Enabling Healthy Decisions

Sun Tzu wrote The Art of War in the 6th Century BC.  Using a few quotes from Wikiquote, I think there is applicability here in thinking about how to be a better patient. In this case, I would view the health care system as the enemy although in some cases it may be the condition or disease itself.

• It is said that if you know your enemies and know yourself, you will not be imperiled in a hundred battles; if you do not know your enemies but do know yourself, you will win one and lose one; if you do not know your enemies nor yourself, you will be imperiled in every single battle.
  
  • It is critical to understand the system and your benefits to take advantage of the opportunities and avoid the loopholes. It is also critical to know your condition and what you are willing to do. Take advantage of the Internet and other information sources (e.g., ePatients) to learn and be prepared to ask the right questions and act to improve your health.
    
• The best victory is when the opponent surrenders of its own accord before there are any actual hostilities… It is best to win without fighting.
  
  • The last thing you want to do as a patient is go to “battle” with the system. It can be overwhelming. You want to provide a solution (e.g., drug coverage) in a framework that they understand. Document your process. Use tools that are available on some of the Health2.0 sites to track things like your pain or how your body is reacting to different medicines.
    
• The more you read and learn, the less your adversary will know.
  
  • The best way to manage your condition is to study it and understand it along with your body and your family history. No matter how much education, physicians and clinicians cannot know every scenario. For common conditions, the evidence-based approach can work very well. For uncommon conditions, it is much more difficult.
    
• What is essential in war is victory, not prolonged operations.
  
  • For a truly sick patient, a prolonged “war” is never good. You want to get diagnosed and determine how to best manage it.
    
• Treat your men as you would your own beloved sons. And they will follow you into the deepest valley.
  
  • What great advice for how you interact with your care team whether that is a provider or your family. You need that support network and you want your clinical team to be very engaged in helping you.
    
• Hold out baits to entice the enemy. Feign disorder, and crush him.
  
  • I think this and several of his quotes are relevant to the attitude you take with your providers and insurers. Don’t come in as the know it all. Let them do their job but understand their motivations and pitfalls and help take advantage of those to get what you need.
    
• Of all those in the army close to the commander none is more intimate than the secret agent; of all rewards none more liberal than those given to secret agents; of all matters none is more confidential than those relating to secret operations.
  
  • You need to find someone in the system that can be your guide. Or in the case of your disease, you need to find a similar patient who can help you through decisions.
    
• In peace prepare for war, in war prepare for peace.
  
  • Be proactive about your health. Preventative medicine is important.
    

I have seen different statistics over the years, but I was shocked to come across a statistic that 20%-60% of patients being started on a new medication for a chronic condition will not fill the prescription. (Hutchins DS et. al. (2008). Uncovering Non-compliance to Prescribed Drugs in Several Therapeutic Classes. Poster presented at 20th Annual Meeting of Academy of Managed Care Pharmacy, San Francisco, CA)

I understand with acute medications (e.g., an antibiotic) that the patient feels better the next day and doesn’t fill the prescription. But, for a chronic condition where the patient has likely gone to the physician for a health issue, it seems surprising that they won’t fill a prescription.