Wednesday, April 29, 2009

Changing Health Care Means Changing our Culture

Improving the quality of care and lowering costs will involve more than just an electronic medical record and improved data. It is people who go to doctors and hospitals and people's beliefs, expectations, and emotions drive the reasons more than facts and data. A study that looked at reasons parents took children to Pediatric Emergency Departments instead of a primary care physician for non-urgent conditions during daytime hours found that the parents believed that they would face long appointment waits in the physician office, that the staff in the ER would be more expert and more helpful and that the evaluation in the ER would be more complete and more expert. In other words they believed that more is better and that the knowledge that their regular physician had about their child was not as important as all the tests and resources available at the pediatric ER. This is a cultural issue and must be addressed as such. Until we find ways to educate people on the advantage of having a health professional who knows the patient over time and who can use their expertise and judgement to choose the right tests and treatments, the bias to "do something" will overwhelm other efforts to control costs and improve quality.