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Managing Expectations

AS I was reading a recent article about health care reform, and the obstacles we physicians face—delivering high-quality care while also controlling its spiraling costs—I was taken in by the author’s call for us, as a society, to manage the expectations of those seeking care.

We all know the U.S. has the best technology in the world to treat many complicated conditions and diseases. We also spend double the amount per capita of any other Western nation on health care, and in spite of the huge financial outlay, our outcomes are among the worst. This varies across all segments of the population, at all age and socioeconomic levels, and is even true for those with health insurance and higher education. So, why do we have such disappointing outcomes?

The author got me thinking we need to look at the concept of expectations.

The reality is that the journey of life ends in death. We cannot prevent this, and so should strive to achieve the highest quality of life for the longest time possible. How many times have we had patients tell us they want to know what is causing their symptoms, with the expectation that if we run the right tests, they will get an answer?

But we physicians know this isn’t always the case. And this is where I think we need a better approach—working to educate society and our patients that we don’t have all the answers. In truth, even if we did have more answers, we would not always be able to prevent disease progression, pain, suffering and eventual death.

Yet if we are going to be evaluated and “graded” on patient satisfaction, what will motivate us to spend the (uncompensated) time addressing our patients’ expectations, rather than just ordering whatever tests patients want or feel they need? The aging baby boomers expect to have active lifestyles in their retirement, and are less accepting of the realities of aging on body functions. However, the sense of personal responsibility and accountability for lifestyle choices seems non-existent. An estimated 70% of our health care costs are related to modifiable lifestyle choices, such as smoking, obesity, alcohol and substance abuse.

The article also brought to mind the effect of expectations on physicians and organized medicine. After meeting with legislators in Washington, DC, last February, I came away realizing how much doctors have to compete with insurers, government, consumer groups, and other special interests. I became increasingly aware that the health care system we physicians may want can be in direct competition with what these other groups are seeking.

Organized medicine at every level is committed to improving the health and well-being of physicians and patients. And part of our job is managing the expectations of our colleagues in organized medicine, and especially of those physicians who do not actively participate in strengthening our voice through membership in our medical societies. We must show how the benefits we provide to the profession and the patients we serve require commitment, dedication and participation. Understanding we won’t be victorious on every legislative item is key to this effort. But with patience and perseverance, and the participation of many physicians who are not currently advocating for our profession, we have a greater chance of shaping the health care delivery system of tomorrow. Please urge your colleagues to join the Chicago Medical Society, and support us as we convey our message to patients and legislators. In this way, we can come closer to achieving our expectations and improving the health of our nation.

Howard Axe, MD
President, Chicago Medical Society

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