HealthPoints

Conspicuous Caring

In an interesting article on Medscape.com, “Have We Missed the Hidden Cause of Medical Overuse,” the author raises a provocative issue about medical overuse. He cites the story of when a mother kisses the scrape of a toddler, "No healing takes place, yet both parties appreciate the ritual." Continuing, he states, "The ritual shows how we might be programmed to both seek and offer healthcare even when it isn't medically useful.” He believes this is "Conspicuous Caring".

 

The provocative conclusion is that healthcare isn't just about health; it's also a grand signaling exercise called conspicuous caring. If healthcare was only a transaction about getting well, you would expect patients to pay for (and doctors to prescribe) only treatments in which benefits exceed costs. Conspicuous caring provides an alternative explanation for demand that leads to consumption that exceeds the point of value. And in modern medicine, demand resulting from conspicuous caring can be masked by the real healing that often occurs.

 - John Mandrola M.D.

 

The thesis of the article is when providers appeared to be doing something that will be perceived as helping the patient, this conspicuous caring provides the public with a tangible signal of medical quality. The article’s primary focus is the evaluation of a book The Elephant in the Brain: Hidden Motives in Everyday Life by Kevin Simler and Robin Hanson and how our thought processes impact on healthcare delivery.

 

The question that arises from this discussion of Conspicuous Caring is - If this is written into our DNA, how do we make it a constructive force in healthcare delivery? When doctors prescribe tests, procedures and prescriptions to simply satisfy our need to perceive them as caring, the articles author argues this is what leads to medical overuse and the high cost of care in the United States. On the other hand, it may well indicate that our providers are losing the ability to communicate with us in a meaningful way that expresses a caring professional.

 

I spoke to a retired healthcare professional recently who indicated he had seen his cardiologist and he felt the doctor had focused totally on the data available on his computer and never had an empathetic interaction with him as a patient. This lack of conspicuous caring motivated this knowledgeable retired healthcare professional in his 80s to seek out a second opinion. What this real life interaction teaches us is there is much more to the healing process then the technology driven data points that are available to professionals.

Doctor working with a tablet computer in his office

 

Today, the need to exhibit empathy, concern and understanding is very important to the recipient of care.  

 

In another instance I watched the interaction between a hospitalist and patient. The hospitalist never took his eyes off of the computer as if it were the one requiring treatment. If we define Conspicuous Caring as our professionals providing empathy, compassion, and concern, we might achieve the ultimate by reducing the cost of healthcare and creating real patient satisfaction.

 

The patients in our healthcare system are beginning to feel like a commodity in a highly mechanized, technology driven system. Their primary care physician no longer makes rounds at the hospital to check on their progress; the patients are visited by the hospitalist who is employed to accelerate the patients’ discharges from the facility and are strangers to the patients. It is no wonder, in this process, why people seeking out healthcare feel estranged.

 

New call-to-actionThe physicians, in their defense, are under increasing pressure to see more patients and have reduced amounts of time to really engage in the process of caring. As a result, they turn to Conspicuous Caring through the writing of prescriptions for lab tests and diagnostic tests to give their patients the appearance of being engaged in their care. There have been studies made that indicate as physician’s face increasingly fatigues as the day goes on, the physician is more inclined to order additional diagnostics because the coping and decision-making processes for them have broken down.

 

 

The driving force for the creation of Curus was an increased understanding that the discerning healthcare consumer needs the expertise, sensitivity and a caring voice to help navigate through the healthcare process. The idea that we receive more attention and empathy from our wealth managers than from our healthcare providers became a compelling reason to create Curus to be that advisor, and empathetic voice -  providing both direction and comfort for our members. Our tagline, "Because health is the greatest wealth there is," reflects our commitment to protect your most invaluable asset, your well-being. 

 

Click Here to schedule time to talk with someone from Curus We need to place caring as one of the highest priorities in the delivery of healthcare. If we achieve this we will substantially reduce Conspicuous Caring.

 

Filed Under: Insider, Health Management, healthcare quality, patient satisfaction, changes in healthcare, mental status affects health, unnecessary testing

Caught in "too big to care"?

