One of my responsibilities in my current and past positions is the coaching of nurses to help them better improve the health of the health plan members with whom they speak.  Consequently I have listened to a lot of conversations between them and the members.  (Yes, this is a case of the phrase we’ve all heard hundreds of times, “this conversation may be monitored and recorded for quality purposes” being true.)  I often hear members at a decision point in their lives, a point when they are trying to decide what to do about some new or worsening symptom they are having.  Often they have made a decision, and it is just fate that our nurse is speaking with them.  Very often, their decision is not the best one from a health perspective.  When that happens our nurse can usually guide them in making a better decision. 

Unfortunately, it is only a coincidence that that conversation took place.  There are countless times that a person is making the wrong health care choice because they don’t know how to make a better one.  Many times it’s because they don’t understand all the relevant issues surrounding illnesses or using the health care system.

Let me give you an example of the kind of poor decisions I mean.  This example is a composite from many conversations I’ve either heard personally or heard about over the years.  In this example, a patient was just discharged from the hospital on an antibiotic after being treated for his emphysema complicated by acute bronchitis.  Instead of getting a little better each day, this patient actually was feeling worse wih increasing difficulty breathing.  When the nurse suggested he should call his doctor right away to have his worsening symptoms evaluated, he said he’d just wait until his scheduled appointment with his doctor in 2 weeks.  Fortunately the nurse was able to convince him to see his physician that same day.  The doctor switched his antibiotic, and he started improving after the third dose of the new medication.  The nurse knew that without prompt evaluation and alteration of therapy, he could deteriorate very rapidly with the only recourse being a trip to the emergency room and rehospitalization.

Why did he plan on waiting?  Several thoughts come to mind.  He might have been in a state of denial regarding how serious his symptoms were and how quickly they could deteriorate.  Or perhaps he didn’t know their significance at all.  I find that hard to believe since people with emphysema typically have frequent attacks that start quickly.  Maybe he wanted to avoid going to the doctor since he thought he might be put back into the hospital.  Of course, avoiding the physician while his symptoms grow worse will not prevent hospitalization, if anything, the delay can make it more likely. 

Another rationale I’ve heard is that the patient wants to avoid the copay for the doctor’s visit.  The only problem with that logic is that the copay for the emergency room is usually a lot more than that for the doctor’s office visit. 

Finally, some patients don’t want to bother the doctor for something that they think will go away on its own. The trouble is that patients don’t always know their bodies the way they think they do, and instead of going away, things often worsen.  An important part of a physician’s responsibility is responding to their patients’ needs after office hours.  Most doctors make arrangements with other physicians to provide this service when they are unavailable so that their patients can get help whenever they need it, so it really is no bother.

From my experience, these are some of the most common explanations for why people make these poor health care decisions.  Next time, I’ll discuss some things to consider when you are faced with this kind of decision.

For Your Health – Dr. Bob