Dave Chase

First published on Forbes on 12/1/2012

Dave Chase, Forbes Contributor and CEO, Avado

Leonard Kish recently wrote about the role patient engagement will play in future reimbursement models in healthcare. In it, he outlined the expected pushback from healthcare providers when they are held accountable for their patient’s actions.

All this is so different for healthcare providers. It’s like a great restaurant learning that their new business is going to be – in addition to continuing to provide a great in-restaurant experience – teaching people how to cook at home. What? This isn’t what we do!  It’s impossible!

Given that physicians haven’t been accountable for their patients’ actions in the past, this is an understandable perspective for them to have — or, so they think. I believe clinicians underestimate their influence. They hold an esteemed place any other profession would kill for.  Consider that Gallup’s recent ranking of the most trusted professions are as follows:

  1. Nurses
  2. Pharmacists
  3. Doctors

Clinicians may not think in these terms, but consider some of the truly distasteful things clinicians regularly convince patients to endure. Whether it’s something that is life-threatening or not, doctors have proven to be persuasive. As I outlined in Doctors Success Hinges on Transactor to Teacher Transition, the root of the word doctor is teacher and it is through instruction of their patients that people are willing to deal with various disagreeable items such as the following:

  • Oncologists convince their patients to endure chemotherapy with its well-known side effects of going bald and extreme nausea.
  • Listen to just about any pharmaceutical advertisement to hear some nasty side effects — some are quite common.
  • Surgeons regularly convince obese patients to staple part of one’s stomach (bariatric surgery) where some studies have shown 1% of patients die (estimates vary pretty wildly) and 40% have complications.
  • When I worked in an Surgical department, the nurses sensitized me to the significant risks of anesthesia yet most don’t question their doctor if they are told they are going to be put under for a surgery.
  • Caesarean Sections: The rate has gone up more than 50% in the last 15 years for a whole host of reasons. Clearly doctors have influenced that whether it’s for outcomes or malpractice reasons. Women are well aware of a longer recovery time, scars and other side effects but trust their doctor’s judgment.
  • Preparing for a colonscopy is “interesting”. At least some people have a sense of humor about it such as this “domestic diva” describing a funny colonscopy story
  • A family member had his toes broken on purpose in order to repair some foot issues
  • Once upon a time, doctors did bloodletting. Hard to imagine but true.
  • There’s a wide array of medical procedures that involve stuffing tubes, fingers and devices into orifices not designed for that.
  • If we swallow the wrong thing, medical professionals tell us to induce vomiting.
  • Dentists and orthodontists rip out teeth, cause a bunch of bleeding, put funny things on our teeth. Most often, it’s done in the name of vanity.
  • I’m not aware of too many people willingly peeing into a tiny cup but we take that for granted when we visit a doctor.

Others in the health and wellness field (non-clinicians) are also able to convince us to suffer yanking hair out, tortuous workouts and more so it doesn’t require a clinical degree to get us to do something that isn’t pleasant in the name of health.

If I compare the items above to getting people to change diet, exercise and lifestyle items that can have at least as dramatic of impact on their health, it doesn’t seem so daunting. Yes, there are some significant habit changes I don’t want to discount, but most of them result in people starting to feel better before too long. Some even have the benefit of triggering endorphins and are reported to improve one’s amorous prowess. Compared to vomiting, defecating, bleeding and other unpleasant things, it doesn’t seem too bad.

The key reason doctors, nurses and pharmacists are able to persuade is their trust and credibility. Not only are clinicians trusted, most remember their classmates who went into medical careers as some of the smartest people they grew up with. Clinicians are some of the smartest, most trusted, authoritative people in any community. For clinicians, it’s clearly an adjustment to being rewarded based upon outcomes impacted by patients, but perhaps not as much as they think. There’s little doubt there’d be more deaths if patients didn’t heed the advice of trusted clinicians and do things such as chemotherapy. I think most people would readily choose making lifestyle changes over something like chemotherapy with the help of their clinical team.