Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

To fix health care, ask patients to change their understanding of how a health care system should work

Richard Young, MD
Policy
May 29, 2018
Share
Tweet
Share

On a recent flight, I sat next to a woman of about 30 who was originally from France but has lived in London for a number of years for work. After exchanging the usual pleasantries, she found out I am a family physician and it became clear she wanted to give me her opinion of the British health care system. I didn’t dissuade her.

For a little background, both the U.K. and French health care systems consistently rank as some of the best in the world. The U.K. commonly is ranked at or near the top as the system that delivers the best care at the lowest cost. The French system costs a little more, but it tends to be ranked at or near the top for scores of overall effectiveness of the system. Apparently, this woman was not aware of the rankings.

She found the U.K. system to be almost primitive. By inference, she was a healthy young woman who accessed the health care system mostly for contraception and cervical cancer screening (Pap smears). Her experience in London was that she was told to lie back on a regular exam table, put her feet by her bottom and lift her pelvis up enough to make room for a speculum. After the sampling was finished, that was it. The doctor or nurse (I’m not sure which) told her the exam was over and the visit was over.

She was mortified about two things. First, the fact she was made to do some minor gymnastics on a plain exam table. The surgery did not have a table with stirrups like she was used to in France. Second, her gynecologist in France always checked her labs each year “to be sure I’m well.” This did not happen in London.

I could tell from the righteous indignity in her voice that it would have been pointless for me to explain the wasteful practice of the French gynecologists that I just learned about and that the British had it right.

I think the take-home message of this story is that even in 2 very high-functioning health care systems, common problems are managed differently. Each country has its own quirks of what it prioritizes. The British planners in effect decided that their resources should be used for purposes other than exam tables with stirrups. The second message is that it is extremely hard to change health care systems because the most numerous units in the system (“agents” in complexity theory) are the patients. If they have fixed beliefs about what a proper health care delivery system should look like that does not match what the system people think, change ain’t going to happen. At least, it will be extremely hard to move the system needle, and even if it moves a little, it will likely snap back to its original state when the external pressure is removed.

This phenomenon is one of the fundamental reasons health care reform in the U.S. has been so ineffective. This is why programs like accountable care organizations, shared savings programs, primary care payment reform programs, patient-centered medical homes, and so on couldn’t show much for their efforts. They never asked the patients to change their understanding of how a health care system should work in the first place. On the national stage, the politicians and system people never ask U.S. patients to change their habits.

And because of this, we remain stuck with the same inefficient exorbitantly expensive health care system that now consumes 18 percent of our economy and will only get worse.

Richard Young is a family physician who blogs at American Health Scare.

Image credit: Shutterstock.com

Prev

The small steps to ensure everyone experiences dignity

May 29, 2018 Kevin 1
…
Next

Clear your mind from all the distracting requirements clinicians face

May 29, 2018 Kevin 0
…

Tagged as: Public Health & Policy, Washington Watch

Post navigation

< Previous Post
The small steps to ensure everyone experiences dignity
Next Post >
Clear your mind from all the distracting requirements clinicians face

ADVERTISEMENT

More by Richard Young, MD

  • When medical protocol meets family concerns

    Richard Young, MD
  • Patients in Sweden received fewer post-op opioids. Why is that?

    Richard Young, MD
  • Medicine is too complex for computers to keep up with or understand

    Richard Young, MD

Related Posts

  • How social media can help or hurt your health care career

    Health eCareers
  • How our health care system traumatizes patients

    Linda Girgis, MD
  • Patients alone cannot combat high health care prices

    Peter Ubel, MD
  • Why health care replaced physician care

    Michael Weiss, MD
  • Turn physicians into powerful health care influencers

    Kevin Pho, MD
  • Health care from the trenches: Change must come from us

    Alejandro Badia, MD

More in Policy

  • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

    AMA Committee on Economics and Quality in Medicine, Medical Student Section
  • Who gets to be well in America: Immigrant health is on the line

    Joshua Vasquez, MD
  • Online eye exams spark legal battle over health care access

    Joshua Windham, JD and Daryl James
  • The One Big Beautiful Bill and the fragile heart of rural health care

    Holland Haynie, MD
  • Why health care leaders fail at execution—and how to fix it

    Dave Cummings, RN
  • Healing the doctor-patient relationship by attacking administrative inefficiencies

    Allen Fredrickson
  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
  • Recent Posts

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Clinical ghosts and why they haunt our exam rooms

      Kara Wada, MD | Conditions
    • High blood pressure’s hidden impact on kidney health in older adults

      Edmond Kubi Appiah, MPH | Conditions
    • Deep transcranial magnetic stimulation for depression [PODCAST]

      The Podcast by KevinMD | Podcast
    • How declining MMR vaccination rates put future generations at risk

      Ambika Sharma, Onyi Oligbo, and Katrina Green, MD | Conditions
    • The physician who turned burnout into a mission for change

      Jessie Mahoney, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 11 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
  • Recent Posts

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Clinical ghosts and why they haunt our exam rooms

      Kara Wada, MD | Conditions
    • High blood pressure’s hidden impact on kidney health in older adults

      Edmond Kubi Appiah, MPH | Conditions
    • Deep transcranial magnetic stimulation for depression [PODCAST]

      The Podcast by KevinMD | Podcast
    • How declining MMR vaccination rates put future generations at risk

      Ambika Sharma, Onyi Oligbo, and Katrina Green, MD | Conditions
    • The physician who turned burnout into a mission for change

      Jessie Mahoney, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

To fix health care, ask patients to change their understanding of how a health care system should work
11 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...