they realize they have some control...they will become more healthy.
Your story is great, and a good example of the upside of patient control and involvement in care.
However, the downside also exists, and is very real. For some patients, having control over their care means demanding unnecessary tests and treatments, which leads to phenomenal increases in costs to the insurer and/or provider, as well as a reduction in compliance with medication and treatment regimens[0] - this has implications both for public health and the patient's own health. Or, worse, demanding medications that they think are helpful but are actually harmful (this happens all the time).
The problem is that control isn't very meaningful without an appropriate level of knowledge to supplement it, and even when the resources are available, very few patients are willing to take the time to educate themselves to the extent necessary to make informed decisions about their own care.
> Once patients become knowledgable, the doctor moves from a pillar of all knowledge to a (hopefully) trusted, knowledgable advisor. That change frightens many in the medical community[1], but it will yield better outcomes.
To be blunt, it's more likely that the doctor will move towards being the person who enacts the wishes of the insurer (or whichever entity is acting as the insurer). This isn't a particularly bold prediction - it's already happened, in that doctors are increasingly beholden to the pressures of insurers. Once you take into account the massive costs that arise from mismanagement of long-term conditions (whether from the patient or the doctor), it's not hard to understand why insurers are taking increasingly active roles in patient care.
[0] This isn't always bad, but think of diseases which require adherence to antibiotics (or, worse, diseases like HIV, which are chronic and for which compliance is a matter of public health) and you'll see why this can get problematic very quickly.