I had an exchange of
opinions (respectful, I think) on Twitter with a Georgia-based
consultant who says he has run many practices. He's very pro High Deductible Health Plans, and
talks about how patients only value what they pay for, along with advancing the old
"skin in the game" argument.
It
then struck me -- so many of my patients were Medicaid and didn't have
"skin in the game." Yet I think we had an excellent relationship and I
have no doubt about their appreciation.
It
seems to me that it's the relationship, and the patient's understanding
that you care, and that you are trying, and that you have respect for
them, that is the crucial element. The patient's paying is like another
way of attacking it, that substitutes for that relationship. Because
if you pay for it, there's a cognitive incentive for you to value
something, because you figure if I paid for it I had better value it or
it's wasted money.
So
looked at that way, the skin in the game argument is taking advantage
of the cognitive error of sunk costs (I think that's what it's called) in lieu of establishing a caring relationship.
Budd Shenkin
It seems to me that it's the relationship, and the patient's understanding that you care, and that you are trying, and that you have respect for them, that is the crucial element.
ReplyDeleteI couldn't agree more, Budd. It is so lacking here (as we discussed).
I have a number of health issues. Of the numerous doctors I either see on an ongoing basis or have seen for alternate opinions, there are only three who I believe genuinely care about me.
Example: I'm having a lot of trouble with my eyes. I've seen a *whole bunch* of ophthalmologists. The only eye doctor I really trust is my optometrist at Mass Eye & Ear, because he's the only one who takes his time with me and seems to be invested in my care. He's spent the past two and a half years explaining things to me the other doctors should have been.
Jeff: Shows among other things why choice is necessary; "doctor" is not a commodity, even though that's the way the inscos treat us. Amazing how poor many docs are at explaining, showing care.
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