Newtown, CT – January 20, 2017
Amid the general cacophony, some continue to be overwhelmed by the sound of silence – A few days ago our colleagues Chris Duke and Christine Stanik, in collaboration with Oliver Wyman and thanks to a grant from the Robert Wood Johnson Foundation, released an important report that summarizes what’s happening to the millions of Americans every day who, despite wanting and needing critical healthcare-related information, are met with resounding silence. There’s a ton in the Right Place Right Time report and the findings confirm what others, in different studies have also found. Last year, for example, the ABIM Foundation hosted a day-long colloquium that brought out vividly and poignantly the silence on the price of care and how it hurts the patient-provider relationship. Findings from RPRT show that many lower income Americans feel disrespected by health care professionals, which leads to lower adherence to medication and treatments. So when physicians say that they have non-compliant patients, perhaps those patients would be more compliant if they were treated with more respect. The recorded transcripts of patient-physician visits that many of us heard at the ABIM meeting clearly demonstrated a lack of complete empathy or ability to identify with the social and economic context of lower income patients. In a paper just published in Health Affairs, Dana Safran and colleagues show that financial and health outcomes between higher and lower income patients are staying stubbornly different. The RPRT report provides important insights about why those inequities persist. Patients want information and they don’t receive it. Or they receive it, but at the wrong time and place. The sound of silence they hear is deafening and few seem to care.
What this means to you – It’s not that tough folks. And as we’ve been advocating for several years with our colleagues from CPR, States have an essential role to play in providing information on cost and quality of care. Most, as readers of this missive know, fail miserably, and in doing so contribute to the sound of silence. And the irony is that while these same States are struggling with budget deficits and unsustainable rates of medical cost growth, they have scores of consumers that could help them control those costs if they simply got the information they want and need at the right time and the right place. All those consumer-patients have mobile devices, all can query user friendly websites, and yet there are none to query. And it’s not just States that can act on this. Employers have a role as well by getting their third party administrators to focus on the important lessons of the RPRT report and finally get useful information in the hands of those who will use it. There’s another important and sobering finding which has to do with caregivers, in particular those who care for disabled or very sick children. And this one struck home because every year I spend a week or so with some of those kids and their caregivers, and, so far, every one of them has expressed the same life experience, namely that they haven’t had a break since the day their child was born. Think about it. While these caregivers are avid users of health care information, they’re also exhausted because they never get a break. Many of them would relish the sound of silence. So amid the trumpets and fanfare of the Presidential Inauguration, amid the cacophony that will continue to envelop us, let’s pause and ponder about those who yearn for a sound of silence and those who have nothing but. Both deserve better. Both can and should be served better. Let’s try.