Uh, I guess it’s too late to find a family doctor?

Meet the Reaper.Amid all the talk about improving the quality of health care through medical homes, pay for performance, electronic health records, Medicare “never events”, and the like, Drew Weilage at Our Own System reminds us about another potentially weak link in the health care quality chain: the patient.

The problem is one of culture. Long a nation of personal responsibility (“pull yourself up by the bootstraps”), we’ve (the U.S. of A) recently (it’s probably been a long trend downward) entered an era of diffusing responsibility that is having an extraordinary impact on our health. Whether or not you are a proponent/evangelist of the consumerist movement in the health care industry, agreement must be reached on this point: personal responsibility in daily decisions of health must improve (greatly!). It is becoming clear that increasing the financial burden on patients to incent more healthful decision making isn’t creating the dramatic improvements necessary.

We’re obese (and getting larger). We don’t do well with preventative physician visits. Our eating habits are atrocious. We exercise dramatically less than we watch television. We’re becoming more dependent on drugs to correct the problem. It’s getting really, really bad. Modern medicine has been the saving grace of many, many patients.

Many of the quality issues that plague health care stem from the fact that quite a large number of patient encounters consist of the patient telling the physician things like  he ran out of his antihypertensive medicine (“I can’t remember the name of it, Doc.  It should be in your records.”) six months ago.  In the nation’s emergency departments, physicians and other health care personnel often find themselves working furiously to snatch a patient from the jaws of death as a direct result of the patient neglecting and/or actively abusing his own health.

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