On Friday, Bill Gates had an op-ed piece in WSJ. He correctly points out delivery of health care is in a crises (the system itself is the 5th leading cause of death in US). Despite the volumes of money spent in the system, it is fragmented greatly with respect to collection of information, redundancy in tests, and the ability to aggregate information from disparate sources. Bill even correctly refers to the 2001 Institute of Medicine report adopting information technology and use of EBP in his position that part of the answer is an internet-based health care network.
The health care industry can only benefit when brilliant thinkers like Bill Gates make it a mission to intervene. I am quite sure these efforts will result in some needed improvement.
My criticism is in the assumptions that many make when it comes to consumer information and that somehow more information and options leads to better decisions. There is no question that when a physician is able to access a myriad of test results coming from different sources that somehow make it way to one patient health record that this can only lead to better diagnostic decision making. But the consumer?
One need to only look at the options that a consumer has for LBP. Information and treatment options are rampant in every community and a simple search on the internet will lead to over 23 Million links, images, and options. Has this much information lead to better treatment? Data would clearly indicate otherwise.
The fact of the matter is that patients trust their medical providers to give them the best options. The best options seem to be the one’s without too much choice or options. In fact, according to social scientist Barry Schwartz and his book the Paradox of Choice:Why More is Less, too much choice can cause “genuine suffering”. Perhaps the ridiculous number of options in the treatment of LBP in fact contributes to more of the problem!
There have been a plethora of research studies (with a lot of replication) that show for example shoppers that were offered free samples of 6 different types of jams were more likely to buy than shoppers who were offered 24 different types. Students offered extra credit for writing a paper with 6 different options were more likely to do it versus students who were offered 30 different options. Different contexts of these studies have always produced the same results.
One of the advantages of using clinical prediction rules and categorization in general for many different treatment diagnoses is the fact that it produces a limited number of options which results in better care and better satisfaction than the unlimited variation and randomness that occurs throughout consumer choices for care of a multitude of problems.
Integrating “limited options” in your clinical care utilizing EBP and a digital internet health care revolution may just be Bill’s secret sauce for making an impact in the industry.
Thoughts?
