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Scrutiny and Skepticism Still Needed

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Five years ago when the late Jessie Gruman asked me to contribute weekly posts to the Center for Advancing Health's Prepared Patient blog, I jumped at the offer. Jessie said she wanted a tell-it-like-it-is, skeptical, incisive look at the medical marketplace. Health care providers and systems were increasingly serving corporate interests rather than consumers, and Jessie believed that story needed to be told. She liked my no-holds-barred approach to journalism, and we struck a deal.

There was to be no follow-the-pack reporting or larding up posts with he said/she said quotes, or offering the same perspective other news outlets were sending to the public. It was to be unique, very much in sync with Jessie's own approach toward writing and speaking about health care.

So I began the first of what became 147 Prepared Patient blog posts that dissected the marketplace, questioned health care's conventional wisdom and assumptions, and uncovered the contradictions in the Affordable Care Act and consumer-is-king theories of health care. Sometimes I put myself in the shoes of shoppers who were assuming the difficult task of finding the best insurance policy, the best doctor, the best hospital or the best whatever, as if that could easily be done.

I welcomed the chance to return to the reporting I cut my teeth on early in my career. The basic consumer protection issues re: honest dealings, transparency, reliability and deceptive/misleading advertising were the same. It was the subject matter – health care – that was different.

All of my stories about shopping for quality health care were challenging to investigate, but perhaps the most frustrating was the series of eight posts I wrote describing my experience signing up for Medicare and then selecting a product to cover its gaps. It was clear early on that consumers have far too many Medicare plan choices; an example of choice run amuck encouraged by regulators and aimed at giving insurers a helping hand to snag new customers. I quickly understood why Medicare beneficiaries stick with the same plans year after year and why they don't behave like rational buyers, which researchers tell us they are or should be.

I put to the test the theory that consumers can shop for health care like a new dishwasher when I faced eye surgery to repair a macular hole and subsequent cataract surgery and found hospital and provider quality information wanting. Looking at hospital metrics through the eyes of a patient having surgery reinforced my belief that there are just some things sick people shouldn't be expected to do. My surgeries provided a chance to evaluate patient safety practices and see if all those hospital ratings schemes could lead me to the "best" place for the surgeries. My two doctors used different hospitals, and if I wanted those doctors, I had no choice.

Nevertheless, I checked out available metrics and concluded that the caveats and ambiguity still made "informed" consumer choice out of reach. When it came to patient safety – from the things I could observe – I quickly discovered a difference in quality between hospitals. But once you're ready to be operated on and see that hospital personnel aren't washing their hands or have messed up the IV, you're not about to leave.

My two posts on a Canadian doctor who has developed a tool for diagnosing poverty among his Toronto patients got gobs of pick-up and interest. The first post a year ago about Dr. Gary Bloch's tool urging physicians to factor poverty into clinical decisions and directing patients to sources of income supports, received more than 3,000 hits on the Prepared Patient site and was widely reprinted in Canadian news outlets.

 A few weeks ago I wrote a follow-up, reporting that Bloch's tool was now being used or about to be used in other Canadian provinces. Several medical professional groups including the Canadian Medical Association supported Bloch's work and shared his goals. The Prepared Patient post was very popular in Canada and the U.S., and the reprints are adding up. What's striking about this is the response of American medical organizations. Dr. Lisa Chamberlain, a pediatrician at Stanford who is working on a poverty intervention with the American Academy of Pediatrics and the Academic Pediatric Association, told me to check back in a year to see whether either group has adopted such a tool.

Those 147 Prepared Patient blog posts describe a health care system that needs consumer scrutiny and skepticism if the goal of being a prepared patient is to be realized. Jessie's instincts for the posts were spot on. If the kind of reporting she championed and fostered on her site continues, it will be one of her legacies to better journalism and better health care. It's been an honor and pleasure to be part of her vision.

More Blog Posts by Trudy Lieberman

author bio

Trudy Lieberman, a journalist for more than 40 years, is an adjunct associate professor of public health at Hunter College in New York City. She had a long career at Consumer Reports specializing in insurance, health care, health care financing and long-term care. She is a longtime contributor to the Columbia Journalism Review and blogs for its website, CJR.org, about media coverage of health care, Social Security and retirement. As a William Ziff Fellow at the Center for Advancing Health, she contributes regularly to the Prepared Patient Blog. Follow her on twitter @Trudy_Lieberman.


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