Editorial: Bottom-Up Medicine; A Push for Self-Managed Care

It was a little daunting to learn last week that some health care experts believe that a key to controlling costs and improving outcomes lies in having patients take ownership of their own care.

Frankly, we have little to no confidence in our ability to do that — which, as Valley News staff writer Chris Fleisher reported Tuesday, is a common problem some practitioners and researchers are setting out to address.

One of them, John Wasson, professor of community and family medicine at Dartmouth’s Geisel School of Medicine, advocates a bottom-up approach to health care, in which patients use various forms of new technology to inform themselves, to consult with each other and to arrive at solutions to their medical problems that seem to fit them best. Having confidence in their ability to manage their own care is vital, Wasson says, because much of the decision-making will occur outside the normal ambit of the doctor’s office. Thus are a number of health-care practices engaging their patients in confidence-building measures, ranging from visual aids that remind patients of questions they should be considering to a website that collects patients’ answers to a series of questions about their health and provides information they can use on their own.

“If you start looking at it from the bottom up, and you start looking at crowd-sourcing and new technologies, what works for you may not work for me,” Wasson told Fleisher. “And so the goal of health confidence as a population strategy and using Internet and other technologies is to enable you to look for people like you who have solved problems like yours in a way that suits your needs.”

Taken to its logical extreme, this amounts to a revolution in health care — “patient heal thyself,” if you will. But short of that, there is undoubtedly merit in the notion of developing in patients the ability to gather and assess medical information as a way to inform their decisions on when they need to seek care and what kind of care they want to receive.

Of course, there are red flags associated with this approach as well. There is as much misinformation as reliable information available on the Internet, and it’s not always easy to assess how even the reliable variety applies to you. And consulting with others about health issues via social media technologies implies ceding a certain amount of privacy in one of the most sensitive areas of personal life.

And then there’s the fact that in one other major area of American life the shifting of institutional responsibility to the individual has proven to be a rolling disaster. When corporations largely abdicated their role as providers of traditional defined-benefit pensions and shifted to new defined-contribution retirement plans like 401(k)s, tens of thousands of employees found themselves ill-equipped to manage the investments, insufficiently disciplined to save enough or so strapped for cash that saving proved impossible. Certainly there is no shortage of information out there on how to successfully accrue sufficient resources to comfortably retire, but there is every evidence that it is not happening.

Finally, there’s a question in our mind whether there is adequate mental space in busy American lives to actively manage our own health care on a continuing basis while juggling all the other responsibilities that once were the province of the experts and now have devolved upon the individual. If you are a retirement planner, it is only natural to think that people ought to be always on top of their savings and investments, and we suppose that to a medical provider, it’s a mystery why anyone would not invest the effort necessary to successfully manage their health portfolio. The simple answer is there’s only so much time in the day.


Letter: Taking Personal Responsibility

Monday, August 5, 2013

To the Editor: I want to thank you for your Aug. 4 editorial, “Bottom-Up Medicine; A Push For Self-Managed Care.” It is a very important topic, and, while I don’t agree with all that was said, I certainly agree with the concept. I have participated in the health care industry for the past 50 years as a nurse. I have …

Letter: The Health-Income Connection

Monday, August 5, 2013

To the Editor: Let’s continue the comparison between medical care and financial planning made in your Aug. 4 editorial, “Bottom-Up Medicine.” Self-management of retirement funds is problematic when people do not have the skills or support to manage their savings — or if they have no money to save. Comparing savings to health is brilliant; in both finances and medicine, …

Letter: Ending the ‘Monopoly of Physicians’

Tuesday, August 6, 2013

To the Editor: Your Aug. 4 editorial, “Bottom-Up Medicine,” criticizing Professor John Wasson’s advocacy of patients getting involved in their own treatment goes entirely in the wrong direction for individuals and collectively for the nation. Overdependence on the medical establishment for health care was recognized over 40 years ago by Ivan Illich in his prescient book Medical Nemesis: The Expropriation …