 There have been two compelling articles in the “New York Times” over the past few weeks focused on healthcare. The first article dated Tuesday, October 30, 2018, is entitled “A Sense of Alarm as Rural Hospitals Keep Closing1 and the second article dated November 14, 2018, entitled “When Hospitals Merge to Save Money, Patients Often Pay More2. These two articles are really bookends of the same set of issues emerging in our healthcare delivery system.

 

"Since 2010, nearly 90 rural hospitals have shut their doors. By one estimate, hundreds of other rural hospitals are at risk of doing so." 1 In many communities these hospitals are amongst the largest employers in the area. Because of the availability of medical care, communities establish a sense of stability that sustains existing businesses and presents opportunities for new commercial enterprises. The reality is that the cost of delivery of healthcare, which continues to accelerate, makes these rural institutions less capable of sustaining the level of quality of care emerging in this era of rapidly expanding technologies.

 

Do you stay or go?

 

These rural community hospitals are relegated to providing primary care services and very few of the specialty services that are available in centers of medical excellence in metropolitan cities. This situation continues to increase the need for patients to migrate to larger communities in order to obtain the specialized services their healthcare will require. This raises an interesting paradox addressed in the second article focuses on increased consolidation of healthcare services in huge healthcare systems with almost monopolistic power in key healthcare markets. "The latest giant hospital consolidations continue to stir concerns. Dignity Health and Catholic Health Initiatives, two large chains are expected to become one of the nation’s largest groups ---- with 139 hospitals in 28 states--- by the end of the year. And two of Texas’ biggest systems, Baylor Scott & White Health and Memorial Herman Health System, recently announced plans to combine.” 2

Piggy bank and stethoscope resting on pile of dollars on white background

 

"In the national analysis, a third of the metropolitan areas experienced increases in the cost of hospital stays of at least 25% from 2012 to 2014, from roughly $12,000 to at least $15,000.”2 Thus, these hospital system consolidations are doing exactly the reverse of what was anticipated as they are continuing to accelerate the cost curve rather than bend the curve with additional savings.

 

 

When you look at this emerging picture of healthcare from the perspective of the individual from a rural community who needs specialized care, the system is fraught with confusion, anonymity and increasing costs. We at Curus referred to this as the "What do I do now? syndrome". In order to seek out the highest quality of care, patients are left to their own ingenuity to figure out what are the best options that are most cost-effective and are in network? This is where the doctor-patient relationship is devolving into an impersonal process where the patient is on the conveyor belt of healthcare delivery. Further complicating the decision-making in this scenario is the fact that physicians are becoming part of the "corporate practice of medicine". While legally that phrase has certain implications in the real world, it represents the fact that physician affiliations to these monolith healthcare systems or to huge practice groups dictate much of the decision-making with regard to the referral patterns to specialists. 

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A patient coming from a rural hospital is at the mercy of the system in which he/she seeks specialty care. They no longer have the familial relationship with the provider that is the historic bedrock of care in rural communities. When we started Curus, we were often confronted with the question of, “What do I need a healthcare manager for?” As we see the continuing consolidation of the healthcare delivery system where the patient has ceased to be the focal point of the care delivery process, the question has begun to answer itself. Without a dedicated team of skilled healthcare professionals who understand the nuances of the healthcare process, patients are directed rather than engaged by the healthcare professionals. They are part of the system, a process.  As one physician told me recently - when the healthcare systems are run by “bean counters”; the role of both the patient and the doctor suffer.    

 

In 2007 and 2008, the nation talked a great deal concerning the financial industry about the problem of "Too Big to Fail". Well, surprise! That is exactly what's happening in healthcare today. Systems of tremendous power are centralizing the delivery process and the patient has become a commodity in the system. In our Curus model the patient is the center of the universe. That's what being patient-centric means. Our role is to ensure the best possible choices so that our members can make value judgments that we can assist them in implementing. Our fundamental goal is to return control of the health care process to the recipient of that care. The reason one needs Curus to coordinate, navigate and evaluate all aspects of the continuum of care is to ensure that the human side of the healthcare experience is one of top quality care, compassion and concern.  

 

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Filed Under: Insider, Traveling, Health Management, doctor shortages, healthcare quality, changes in healthcare, pros and cons of concierge medicine, medical access