Right around the same time the Affordable Care Act was being debated, there was a move in Washington to force the U.S. healthcare sector to switch from a fee-for-service model to an outcome-based model. The goal was to give patients a greater role in determining therapies and treatments in hopes of improving outcomes.
More than 10 years later, how are we doing? What is the patient’s real role in determining medical therapies and treatments? My own experience tells me that things have improved somewhat, but we are still far from the outcome-based model envisioned more than a decade ago.
A patient’s role in determining what therapies and treatments he will accept is by no means minor. First and foremost, patients know themselves best. They know how they feel. They innately know when something is wrong. And more than anyone else, they know how a particular treatment or therapy affects them.
Treating chronic pain with medical cannabis illustrates the point simply enough. Doctors practicing in states with legal medical cannabis do not actually write prescriptions. They make recommendations based on their knowledge of THC as a pain reliever. Ultimately though, patients determine which products they will use, how often they will use them, and delivery method and dosage.
Medical cannabis states like Utah only require that patients have valid medical cannabis cards to purchase cannabis products. A patient visiting Utah medical marijuana dispensary Beehive Farmacy will present his card, talk to the on-site pharmacist, and then make a purchase. But he alone decides how to use the medicines he takes home.
The patient knows whether marijuana helps relieve his pain. If he decides it does, he keeps buying and consuming. If not, he moves on to something else. One way or the other, no doctor or pharmacist can truly understand his pain experience like he does.
Politics and ethics aside, the one thing the medical marijuana debate teaches us is that patients should be active participants in their own healthcare. Traditionally, that is not how things have been. Yesterday’s doctors made all the decisions while patients dutifully listened and complied. Today’s doctors are being forced by reality to change the way they work.
So much of what we call medicine is little more than relieving symptoms. As far as cures go, there is not much in modern medicine that is curative at all. This matters to the question of efficacy. Are narcotics more efficacious for pain relief than medical marijuana? Perhaps. But if a patient achieves the desired level of relief with marijuana and would rather use it, shouldn’t she have that choice?
There is also the question of invasiveness. Western medicine is rooted in pharmacology. But there are certain times when treatments go beyond drugs to include invasive procedures. Take the example of joint replacement surgery.
Joint replacement surgery is often recommended for people who cannot find adequate relief for arthritic pain in the knees or hips. The surgery is incredibly invasive, and there are no guarantees that patients will actually feel better when all is said and done. Yet there are alternative options including prolotherapy, PRP injections, and stem cell therapy. Should patients not have a choice?
A patient’s role in determining medical therapies and treatments is clear enough. At issue is whether the medical community accepts that role. Acceptance has not traditionally been the case. The good news is that things are changing. More and more, patients are becoming active participants rather than mere listeners.