What Do Patients Really Want?

As someone working in a public health care system, I am particularly interested in what exactly patients ‘value’ in health care.

In other words, what is it that patients really want from health care?

This, is the topic of a commentary by Allan Detsky from the University of Toronto, published in a recent issue of JAMA.

According to his analysis (and experience), here are some of the things that patients value and want most:

• Most patients want a health care system that responds (quickly) when care is needed. Although patients generally understand the concept of preventive medicine, they are really far more interested in quickly receiving help that relieves illness and symptoms when they have the problem (or in other words, “while prevention is nice – what I really want is quick help when I am sick!”)

• Patients want hope and certainty (even if there is no hope and things are uncertain). They also prefer doing ‘something’ to doing nothing. When in doubt, many would prefer the extra test or two even if it is unlikely that the test will be useful – ‘just to be sure’. Many are also open to ‘trying’ something, even if the likelihood that the treatment will actually work is small.

• Patients want continuity, build relationships with their providers, and want their providers to communicate effectively with each other.

• Patients prefer treatments that require little effort (medications, surgery) to treatments that require a lot of effort (behavioural change).

Not quite as high on the priority list are:

• Efficiency, whereby, patients define efficiency in terms of ‘their own time not being wasted’. This is different from how decision makers define efficiency, namely delivering the best value with the least resources. The latter is something patients don’t really worry about too much.

• Statistics, whereby, most patients don’t really care about the ‘average’ patient. Most care mainly about themselves. They are also not impressed by ‘statistical’ findings of what works and what doesn’t – “so what if the treatment doesn’t work for most people, as long as it works for me”. (also, I would add, “if it works for me, it should be covered!”).

• Conflicts of interest, whereby, most patients are less concerned about whether or not their doctors are making extra money, as long as the service they receive makes them feel better.

Interestingly enough, according to Detsky, things that have the lowest priority for patients are

• The real cost of the care they receive (as long as they are not paying directly ‘out of pocket’)

• How much of the total GNP the government spends on health or how their health care compares to other provinces or countries.

As Detsky states:

“Preferences for immediate care and elimination of uncertainty make excess capacity and waste tolerable to the public. It may be more rational to spend resources on interventions that are of more value, like efforts to combat obesity, but most of the public cares more about treating illness”.

He also points out, that although these consumer preferences may appear irrational or unrealistic,

“What people want when they are healthy may be different from what they want when they are sick”.

Perhaps politicians and decision makers are indeed smarter than we think, when it comes to knowing what people really want, namely much talk about prevention for those who are healthy but real action and quick help (with all diagnostic and treatment options – whether necessary or not) for those who are sick.

AMS
Edmonton, Alberta

Detsky AS (2011). What patients really want from health care. JAMA : the journal of the American Medical Association, 306 (22), 2500-1 PMID: 22166610

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