Patients or Health Care Decision Makers?

The first time I refused to go along with a physician’s directive, I was 8 months’ pregnant with my first child. My doctor wanted to order a glucose tolerance test to screen for gestational diabetes. I needed to drink a sugary cocktail and then be tested as my blood glucose levels first rose and then fell. Why? I asked. Wouldn’t this put undue stress on the baby? It didn’t make sense to me. I was not overweight and had no personal or family history or other risk factors that I could tell.

Rather than answer my questions directly, my doctor explained that all of his pregnant patients take this test. What’s more, gestational diabetes is a serious condition, he said, sounding somewhat annoyed. I tried another approach. What would happen if I was found to have gestational diabetes? The doctor replied that I would have to watch my diet. Okay then, I answered. How about if I agree to watch my diet but skip the test? He reluctantly said okay.

Several years later, I was back in this same doctor’s office, pregnant with my second child. Again I was asked to take the glucose tolerance test. Again I explained that it didn’t make sense to me to put the baby under such stress. The doctor told me that no patient of his had ever refused the test. I knew that wasn’t true and told him how I had previously refused the test. This time I had to sign a paper saying that I was going against his orders.

Today in health care, more Americans are eschewing the role of compliant patient in favor of a more independent-minded and take-charge approach, according to findings of the 2008 Survey of Health Care Consumers produced by the Deloitte Center for Health Solutions and highlighted in the Trend of the Month. No longer content to meekly follow doctors’ orders, health care consumers are assuming a much more questioning and demanding role. Physicians are viewed as coaches, with consumers making their own health care decisions as they increasingly consider a range of alternative therapies and practitioners as well as mainstream approaches.

Consumers are not only taking on greater responsibility for decisions affecting their own health care, they also indicate an even greater willingness to do so in the future. While 14% have delayed a course of treatment recommended by a physician, 33% said they might do so in the future. Similarly, 13% have decided not to follow a course of treatment recommended by a physician, and 32% might do so in the future.

While one-fifth of consumers strongly prefer to have their physician make treatment decisions for them, nearly as many (17%) strongly prefer to make treatment decisions themselves. Thirty percent have questioned their physician about a recommended course of treatment, with 45% likely to do so in the future. While fewer than 20% of consumers have sought a second opinion, 52% say they might do so in the future.

Who are these independent-minded health care consumers and how should physicians and health plans respond to them? The Deloitte survey divides health care consumers into 6 segments according to attitudes and behaviors (page 88). Only about 30% of health care consumers accept what the doctor recommends without question. The other 70% also rely on their own judgments to a greater or lesser degree.

Physicians and health plans need to reach out in new and more meaningful ways to engage health care consumers and support them in their role as health care decision makers for themselves and their families. The Deloitte survey report offers some valuable insights on how to do so.